Proteomic profiling of human plasma extracellular vesicles identifies PF4 and C1R as novel biomarker in sarcopenia.

BACKGROUND: Sarcopenia, the gradual and generalized loss of muscle mass and function with ageing, is one of the major health problems in older adults, given its high prevalence and substantial socioeconomic implications. Despite the extensive efforts to reach consensus on definition and diagnostic tests and cut-offs for sarcopenia, there is an urgent and unmet need for non-invasive, specific and sensitive biomarkers for the disease. Extracellular vesicles (EVs) are present in different biofluids including plasma, whose cargo reflects cellular physiology. This work analysed EV proteome in sarcopenia and robust patients in the search for differentially contained proteins that can be used to diagnose the disease. METHODS: Plasma small EVs (sEVs) from a total of 29 robust controls (aged 73.4 ± 5.6 years; 11 men and 18 women) and 49 sarcopenic patients (aged 82.3 ± 5.4 years; 15 men and 34 women) aged 65 years and older were isolated and their cargo was analysed by proteomics. Proteins whose concentration in sEVs was different between sarcopenic and robust patients were further validated using ELISA. The concentration of these candidates was correlated to the EWGSOP2 sarcopenia tests for low muscle strength and low physical performance, and receiver operating characteristic (ROC) curve analyses were carried out to evaluate their diagnostic power, sensitivity and specificity. RESULTS: Proteomic analysis identified 157 sEVs proteins in both sarcopenic and robust samples. Among them, 48 proteins had never been reported in the ExoCarta nor Vesiclepedia databases. Statistical analysis revealed eight proteins whose concentration was significantly different between groups: PF4 (log2 FC = 4.806), OIT3 (log2 FC = -1.161), MMRN1 (log2 FC = -1.982), MASP1 (log2 FC = -0.627), C1R (log2 FC = 1.830), SVEP1 (log2 FC = 1.295), VCAN (FC = 0.937) and SPTB (log2 FC = 1.243). Among them, platelet factor 4 (PF4) showed the lowest concentration while Complement C1r subcomponent (C1R) increased the most in sarcopenic patients, being these results confirmed by ELISA (P = 1.07E-09 and P = 0.001287, respectively). The concentrations of candidate proteins significantly correlated with EWGSOP2 tests currently used. ROC curve analysis showed an area under the curve of 0.8921 and 0.7476 for PF4 and C1R, respectively. Choosing the optimal for PF4, 80% sensitivity and 85.71% specificity was reached while the optimal cut-off value of C1R would allow sarcopenia diagnosis with 75% sensitivity and 66.67% specificity. CONCLUSIONS: Our results support the determination of EV PF4 and C1R as plasma diagnostic biomarkers in sarcopenia and open the door to investigate the role of the content of these vesicles in the pathogeny of the disease.

Effects of an online home-based exercise intervention on breast cancer survivors during COVID-19 lockdown: a feasibility study.

PURPOSE: The strict lockdown implemented due the COVID-19 pandemic is generating a great impact on wellbeing and health-related quality of life (HRQoL) in people with cancer. We aimed to evaluate the efficacy and feasibility of an online home-based exercise intervention performed during a lockdown period analysing its effects on body composition, physical fitness, and HRQoL in breast cancer survivors. METHODS: Fifteen women with breast cancer receiving hormonal therapy (55.5 ± 6.7 years) were included in the study. The exercise intervention consisted of two weekly sessions of remotely supervised functional training (60 min per day) and two weekly sessions of unsupervised aerobic training (20-30 min/session; 60-85% of maximum heart rate) for a total of 16 weeks. DXA absorptiometry was used for the assessment of body composition. Functional assessment included cardiorespiratory fitness (CRF) by Rockport walking test, upper and lower body strength (grip strength, arm curl test, and chair stand test), walking speed (brisk walking test), and agility (8-foot up-and-go test). The HRQoL was evaluated with the QLQ-BR23 questionnaire. The adherence to the intervention was measured as the percentage of online classes attended. RESULTS: Rate of adherence for the online exercise intervention was 90 ± 17%. The exercise intervention induced significant (p < 0.05) improvements in physical fitness: CRF (+ 9%), right arm and lower limb strength (+ 10% and + 18%, respectively) and lower limbs lean mass (+ 2% and + 3.5% for left and right leg, respectively). CONCLUSION: This feasibility study suggests that an online home-based exercise intervention during COVID-19 lockdown could improve physical fitness and body composition in breast cancer survivors even in a context of heightened concern for future health.

