Observing the neighborhood multidimensionality and overweight in children of different developmental stages-the emergence of an unusual association.

The present study examines whether the association of the neighborhood environment and overweight in children is moderated by age. This was a cross-sectional study of 832 children aged 3 to 10 years living in the city of Oporto (Portugal). Children were recruited under the scope of the project "Inequalities in Childhood Obesity: The impact of the socioeconomic crisis in Portugal from 2009 to 2015." Overweight was defined according to the International Obesity Task Force criteria. Parents completed a self-administered questionnaire capturing sociodemographic characteristics and their perceptions of their neighborhood environment. Logistic regressions were used to examine the influence of parental perceived neighborhood characteristics (latent variables: attractiveness, traffic safety, crime safety, and walkability) on overweight in children. A stratified analysis by age category was conducted. Overall, 27.8% of the children were overweight, 17.4% were aged 3 to 5 years, and 31.8% were aged 6 to 10 years. Children aged 3 to 5 years were more sensitive to the neighborhood environment than children aged 6 to 10 years. For children aged 3 to 5 years, the risk of overweight was inversely associated with neighborhood crime safety (OR = 1.84; 95% CI 1.07-3.15; p = 0.030).    Conclusion: Our study suggests the existence of a sensitive age period in childhood at which exposure to a hostile neighborhood environment is most determining for weight gain. Until today, it was thought that the impact of the neighborhood environment on younger children would be less important as they are less autonomous. But it may not be true. What is Known: • The neighborhood environment may adversely affect children's weight status. However, the moderating role of child age in the association between neighborhood environment and overweight is uncertain. What is New: • The study highlights that the association between the neighborhood environment and child overweight is attenuated by age. It is stronger for preschoolers than for early school-age children.

Are sun exposure time, dietary patterns, and vitamin D intake related to the socioeconomic status of Portuguese children?

OBJECTIVES: To investigate the association among sun exposure time, vitamin D intake, dietary patterns, and socioeconomic status in Portuguese children. METHODS: Participants aged 3-11 years (50.1% females) were recruited from public and private schools (n = 118) in the districts of Coimbra (n = 2980), Lisbon (n = 3066), and Porto (n = 2426). Parents reported their children's daily sun exposure time during the summer season and reported children's food consumption, including vitamin D food sources, using standardized questionnaires. Parents' education level was used as a proxy measure to the socioeconomic status (SES). The principal component factor analysis (PCA) method was used to identify dietary patterns. The eight dietary patterns identified were labeled in: "fast food", "rich in vitamin D", "sugary drinks", "vitamin D", "candies", "supplements", "rich in calcium" and "vegetables/healthy". Linear regression analyses were performed to investigate the association between sun exposure time and dietary patterns according to SES. RESULTS: A total of 4755 children were included. Children from high SES had significantly longer sun exposure time (p < .001) and more frequently consumed vitamin D supplements (p < .001). "Fast food" pattern showed a negative association with sun exposure time in medium and high SES (p = .014 and p < .001, respectively). CONCLUSION: Children with lower SES spend less time exposed to the sun, consume fewer dietary sources of vitamin D, and consume more foods rich in fat and sugar.

Body size, form, composition, and a healthy lifestyle associates with health-related quality of life among Portuguese children.