The medium-term consequences of a COVID-19 lockdown on lifestyle among Spanish older people with hypertension, pulmonary disease, cardiovascular disease, musculoskeletal disease, depression, and cancer.

OBJECTIVES: This study investigated the associations of chronic diseases with changes in lifestyle and health behaviours in older people following the coronavirus disease 2019 (COVID-19) lockdown in Spain and compared the differences in changes over time. METHODS: 1,092 participants (80.3±5.6 years; 66.5% female) from 2 Spanish cohorts were included. Telephone-based questionnaires were conducted to evaluate lifestyle and health risk behaviours at the end of lockdown and 7 months post-lockdown. Participants were classified as having physician-diagnosed chronic diseases based on self-reported data. Cox proportional models adjusted for major confounders were used. RESULTS: Compared to those without the corresponding chronic diseases, older people with hypertension were less likely to report increased alcohol consumption (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.55 to 0.99). Pulmonary diseases were associated with lower risks of increased sedentary time (HR, 0.58; 95% CI, 0.39 to 0.86) and worsened sleep quality (HR, 0.56; 95% CI, 0.36 to 0.87), while cardiovascular diseases were associated with a lower risk of decreased sedentary time (HR, 0.58; 95% CI, 0.38 to 0.88). Depression was linked to a higher likelihood of improved diet quality (HR, 1.53; 95% CI, 1.00 to 2.36). Cancer pacients were less likely to have worsened sleep quality (HR, 0.44; 95% CI, 0.22 to 0.89) but more likely to have reduced their frequency of social contact (HR, 2.05; 95% CI, 1.05 to 3.99). CONCLUSIONS: Older people with chronic diseases showed beneficial changes in lifestyle and health risk behaviours after the COVID-19 lockdown. In particular, older people with hypertension, pulmonary disease, and cancer tended to make beneficial lifestyle and health behaviour changes. However, older people with cardiovascular disease and depression engaged in more health risk behaviours.

Fitness vs Fatness as Determinants of Survival in Noninstitutionalized Older Adults: The EXERNET Multicenter Study.

BACKGROUND: Physical fitness and body composition are important health indicators; nevertheless, their combined pattern interrelationships and their association with mortality are poorly investigated. METHODS: This longitudinal study is part of the Spanish EXERNET-Elder project. Person-months of follow-up were calculated from the interview date, performed between June 2008 and November 2009, until the date of death or censoring on March 2018 (whichever came first). In order to be included, participants had to fulfill the following criteria: (a) be older than 65 years, (b) live independently at home, (c) not suffer dementia and/or cancer, and (d) have a body mass index above 18.5. Body fat and weight were assessed by a bioelectrical impedance analyzer. Fitness was measured with the Senior Fitness and the one-leg static balance tests. The Spanish Death Index was consulted for the death's identification. Cluster analysis was performed to identify Fat-Fit patterns and traditional cut-points and percentiles to create the Fat-Fit groups. Cox proportional hazards regression models were used to calculate the hazard ratios (HRs) of death in clustered Fat-Fit patterns and in traditional Fat-Fit groups. RESULTS: A total of 2299 older adults (76.8% of women) were included with a baseline mean age of 71.9 ± 5.2 years. A total of 196 deaths (8.7% of the sample) were identified during the 8 years of follow-up. Four clustered Fat-Fit patterns (Low fat-Fit, Medium fat-Fit, High fat-Unfit, and Low fat-Unfit) and 9 traditional Fat-Fit groups emerged. Using the Low fat-Fit pattern as the reference, significantly increased mortality was noted in High fat-Unfit (HR: 1.68, CI: 1.06-2.66) and Low fat-Unfit (HR: 2.01, CI: 1.28-3.16) groups. All the traditional Fit groups showed lower mortality risk when compared to the reference group (obese-unfit group). CONCLUSION: Physical fitness is a determinant factor in terms of survival in community-dwelling older adults, independently of adiposity levels.