OBJECTIVES: This study aimed to describe the relationship between body size, form, and composition, and children's lifestyle on health-related quality of life (HRQoL). METHODS: This cross-sectional study comprised 1333 children (9.05 ± 0.75 years; 683 females) living in mainland Portugal. Objective anthropometric measures were collected. Parents answered a standardized questionnaire related with children's lifestyle (e.g., sport participation, screen- and sleep-time) and family socioeconomic status (e.g., parental education). HRQoL was measured using the Portuguese version of the KIDSCREEN-27. Scores were categorized into low and high using a sex-specific normative cut-off from European children. A healthier score was created including positive scores for body weight, abdominal obesity, sport participation, sleep- and screen-time. RESULTS: Body size, form and composition were correlated with children's physical wellbeing. However, sex differences were found in which parameters were associated with wellbeing. Among boys, the body mass index, waist circumference, waist-to-height ratio, subscapular and suprailiac skinfold were most correlated with wellbeing, while waist circumference and subscapular skinfold showed the strongest correlations for girls. Sleep duration and sport participation revealed a significant relationship with girls' HRQoL. A logistic regression analysis (adjusted for parental education) revealed that boys scoring 4 or 5 in the healthier index had an increased likelihood of high HRQoL level compared to those fulfilling none. CONCLUSIONS: Future programs aimed at reducing obesity, particularly central obesity, and incorporating multiple health indicators and behaviors, such as sport participation and sleep duration may help improve children's health and wellbeing.

Is more prolonged sun exposure associated with healthier life habits and obesity indicators in Portuguese children?

OBJECTIVES: Sun exposure seems to have an indirect effect on the development of obesity through vitamin D synthesis in the skin, the primary source of this vitamin. The present study aimed to investigate associations among sun exposure time, obesity indicators, and lifestyle habits in children. METHODS: A total of 4755 children (3-10 years; 49.86% boys) from the north, center and south-central Portugal were included in the present study. During 2016/2017 children's sun exposure time, screen time, time devoted to the practice of physical activity and active play were collected through standard questionnaires answered by parents. Statistical analyses were conducted to investigate differences among sun exposure time according to the sex, age, obesity indicators and lifestyle habits. RESULTS: Linear regression analysis showed that sun exposure time presented a negative association with Body Mass Index (ß = -0.09, 95% CI: -0.18; -0.003; p = .042), body fat % (ß = -0.31, 95%; CI: -0.54; -0.07; p = .010), computer time (ß = -0.08, 95% CI: -0.12; - 0.05; p < .0001) and a positive association with active play time (ß = 0.22, 95% CI: 0.17; 0.27; p < .0001) and total time of physical activity practice (ß = 10.01, 95% CI: 4.52; 15.20; p < .0001). CONCLUSIONS: The results reinforce the need for future guidance on the ideal sun exposure time, especially in children, who are at risk for vitamin D deficiency. Standardization of criteria for classifying optimal sun exposure time in this age group, considering the parameters that affect vitamin D status, such as age and seasonality, should be considered when planning future guidelines.

The Portuguese economic crisis is associated with socioeconomic and sex disparities on children's health-related behaviors and obesity: A cross-sectional study.

OBJECTIVES: Our objective was to examine the relationship between the 2008 and 2015 economic crisis and children's physical activity (PA) outcomes, eating behaviors and obesity prevalence, while considering sex inequalities and familial socioeconomic status. METHOD: This is a cross-sectional study, including data collected in 2016/2017 among 5134 children aged 6-11 years (mean age: 8.11 ± 1.24; 50.0% boys). Children's height, weight, and waist circumference were objectively measured. Children's sleep- and screen-time, participation in organized sports, and specific dietary habits were reported parental-reported using a standardized questionnaire. An economic crisis impact score, with data from 10 indicators of economic needs in the family, was used to characterize the crisis' impact. RESULTS: First, the prevalence of overweight and obesity was higher in children whose families had a higher impact of the crisis. Second, children's intake of fruit and high-fat food, screen-time, sleep-time, and participation in organized sports differed according to the level of impact of the economic crisis. Third, the association between health-related behaviors and the impact of the economic crisis was stronger for girls compared to boys. CONCLUSION: Our findings give us an indication of how economic crises may drive changes in health outcomes.

Socioeconomic inequalities in the prevalence of overweight and obesity among Portuguese preschool-aged children: Changes from 2009 to 2016.

OBJECTIVES: We evaluated, for the first time in Portugal, the prevalence of overweight and obesity according to parental education in a population of preschool-aged Portuguese children in 2009/2010 and 2016/2017. METHODS: Anthropometric data were collected in public and private preschools (n = 1996 in 2009/2010; n = 2077 in 2016/2017). Body mass index was calculated and weight status categories were based on the International Obesity Task Force cutoff points. Parental education level was self-reported. RESULTS: Prevalence of overweight (17.1%-14.1%; p < 0.001) and obesity (6.6%-3.9%, p < 0.001) was lower in 2016/2017 than in 2009/2010, with higher rates being found in the north of the country. Parental education was significantly associated with childhood overweight and obesity and inequalities between low- and high-education increased between the two periods. CONCLUSIONS: While a decrease in childhood overweight and obesity were positive findings, the prevalence is still high and shows pronounced socioeconomic differences. Policies for obesity prevention need to be inclusive and tackle inequalities, with interventions tailored to suit local contexts.

The Great Recession weighted on Portuguese children: A structural equation modeling approach considering eating patterns.

OBJECTIVES: Further evidence on how the Great Recession was associated with childhood obesity is needed, particularly when the world is facing a new and severe economic downturn caused by the COVID-19 pandemic. This study explores: (1) the direct association of the 2008's economic crisis with eating patterns and body mass index (BMI), among children, independently of their socioeconomic status (SES), and (2) the indirect association between the crisis and children's BMI, by using eating patterns as mediators. METHODS: A sample of children (n = 8472, mean age: 7.17 years old, 50.8% male) was recruited in schools from the cities of Porto, Coimbra and Lisbon, Portugal. Children's height and weight were objectively measured; BMI was calculated. Other data were collected by a parental questionnaire. A structural equation modeling studied the associations between the economic crisis impact, eating patterns, and BMI; model was adjusted for SES. RESULTS: Children in families that reported a greater impact of the economic crisis showed higher consumption of unhealthy food items and lower consumption of healthy foods, regardless of SES. Indirectly, children whose parents scored higher in the economic crisis impact had higher BMI mediated by a higher consumption of cakes/chocolates and lower intake of vegetables/salads. CONCLUSIONS: The economic crisis was associated with higher BMI and unhealthy eating patterns. Efforts to promote healthy diets and weight are needed at a population level rather than for specific social classes, particularly in the face of a new economic crisis caused by the COVID-19 pandemic.

Effect of peri-conception high-fat diets on maternal ovarian function, foetal and placentome growth, and vascular umbilical development in goats.

The objective of this study was to determine whether a high-fat diet (HFD) fed to goats for a brief period during peri-conception would optimize reproductive and foetal responses. Thirty-four Anglo-Nubian crossbred adult goats were allocated into three groups: control (n = 11), fed with a total mixed ration (TMR) based on chopped elephant grass and concentrate; HFBM (n = 11), given TMR supplemented with soybean oil on a 0.5% dry matter basis for 11 days starting nine days before mating (BM); and HFAM (n = 12), fed with soybean oil included in the TMR for 15 days after mating (AM). The TMR diets differed in their fat content (7.5% vs. 2.9%). All goats had oestrus synchronized for 14 days BM by intravaginal administration of 60 mg MPA sponge for 12 days. Forty-eight hours BM, the sponge was removed and 0.075 mg PGF2α was applied intramuscularly. After 36 h, 1 ml GnRH was administered intramuscularly, and goats were mated after sponge removal. The fat groups showed lower feed intake (p < .001) and higher cholesterol levels (p < .001) when HFD was administered. Doppler and B-mode ultrasound evaluations revealed a greater (p < .05) number of small (<3 mm, 10 ± 0.6 vs. 8 ± 0.5) and large (≥3 mm, 6 ± 0.4 vs. 5.0 ± 0.2) follicles and intraovarian blood area (p < .05) in the HFBM group during sponge removal (57.6%) and mating (24.2%) than those of the no-fat group. During AM, the fat-fed groups exhibited higher glutathione peroxidase levels (p < .05) and a reduction (p < .001) in corpus luteum size (19%) and vascularized Doppler area (41%). No difference (p > .05) between groups was found in foetal traits, placentome and umbilical vascular development, except for the embryonic vesicle where HFAM twin pregnancy showed a smaller size than the control (26.1 ± 3.5 cm vs. 33.7 ± 2.7 cm; p < .01). Thus, HFD applied during peri-conception of goats has no impact on later foetal development but improved the follicular growth when given before the mating. Thus, the use of HFD in periconception has no impact on foetal development but increases follicular growth before breeding time.