Fat-Fit Patterns, Drug Consumption, and Polypharmacy in Older Adults: The EXERNET Multi-Center Study.

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

Changes in Health Behaviors, Mental and Physical Health among Older Adults under Severe Lockdown Restrictions during the COVID-19 Pandemic in Spain.

We used data from 3041 participants in four cohorts of community-dwelling individuals aged ≥65 years in Spain collected through a pre-pandemic face-to-face interview and a telephone interview conducted between weeks 7 to 15 after the beginning of the COVID-19 lockdown. On average, the confinement was not associated with a deterioration in lifestyle risk factors (smoking, alcohol intake, diet, or weight), except for a decreased physical activity and increased sedentary time, which reversed with the end of confinement. However, chronic pain worsened, and moderate declines in mental health, that did not seem to reverse after restrictions were lifted, were observed. Males, older adults with greater social isolation or greater feelings of loneliness, those with poorer housing conditions, as well as those with a higher prevalence of chronic morbidities were at increased risk of developing unhealthier lifestyles or mental health declines with confinement. On the other hand, previously having a greater adherence to the Mediterranean diet and doing more physical activity protected older adults from developing unhealthier lifestyles with confinement. If another lockdown were imposed during this or future pandemics, public health programs should specially address the needs of older individuals with male sex, greater social isolation, sub-optimal housing conditions, and chronic morbidities because of their greater vulnerability to the enacted movement restrictions.

'Fat but powerful' paradox: association of muscle power and adiposity markers with all-cause mortality in older adults from the EXERNET multicentre study.

OBJECTIVES: To assess the influence of muscle power and adiposity on all-cause mortality risk and to evaluate the 'fat but powerful' (F+P) (or 'fat but fit') paradox in older adults. METHODS: A total of 2563 older adults (65‒91 years old) from the EXERNET multicentre study were included. Adiposity (body mass index (BMI), waist circumference, body fat percentage (BF%) and fat index), allometric and relative power (sit-to-stand muscle power test) and various covariates (age, sex, hypertension, smoking status and walking and sitting times per day) were registered at baseline. All-cause mortality was recorded during a median follow-up of 8.9 years. Participants were classified into four groups: lean and powerful (L+P), F+P, lean but weak and fat and weak (F+W). Cox proportional hazard regression models and adjusted HRs were calculated. RESULTS: According to BMI and waist circumference, all-cause mortality risk was reduced in the F+P (HR=0.55 and 0.63, p=0.044 and 0.049, respectively) and L+P (HR=0.57 and 0.58, p=0.043 and 0.025, respectively) groups. According to BF%, all-cause mortality decreased in the L+P group (HR=0.53; p=0.021), and a trend for a reduction was reported in the F+P group (HR=0.57; p=0.060). According to fat index, a survival benefit was only noted in the L+P group (HR=0.50; p=0.049). Higher levels of relative power reduced all-cause mortality risk among older people (HR=0.63 and 0.53, p=0.006 and 0.011, respectively). CONCLUSION: Powerful older people exhibited a reduced 9-year all-cause mortality regardless of BMI, waist circumference and BF%. Obesity according to fat index blunted the survival benefits of being powerful.

Low interest in physical activity and higher rates of obesity among rural teachers.

BACKGROUND: Few studies have evaluated the causes of physical inactivity in rural teachers from South America. Determining the causes and effects of physical inactivity in rural teachers could be the base for future intervention studies aiming to improve physical activity (PA) engagement in this population. OBJECTIVES: To examine the levels of PA in rural teachers and evaluate the associations between their jobs, interest in PA, body composition and practice of PA. METHODS: Body mass index (BMI) and body fat % (BF) of rural teachers from the Valparaiso Region in Chile were measured; interviews regarding PA habits, interests and PA practice were conducted. The relationship between BF% and interest in PA and the practice of sports was analysed stratifying by sex. RESULTS: Around 71% were overweight/obese and 80% of the teachers reported not practicing any PA. These figures are higher than the Chilean national average for adults (64.5% overweight/obese). Moreover, females presented a higher BF% than male teachers (35.98% vs. 26.44%, p < 0.05). The main causes of not performing PA were: firstly, the lack of time (51.8%), and secondly, fatigue after work and/or finishing work late. In addition, rural teachers claim that in their free time they continue to finish tasks that they were not able to complete during their working hours. CONCLUSIONS: Rural Chilean teachers show a high prevalence of obesity and low PA levels. Moreover, rural teachers have a work overload stemming from their jobs, and this could be an important link to an overall sedentary lifestyle. Further studies should focus on the relationship between teacher obesity, physical activity, nutrition and work overload.