Household Food Security and Associated Factors among Portuguese Children.

This study investigated the household food insecurity (HFI) among Portuguese children following the last world financial crisis. A cross-sectional study was conducted on 4737 Portuguese children (3-11 yrs). Socio-demographics, food insecurity, and household geographic location were assessed via questionnaire. Nutritional status was measured. Following the economic crisis, 14.2% of school children and 12.0% of preschool children experienced HFI. Preschool children having parents with low and medium parental education (paternal: OR = 4.4; 95% CI 2.7-7.1 and OR = 2.4; 95% CI 1.5-3.6; maternal: OR = 2.2; 95% CI 1.4-3.5 and OR = 1.6; 95% CI 1.1-2.3), living in the south (OR = 1.4; 95% CI 1.0-2.0) and being overweight/obese (OR = 1.1; 95% CI 0.7-1.3) were more likely to experience HFI than food secure household peers. Higher OR of belonging to a food insecure household were observed in school-aged children with low and medium parental education (paternal: OR = 2.9; 95% CI 1.9-4.6 and OR = 1.7; 95% CI 1.1-2.5; maternal: OR = 2.5; 95% CI 1.6-3.9 and OR = 2.3; 95% CI 1.6-3.3), living in Coimbra (OR = 1.7; 95% CI 1.1-2.6) and being overweight/obese (OR = 1.3; 95% CI 0.8-1.5) compared to food secure household peers. Data are instructive and support the need to increase awareness of HFI, reduce its incidence in overweight/obese children from low socio-economic status families and specific geographic areas, and increase food availability based on local ecology.

Socioeconomic inequalities in children's health-related quality of life according to weight status.

OBJECTIVES: This study explores the association between socioeconomic position (SEP) and health-related quality of life (HRQoL) among Portuguese children according to their weight status. METHODS: A total of 1215 primary school-aged children (mean age 8.78 years) from three Portuguese districts (Lisbon, Porto, Coimbra) were assessed during 2016/2017. Father and mother's education (low, medium, high) and work status (employed, unemployed/retired) were used as SEP indicators. Self-reported HRQoL was assessed with the KIDSCREEN-27. Height and weight were objectively measured and body mass index categorized in normal, overweight or obese. Age, sex, and district-adjusted linear regression models were fitted to estimate associations between SEP indicators and HRQoL dimensions, according to weight status. RESULTS: We found that 24.9% of children were categorized as having overweight/obesity. The mean scores of the Physical Well-Being, and School Environment dimensions of HRQoL were lower among children classified with overweight/obesity compared to children with normal weight (57.21 vs 54.11, P < .001 and 57.85 vs 56.04, P = .010, respectively). Father's education was significantly associated with all HRQoL dimensions in children with a normal weight, but the same was not observed among children presenting overweight/obesity. An increase in the level of maternal education was also significantly associated with all HRQoL dimensions among children classified with a normal weight, and only for the School Environment dimension among children classified with overweight/obesity. CONCLUSIONS: These results suggest the presence of socioeconomic inequalities in self-reported HRQoL from early age, particularly among children with normal weight.

The economic crisis impact on the body mass index of children living in distinct urban environments.

OBJECTIVES: Little is known about the impact of the 2008 global economic recession on childhood obesity in Portugal. Thus, this study's goals were to compare weight status of children during and after the economic crisis according to their neighbourhood environment features and to assess changes in specific dietary habits during the economic crisis. STUDY DESIGN: Cross-sectional study. METHODS: Data including weight, height, residence address to allow its geocoding and dietary habits changes during the crisis from children living in Lisbon municipality were collected in 2009 (N = 929) and in 2016 (N = 1751). A multidimensional environment index, with data of both built and socioeconomic nature collected at the statistical section level (areas comprised 300 dwellers) in the 2011 census, was used to characterize neighbourhoods. RESULTS: Overall, the proportion of children who are overweight or obese living in the socioeconomically vulnerable areas decreased in 2016. Families living in the latter areas stopped buying some food items, started to buy cheaper food items, cooked more meals at home and ate less in restaurants. In 2016, the risk for overweight and obesity increased in children who lived in the least advantageous areas. Living in areas with high socioeconomic status or most advantageous areas no longer represented a decreased risk of being overweight or obese in children in 2016 as it did in 2009. CONCLUSIONS: This study suggests that the economic crisis enhanced the social inequalities regarding childhood obesity. These results aid the development of evidence-based strategies to lessen the social inequities in health outcomes created by the crisis.

Screen media use by Portuguese children in 2009 and 2016: a repeated cross-sectional study.

BACKGROUND: Few studies have examined how access to mobile media is disrupting more traditional forms of media use. AIM: To examine screen-time in 2009/10 and 2016/17 among children aged 3-6 years and assess potential socio-economic determinants of adherence to screen-time recommendations. SUBJECTS AND METHODS: Two independent cross-sectional studies included 6874 Portuguese children. Screen-time (including television, computer, tablet, and smartphone) and proxy measures to calculate socioeconomic position (SEP) were parent-reported using a standardised questionnaire. Screen-time and adherence to screen-time recommendations were calculated for both periods. Determinants of excessive screen-time were identified using adjusted logistic regression models. RESULTS: In 2009/10 screen-time averaged 107 min/day for pre-school children and 149 min/day for school-aged children. In 2016/17 values were 142 min/day and 173 min/day, respectively. Screen-time allocated to television was the highest, independently of children's age. In 2016/17, mobile media use was common among pre-school (37 min/day) and school-aged children (43 min/day). Exceeding the recommended screen-time was more prevalent in boys than girls (adjusted odds ratio (aOR) between 1.02 and 1.59) and in children whose parents had lower education levels or were unemployed (aOR between 1.00 and 2.23). CONCLUSION: Screen-time was high among pre-school children, emphasising the need for earlier interventions, particularly among those from lower-SEP who had higher risk of exceeding the screen-time recommendations.

Self-reported symptoms of depression, anxiety and stress in Portuguese primary school-aged children.

BACKGROUND: Symptoms of depression, anxiety and stress experienced during childhood might have a negative impact on development. This study explores factors associated with such symptoms among Portuguese primary school-aged children. METHODS: A sample of children (n = 1022, mean age = 8.77 years old) was recruited in public and private schools from the cities of Coimbra, Lisbon and Porto, Portugal. The children's version of the Depression, Anxiety and Stress Scale (DASS-C) was self-administered. Multivariate logistic regression models were fitted to measure associations (expressed as Odds Ratio, OR and 95% Confidence Intervals, CI) between each DASS-C subscale, dichotomized by its 4th vs. 3rd or less quartiles (symptoms increase with scores), and covariates: child sex, age, socioeconomic status (SES), sports activity beyond school, children self-assessed health status, child and mother's body mass index and mother's DASS scores. RESULTS: Age was negatively associated with anxiety symptoms (adjusted OR, 95% CI: 0.70, 0.57-0.87) and girls, compared to boys, presented lower odds of depressive and stress symptoms (adjusted OR, 95% CI: 0.65, 0.47-0.92 and 0.57, 0.41-0.80, respectively). A low socioeconomic status was associated with more frequent symptoms of stress (adjusted OR, 95%CI for low compared to high SES: 1.61, 1.01-2.56). Children with poorer self-assessed health status and whose mothers scored higher in the DASS also presented significantly higher odds of scoring in the 4th quartile (vs. 3rd or less) of the three DASS-C subscales. CONCLUSIONS: These results suggest the need to tailor preventive efforts targeting childhood mental health symptoms.