Effects of whole-body vibration training on bone density and turnover markers in adolescent swimmers.

Background Whole-body vibration training has recently been proposed as a complementary training modality to improve the bone health of adolescent swimmers. However, there is no longitudinal study regarding the effects of this training combination on bone metabolism. Therefore, the main goal was to analyze the effects of swimming and vibration training on bone turnover markers during adolescence. Methods The present study included 68 adolescent swimmers and 41 normoactive controls (CON). Swimmers were randomly selected to either continue with their regular swimming training (SWI) or participate in an additional vibration protocol (VIB). Anthropometric measurements and serum level determinations of osteocalcin (OC), procollagen type 1 N-terminal propeptide (P1NP) and C-terminal telopeptide crosslaps (CTX) were performed before and after the 6-month intervention. Results Statistically significant group by time interactions were found for both bone formation markers. VIB showed a decrease over time in OC (baseline: 101.4 µg/mL, follow-up: 82.8 µg/mL, p < 0.05) and P1NP (baseline: 528.4 µg/mL, follow-up: 389.0 µg/mL, p < 0.05) and SWI had analogous reductions in P1NP (baseline: 685.8 µg/mL, follow-up: 542.0 µg/mL, p < 0.05), whereas CON experienced an increase in OC levels (baseline: 94.4 µg/mL, follow-up: 103.4 µg/mL, p < 0.05). After stratifying the sample according to the pubertal status, similar interactions were observed. Conclusions The combination of swimming training and this particular vibration protocol led to a decrease in bone formation markers, especially during early puberty. Whole-body vibration might not induce an osteogenic stimulus in adolescent swimmers.

Associations of dietary energy density with body composition and cardiometabolic risk in children with overweight and obesity: role of energy density calculations, under-reporting energy intake and physical activity.

This study examined (1) the association of dietary energy density from solid (EDS) and solid plus liquids (EDSL) with adiposity and cardiometabolic risk factors (CRF) in children with overweight and obesity, (2) the effect of under-reporting on the mentioned associations and (3) whether the association between ED and body composition and CRF is influenced by levels of physical activity. In a cross-sectional design, 208 overweight and obese children (8-12-year-old; 111 boys) completed two non-consecutive 24 h recalls. ED was calculated using two different approaches: EDS and EDSL. Under-reporters were determined with the Goldberg method. Body composition, anthropometry and fasting blood sample measurements were performed. Moderate to vigorous physical activity (MVPA) was registered with accelerometers (7-d-register). Linear regressions were performed to evaluate the association of ED with the previously mentioned variables. Neither EDS nor EDSL were associated with body composition or CRF. However, when under-reporters were excluded, EDS was positively associated with BMI (P=0·019), body fat percentage (P=0·005), abdominal fat (P=0·008) and fat mass index (P=0·018), while EDSL was positively associated with body fat percentage (P=0·008) and fat mass index (P=0·026). When stratifying the group according to physical activity recommendations, the aforementioned associations were only maintained for non-compliers. Cluster analysis showed that the low-ED and high-MVPA group presented the healthiest profile for all adiposity and CRF. These findings could partly explain inconsistencies in literature, as we found that different ED calculations entail distinct results. Physical activity levels and excluding under-reporters greatly influence the associations between ED and adiposity in children with overweight and obesity.