Influence of parental perceived environment on physical activity, TV viewing, active play and Body Mass Index among Portuguese children: A mediation analysis.

OBJECTIVES: The environment is believed to be key in obesity prevention, yet it is unclear how factors in the neighborhood influence weight-related behaviors. The present study aimed to investigate the influence of parental perceived environment on physical activity (PA), television (TV) time, active play and Body Mass Index (BMI) z score, and the mediating role of these weight-related behaviors on the relationship between neighborhood characteristics and children's BMI. METHODS: Data of 8472 Portuguese preschool (aged 3-6, n = 3819) and school-aged children (aged 7-11 years, n = 4653) were collected during 2016/2017. Structural equation modeling was used to estimate the associations between parents perceived neighborhood characteristics (latent variables: unsafety and built/physical environment) and child's BMI z score, PA and TV time. RESULTS: Among preschoolers, the latent variables of the perceived environment were not associated with the BMI, TV time, extracurricular PA, and active play. Among schoolchildren, the unsafety environment was positively associated with both the BMI (SC = 0.050, P = .008) and the time spent watching TV (SC = 0.052, P = .031) and negatively associated with extracurricular PA (SC = -0.125, P < .001). The latent variable Favorable Built Environment for PA (ie, environmental facilitating elements) was positively associated with active play (SC = 0.041, P = .031). Moreover, the TV time was a marginally significant mediator of the relationship between the perceived unsafe environment and the BMI of school-aged children (B = 0.002, P = .096). CONCLUSIONS: In conclusion, changes in the environment to targeting parental perception of neighborhood safety could have positive effects on the promotion of healthy weight and the adoption of a healthy lifestyle in school-aged children.

The environment contribution to gender differences in childhood obesity and organized sports engagement.

OBJECTIVE: This study aims to analyze gender-specific associations between sports activity outside of school and obesity, observing to what extent the local built environment contributes to the patterns found. METHODS: A total of 2253 children aged 6.0-11.0 years were assessed: 49.3% girls and 50.7% boys. Children's weight and height were measured, age and sex-specific BMI cut-off points were used to define normal vs overweight/obesity. Children's organized sports (OS) activity was assessed by questionnaire, and local facilities for children's engagement in OS were analyzed. Logistic regression models were computed, adjusted for confounding variables. RESULTS: Results showed greater overweight and obesity (25.1% vs 20.1%) and lower OS engagement (66.5% vs 73.8%) in girls as well as greater impact of OS engagement on weight status in girls (OR for having a normal weight = 1.434 in girls vs 1.043 in boys). Additionally, opportunities to engage in OS were scarce for girls. CONCLUSIONS: The gender gap in children's weight status and OS engagement might be enhanced by an environmental mismatch that undermines girls' opportunities to play sports. There should be more opportunities for girls to engage in their favorite sports as a means to tackle the obesity epidemic and to promote gender equality.

Social inequalities in traditional and emerging screen devices among Portuguese children: a cross-sectional study.

BACKGROUND: Children are often exposed to too much screen time but few studies have explored the use of old and new digital media among young children. This study assesses screen time, including traditional and mobile devices, in pre-school and elementary school-aged children, according to their gender, age, and socioeconomic position (SEP). METHODS: A total of 8430 children (3 to 10 years; 50.8% boys) from the north, center and south-central Portugal were included in the present study. Data was collected by a parental questionnaire during 2016/2017. Children's screen time (by media device, weekdays and at the weekend; calculated by mean minutes per day) were reported by parents. Analysis were carried to compare screen time by children's age, gender and family SEP (classified using father's educational degree). RESULTS: Daily screen time was high both in children aged 3 to 5 and 6 to 10 years - 154 min/day (95% CI: 149.51-158.91) and 200.79 min/day (95% CI: 197.08-204.50), respectively - and the majority of children, independently of their gender, exceed the recommended 2 h/day of screen viewing. Children are still primarily engaging in screen time through television but the use of mobile devices, particularly tablets, were already high among 3 year-old children and increased with age. SEP was a negative predictor of screen time in the linear regression analysis, including after adjustment. CONCLUSIONS: Considering the negative health impacts of excessive screen time, recognizing subgroups at risk of excessive screen time and identifying how each device is used according to age is fundamental to enable appropriate future interventions. The screen time in children aged 3-10 years is longer than the recommended, particularly among boys and in those children from lower SEP. Parents and policymakers should have in mind that children spend most of their screen time watching television but mobile devices are becoming extremely popular starting at a young age.

Sleep duration, body composition, dietary profile and eating behaviours among children and adolescents: a comparison between Portuguese acrobatic gymnasts.

Sleep, body composition and dietary intake are crucial for athletes' health and performance but have never been investigated in acrobatic gymnasts. Thus, this study aimed to evaluate sleep, body composition, dietary intake and eating behaviours of acrobatic gymnasts. Using a cross-sectional study, 82 Portuguese acrobatic gymnasts (12.8 ± 3.1 years, 61 females and 21 males) were evaluated during the competitive period to collect training data, sleep duration, body composition, dietary intake and eating behaviours before, during and after practices. Most of the gymnasts (91.5%) slept less than 8 h/night. Female adolescents slept significantly less on weekdays than female children (P = 0.024). Female adolescents' mean body mass was below the normal and 60.0% showed menstrual irregularities; 4.9% of females bases were overweight and 2.4% obese. Male adolescents slept significantly less on weekdays than male children (P = 0.001); significant differences were shown for fat-free mass (P = 0.014); however, 3.7% were overweight. All daily energy and macronutrient intakes were significantly different according to age and gender, with exception for fibre and energy intake in females (P = 0.057 and P = 0.052, respectively), and for protein in males (P = 0.068). Female and male adolescents demonstrated significant lower energy availability (32.8 ± 9.4 kcal/kg FFM/day and 45.1 ± 14.7 kcal/kg FFM/day) than children (45.8 ± 8.7 kcal/kg FFM/day and 53.8 ± 9.1 kcal/kg FFM/day), respectively. Significant low intakes of important vitamins and minerals were reported. Most of the participants did not eat or drink during or immediately after training sessions. CONCLUSION: Acrobatic gymnasts revealed low BF, short sleep duration and macro- and micronutrients inadequate intakes. The Female Athlete Triad was demonstrated by female adolescent gymnasts. What is Known: • Adequate dietary intake is an important resource for athletes' short and long-term health and performance. • There are no published studies in acrobatic gymnasts' sleep, body composition or dietary intake. What is New: • This study provides the first data on significant differences in energy intake and availability between acrobatic gymnasts; overweight and obesity were present in females. • Macro and micronutrients were inappropriate. Female Athlete Triad was observed in female adolescent acrobatic gymnasts.

Comparison of body composition and nutrients' deficiencies between Portuguese rink-hockey players.