Prácticas en enfermería para prevenir la mortalidad materna de la mujer en edad fértil / Nursing Care to Women in Fertile Age: Practices to Prevent Maternal Mortality

Introducción: En el sector salud es conocido que las enfermeras son las profesionales que mayor contacto tienen con la mujer en los momentos de atención de su vida fértil. Esta circunstancia les permite llevar a cabo diversas prácticas que buscan prevenir la muerte materna desde la preconcepción y garantizar el nacimiento seguro. Objetivo: Describir las prácticas realizadas en torno a la prevención de la mortalidad materna desde el ejercicio profesional de la enfermera, en tres instituciones de salud en Bogotá, Colombia. Métodos: Estudio cuantitativo, descriptivo transversal. El muestreo fue no probabilístico por conveniencia. Durante la recolección de la información 60 enfermeras diligenciaron un cuestionario constituido de cuatro módulos (conocimiento del sujeto de cuidado, trabajo mutidisciplinario, gestión y fundamentación normativa, y educación continuada) que fue diseñado y validado para el presente estudio. Resultados: Se identificó una correlación moderada entre el conocimiento del sujeto de cuidado y el trabajo multidisciplinario (rs=0,631, p= <0,01), el trabajo multidisciplinario y la gestión del cuidado (rs=0,648, p= <0,01), la gestión del cuidado y la educación continuada (rs=, 665, p =<0,01), y una asociación estadísticamente significativa (χ²= <0,05) entre el servicio y nivel de complejidad de la institución donde se trabaja, con respecto a la implementación de estas prácticas. Conclusiones: La ejecución de prácticas que contrarrestan la mortalidad materna es mayor cuando las enfermeras tienen un conocimiento actualizado, que las lleva a desarrollar un mejor trabajo multidisciplinario; y por ende una mayor gestión del cuidado(AU)

Introduction: Professional nurses have more contact with women during the assistance moments of their fertile life. These circumstances allow carrying on diverse practices to prevent the maternal mortality since the preconception and to guarantee a secure birth. Objective: To describe practices developed on prevention of maternal mortality from the nursing professional praxis in three health institutions in Bogotá, Colombia. Methods: It corresponds to a quantitative, descriptive, transversal design. Sixty nurses took part. We gathered information by means a questionnaire conformed in four modules (knowledge of the subject of care, multidisciplinary work, care management and normative foundation and continuing education) designed and valid for this study. Results: This study identified moderate correlation between the knowledge of the subject of care and the multidisciplinary work (rs=, 631, p=<0, 01). We also found correlation between the multidisciplinary work and the nursing care management (rs=, 648, p=<0, 01), the nursing care management and the continuing education (rs=, 665, p=<0, 01), and one meaningful statistical association (?²=<0, 05) between the service and complexity level where they work and fulfil these practices. Conclusions: The implementation of practices that counteract maternal mortality is better when nurses have updated knowledge that leads to develop better multidisciplinary work; and therefore better care management(AU)

Grip strength cutpoints for youth based on a clinically relevant bone health outcome.

The National Academy of Medicine recommends the handgrip for school-based surveillance of muscle strength for bone health. We established grip strength cutpoints that are linked to bone health in both US and European youth. These cutpoints could serve as a potential set of standards for surveillance and clinical applications. PURPOSE: The U.S. National Academy of Medicine and experts in Europe recommend the use of grip strength as a valuable and accessible musculoskeletal fitness measure due to its association with bone health. This is the first study to facilitate this recommendation by developing bone health-related grip strength cutpoints for youth based on empirical associations with the well accepted marker of bone development, i.e., height-adjusted total body less head bone mineral content (TBLH_BMC). METHODS: A purposive sample of healthy youth from Midwest USA (n = 433 youth; 14.1 ± 2.3 years; 1998-2004) and a random sample of healthy adolescents from Zaragoza, Spain (n = 355 youth; 14.9 ± 1.2 years; 2006-2007) were used to develop and test cut-points. Participants' grip strength was measured using a hand-held dynamometer while height-adjusted TBLH_BMC was determined using dual-energy x-ray absorptiometry. Grip strength scores were linked to TBLH_BMC using receiver operator characteristic curves, and grip strength cutpoints were tested based on the area under the curve (AUC), sensitivity (Se), specificity (Sp), and predictive odds ratios. All analyses were conducted in 2016. RESULTS: The AUC approximated or exceeded 0.80 for grip strength cutpoints, and the associated Se and Sp indices ranged from 53.6 to 92.5%. Sensitivity and Sp remained similar in the validation sample and those not meeting the grip strength cutpoints were five to eight times more likely to have insufficient TBLH_BMC, depending on their sex and cutpoint being considered. CONCLUSIONS: Grip strength is strongly related to TBLH_BMC, and the proposed cutpoints demonstrated acceptable classification accuracy for screening healthy youth and tracking healthy bone development in community settings. The utility of the cutpoints should be further examined in more diverse populations of youth.

Evidencia del aporte proporcionado desde el cuidado de enfermería a la salud materna / Evidence of contributions made by the nursing care to maternal health

Introducción: La enfermera es esencial en la detección temprana de riesgos que pueden llegar a comprometer la vida de la mujer. Objetivo: Determinar la evidencia del aporte proporcionado desde el cuidado de enfermería a la salud materna. Fuente de datos: Se revisaron las bases de datos PubMed, Science Direct y Scielo entre los años 2010-2016. Se realizó además, rastreo manual de estudios en revistas indexadas que no estaban integradas a las fuentes mencionadas. Se encontraron 110 artículos y se seleccionaron 20 que cumplían con los criterios de inclusión establecidos. Síntesis de los datos: Se identificaron tres áreas temáticas: I. Los beneficios en la salud de la mujer con el cuidado de enfermería, II. La relevancia de fortalecer la formación relacionada con la atención materna. III. Los efectos de la regulación en el ejercicio profesional. En ellas se destaca la educación y asistencia prenatal en la adolescente embarazada y las visitas domiciliarias a las mujeres con riesgo antenatal. Se enfatiza la necesidad de robustecer las competencias relacionadas con el parto y las dirigidas al entendimiento de la cultura de la mujer gestante así como la permanencia de las enfermeras en su área de trabajo para proporcionar un cuidado de calidad a las madres y la necesidad de regular su carga de trabajo. Conclusiones: Desde la enfermería se genera evidencia para el manejo de la salud materna. Es indiscutible que el cuidado especializado incide de forma positiva en la disminución de la mortalidad materna en los diversos contextos de la práctica laboral(AU)

Introduction: Nurses are essential in the early detection of risks which can affect women's life. Objective: To determine the evidence of the given contribution from the nursing care to maternal health. Data source: PubMed, Science Direct and Scielo data bases were reviewed from 2010 to 2016.In addition, it was done manual searching of studies of indexed magazines that were not integrated to the above mentioned sources. 110 articles were found and 20 articles that fulfilled the established inclusion criteria were selected. Data synthesis: Three thematic areas were identified: I. Benefits of woman's health with nursing care; II. The relevance of strengthening the training related to maternal health; III. The effect of regulation on the professional practice. In these areas are highlighted the education and the prenatal care in the pregnant adolescent, and the home visit to the women with antenatal risk. It emphasizes the need to foster the competences which has to do with the birth aimed to understand the culture of the pregnant woman; and the continuance of the nurses in their working area to provide a qualified care to the mothers, and the need to regulate their work burden. Conclusions: Nursing generates evidence to the management of maternal health. It is undeniable that the specialized care influences in a positive way in the decrease of maternal mortality in the different contexts of the professional practice(AU)

Comparison of anthropometric measurements of adiposity in relation to cancer risk: a systematic review of prospective studies.

PURPOSE: In epidemiology, the relationship between increased adiposity and cancer risk has long been recognized. However, whether the association is the same for measures of abdominal or whole body adiposity is unclear. The aim of this systematic review is to compare cancer risk, associated with body mass index (BMI), an indicator of whole body adiposity, with indicators of abdominal adiposity in studies in which these indicators have been directly measured. METHODS: We conducted a systematic search from 1974 (EMBASE) and 1988 (PubMed) to September 2015 with keywords related to adiposity and cancer. Included studies were limited to cohort studies reporting directly measured anthropometry and performing mutually adjusted analyses. RESULTS: Thirteen articles were identified, with two reporting on breast cancer, three on colorectal cancer, three on endometrial cancer, two on gastro-oesophageal cancer, two on renal cancer, one on ovarian cancer, one on bladder cancer, one on liver and biliary tract cancer and one on leukaemia. Evidence suggests that abdominal adiposity is a stronger predictor than whole body adiposity for gastro-oesophageal, leukaemia and liver and biliary tract cancer in men and women and for renal cancer in women. Abdominal adiposity was a stronger predictor for bladder and colorectal cancer in women, while only BMI was a predictor in men. In contrast, BMI appears to be a stronger predictor for ovarian cancer. For breast and endometrial cancer, both measures were predictors for cancer risk in postmenopausal women. CONCLUSIONS: Only few studies used mutually adjusted and measured anthropometric indicators when studying adiposity-cancer associations. Further research investigating cancer risk and adiposity should include more accurate non-invasive indicators of body fat deposition and focus on the understudied cancer types, namely leukaemia, ovarian, bladder and liver and biliary tract cancer.