We evaluated dietary intake and body composition of child and adolescent rink-hockey players and controls. Seventy-two male rink-hockey players (38 children and 34 adolescents) and 79 male controls (43 children and 36 adolescents) were evaluated in order to collect training data, detailed dietary intake and body composition. Rink-hockey players presented significantly lower body fat (BF) and higher fat-free mass (FFM) than controls. Mean intakes of carbohydrate and protein were considered to be adequate, but mean intakes of fat were above the recommended levels in athletes. Significant differences were found for energy intake (EI) and exercise energy expenditure (EEE) between athletes and controls (P < 0.05), resulting in some cases of low energy availability in rink-hockey players. Significant group differences (P < 0.05) were also observed for vitamins and mineral intakes in child and adolescent rink-hockey players due to higher mean intakes in control groups. Low intakes of vitamins D, E and K, calcium, iron, boron and magnesium were reported in athletes, with exception for thiamine (P = 0.449), riboflavin (P = 0.246), pantothenic acid (P = 0.065), magnesium (P = 0.061) and phosphorus (P = 0.051) in children and for niacin (P = 0.652), vitamin D (P = 0.406) and zinc (P = 0.783) in adolescents. CONCLUSION: Nutritional deficiencies in macronutrients and micronutrients observed in very young rink-hockey players can impair their growth and development with negative consequences upon athletic performance. What is Known: • Adequate dietary intake is an important resource for athletes' short- and long-term health, performance and recovery. • There are no published studies in rink-hockey players' energy availability. What is New: • This study provides the first data on significant differences in energy intake between very young athletes and controls, resulting in low energy availability in rink-hockey players. • Mean intakes of fat were above the recommended levels, and micronutrients intakes were inappropriate in athletes with consequences for their health and performance.

Parental Perception of Their Child's Weight Status in Portugal: An Observational Study.

INTRODUCTION: Parental perceptions of a child's weight status may influence family readiness to foster healthy behaviors. Our aim was to observe parental perceptions of their child's weight status in two time periods and in multiple population subgroups. METHODS: Data were collected in two national projects, 2009 - 2010 (n = 6577) and 2016 - 2017 (n = 7594), in public and private kindergartens and primary schools in Portugal (children aged three to 10 years old). Parents filled out a questionnaire regarding their perception of their child's weight status, namely: 1) too thin, 2) thin, 3) normal weight, 4) with some excess weight, or 5) with a lot of excess weight. Children's height and weight were objectively collected, and the International Obesity Task Force cut-offs were used to classify overweight and obesity. Accurate and misclassification levels were calculated for children according to their sex, age, as well as child and parental weight status, while considering differences within and between the two time periods. RESULTS: Overall, accuracy in parental perception of their child's weight was higher in 2016 - 2017 than in 2009 - 2010, regardless of children's sex, age, parental weight status, and education (65.7% and 60.5%, respectively). However, the ability of parents to detect obesity was ~ 50% lower in 2016 - 2017 compared with 2009 - 2010. CONCLUSION: Even though parental perception of their child's weight was better in 2016 - 2017 than in 2009 - 2010 , the inverse result was found among children with obesity. Strategies are needed to encourage parents to improve their perception of the appropriate weight for their child.

INTRODUCTION: Parental perceptions of a child's weight status may influence family readiness to foster healthy behaviors. Our aim was to observe parental perceptions of their child's weight status in two time periods and in multiple population subgroups. METHODS: Data were collected in two national projects, 2009 - 2010 (n = 6577) and 2016 - 2017 (n = 7594), in public and private kindergartens and primary schools in Portugal (children aged three to 10 years old). Parents filled out a questionnaire regarding their perception of their child's weight status, namely: 1) too thin, 2) thin, 3) normal weight, 4) with some excess weight, or 5) with a lot of excess weight. Children's height and weight were objectively collected, and the International Obesity Task Force cut-offs were used to classify overweight and obesity. Accurate and misclassification levels were calculated for children according to their sex, age, as well as child and parental weight status, while considering differences within and between the two time periods. RESULTS: Overall, accuracy in parental perception of their child's weight was higher in 2016 - 2017 than in 2009 - 2010, regardless of children's sex, age, parental weight status, and education (65.7% and 60.5%, respectively). However, the ability of parents to detect obesity was ~ 50% lower in 2016 - 2017 compared with 2009 - 2010. CONCLUSION: Even though parental perception of their child's weight was better in 2016 - 2017 than in 2009 - 2010 , the inverse result was found among children with obesity. Strategies are needed to encourage parents to improve their perception of the appropriate weight for their child.