Physical activity, exercise and sport practice to fight against youth and childhood obesity / Actividad física, ejercicio y deporte en la lucha contra la obesidad infantil y juvenil

The aim of this document (written by professionals in physical activity and health EXERNET - Red Española de Investigación en Ejercicio Físico y Salud-) is to propose a list of recommendations about the practice of the physical and sport activity that in an individual, familiar and institutional level, help to prevent and manage the obesity in childs and teenagers.

El propósito del presente documento es proponer desde el grupo de expertos en ejercicio físico y salud de EXERNET (Red Española de Investigación en Ejercicio Físico y Salud) una serie de recomendaciones sobre la práctica de la actividad física y deportiva que a nivel individual, familiar e institucional ayuden a prevenir y tratar la obesidad infantil y juvenil, basadas en la evidencia científica actual.

Impact of physical activity and cardiovascular fitness on total homocysteine concentrations in European adolescents: The HELENA study.

We examined the association of physical activity (PA), cardiovascular fitness (CVF) and fatness with total homocysteine (tHcy) concentrations in European adolescents. The present study comprised 713 European adolescents aged 14.8 ± 1.2 y (females 55.3%) from the multicenter HELENA cross-sectional study. PA was assessed through accelerometry, CVF by the 20-m shuttle run test, and body fat by skinfold thicknesses with the Slaughter equation. Plasma folate, cobalamin, and tHcy concentrations were measured. To examine the association of tHcy with PA, CVF, and fatness after controlling for a set of confounders including age, maturity, folate, cobalamin, creatinine, smoking, supplement use, and methylenetetrahydrofolate reductase 677 genotype (CC 47%, CT 43%, TT 10%), bivariate correlations followed by multiple regression models were performed. In the bivariate correlation analysis, tHcy concentrations were slightly negatively correlated (p<0.05) with CVF in females (measured both by stages: r=-0.118 and by VO2max: r=-0.102) and positively with body mass index (r=0.100). However, daily time spent with moderate and vigorous PA showed a weak positive association with tHcy in females (p<0.05). tHcy concentrations showed a tendency to decrease with increasing CVF and increase with increasing BMI in female European adolescents. However, tHcy concentrations were positively associated with moderate and vigorous PA in female European adolescents.

Influences of physical fitness on bone mass in women with fibromyalgia.

The aim of this study was to provide information about the relationship of bone mineral content (BMC) and density (BMD) with some physical-fitness-related variables in a sample of women with fibromyalgia (FM) and age-matched women without FM. Twenty-eight women clinically diagnosed with FM (age 51.1 ± 8.4 yr, M ± SD) and 22 age-matched controls participated in the study. Whole-body BMC and BMD, lean mass, handgrip strength, quadriceps strength, and cardiovascular fitness were measured in all participants. The association between physical-fitness variables and bone-related variables was tested by linear regression controlling for body weight as a possible confounder. There were no differences in BMC or BMD between groups. Women with FM had lower values of handgrip strength, quadriceps strength, and VO2peak than the control group. Handgrip strength and aerobic capacity were associated with BMC and BMD and quadriceps strength was associated with BMD in women with FM; however, only VO2peak was associated with BMC in the group of women without FM. Bone mass of women with FM may be more susceptible to changes in physical fitness than that of the women without fibromyalgia.

Cardiorespiratory fitness and ideal cardiovascular health in European adolescents.

OBJECTIVE: We studied in European adolescents (i) the association between cardiorespiratory fitness and ideal cardiovascular health as defined by the American Heart Association and (ii) whether there is a cardiorespiratory fitness threshold associated with a more favourable cardiovascular health profile. METHODS: Participants included 510 (n=259 girls) adolescents from 9 European countries. The 20 m shuttle run test was used to estimate cardiorespiratory fitness. Ideal cardiovascular health was defined as meeting ideal levels of the following components: four behaviours (smoking, body mass index, physical activity and diet) and three factors (total cholesterol, blood pressure and glucose). RESULTS: Higher levels of cardiorespiratory fitness were associated with a higher number of ideal cardiovascular health components in both boys and girls (both p for trend ≤0.001). Levels of cardiorespiratory fitness were significantly higher in adolescents meeting at least four ideal components (13% higher in boys, p<0.001; 6% higher in girls, p=0.008). Receiver operating characteristic curve analyses showed a significant discriminating accuracy of cardiorespiratory fitness in identifying the presence of at least four ideal cardiovascular health components (43.8 mL/kg/min in boys and 34.6 mL/kg/min in girls, both p<0.001). CONCLUSIONS: The results suggest a hypothetical cardiorespiratory fitness level associated with a healthier cardiovascular profile in adolescents. The fitness standards could be used in schools as part of surveillance and/or screening systems to identify youth with poor health behaviours who might benefit from intervention programmes.

Health inequalities in urban adolescents: role of physical activity, diet, and genetics.

OBJECTIVE: Coordinated European projects relying on standardized methods are needed to identify health inequalities across Europe. This study aimed to compare fitness, fatness, and cardiometabolic risk between urban adolescents from the south and center-north of Europe and to explore whether physical activity (PA) and other factors might explain these differences. METHODS: The Healthy Lifestyle in Europe by Nutrition in Adolescence cross-sectional project comprised 3528 adolescents from the south (4 cities) and central-north (6 cities) of Europe, 1089 of whom provided blood samples for analysis. Fitness (strength, speed-agility, and cardiorespiratory fitness), total and abdominal fatness (anthropometry and bioelectrical impedance), and cardiometabolic risk (z scores including fitness, fatness, blood lipids, insulin resistance, and blood pressure) were assessed. The analyses were adjusted for socioeconomic factors, objectively measured PA (accelerometry), total energy intake and diet quality, and genetic variants of the FTO rs9939609 polymorphism. RESULTS: Adolescents from southern Europe were less fit and fatter according to all markers (P < .001). Differences in cardiometabolic risk scores were not consistent. Adolescents from the south were less active and this would largely explain the differences observed in speed-agility and cardiorespiratory fitness. Differences in total and abdominal fatness could not be explained by PA, energy intake, diet quality, or FTO rs9939609 polymorphism. CONCLUSIONS: Fitness and fatness levels indicate that urban adolescents from the south are less healthy than those from central-northern Europe. Our data suggest that differences in PA might explain differences in important health-related fitness components, yet factors explaining the differences in fatness encountered remain unknown.

More physically active and leaner adolescents have higher energy intake.

OBJECTIVE: To test whether youths who engage in vigorous physical activity are more likely to have lean bodies while ingesting relatively large amounts of energy. For this purpose, we studied the associations of both physical activity and adiposity with energy intake in adolescents. STUDY DESIGN: The study subjects were adolescents who participated in 1 of 2 cross-sectional studies, the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study (n = 1450; mean age, 14.6 years) or the European Youth Heart Study (EYHS; n = 321; mean age, 15.6 years). Physical activity was measured by accelerometry, and energy intake was measured by 24-hour recall. In the HELENA study, body composition was assessed by 2 or more of the following methods: skinfold thickness, bioelectrical impedance analysis, plus dual-energy X-ray absorptiometry or air-displacement plethysmography in a subsample. In the EYHS, body composition was assessed by skinfold thickness. RESULTS: Fat mass was inversely associated with energy intake in both studies and using 4 different measurement methods (P ≤ .006). Overall, fat-free mass was positively associated with energy intake in both studies, yet the results were not consistent across measurement methods in the HELENA study. Vigorous physical activity in the HELENA study (P < .05) and moderate physical activity in the EYHS (P < .01) were positively associated with energy intake. Overall, results remained unchanged after adjustment for potential confounding factors, after mutual adjustment among the main exposures (physical activity and fat mass), and after the elimination of obese subjects, who might tend to underreport energy intake, from the analyses. CONCLUSION: Our data are consistent with the hypothesis that more physically active and leaner adolescents have higher energy intake than less active adolescents with larger amounts of fat mass.