Factors associated with Mediterranean diet adherence in a sample of high socio-economic status children from southern Spain.

OBJECTIVE: The present study examined the association of BMI, fat mass, physical activity engagement (PA), maximal oxygen consumption (VO2max), screen time and academic performance (AP) with Mediterranean diet (MD) adherence in a sample of high socio-economic status (SES) children. DESIGN: A non-randomised design was used. A multilinear regression model was developed using backward elimination. Analysis included variables pertaining to age, BMI, VO2max, fat percentage, AP, PA engagement and screen time. All participants had a high SES and so this variable was not included as a predictor. Data met the assumptions required for multiple regressions in terms of linearity, homoscedasticity, normality, independence and non-multicollinearity. SETTING: Two state and three mixed funding schools in Granada, Spain. PARTICIPANTS: Data were collected from 244 children aged between 10 and 12 years. RESULTS: Better AP, higher PA engagement and lower screen time were found to be predictive of MD adherence. These variables explained 22·9 % of the variance in data measuring adolescent MD adherence. CONCLUSIONS: The present study suggests that, in addition to SES, PA, AP and screen time are important components to consider when targeting improvements in MD adherence in children. It is, therefore, concluded that interventions targeting improvements in PA, AP and screen time are needed to promote MD adherence in children, regardless of SES.

Differences in healthy lifestyle habits in university students as a function of academic area.

BACKGROUND: It is known that the promotion and acquisition of healthy attitudes is a key factor depending on the academic training provided by the university studies on which students are enrolled.The aim of the present research is to analyse and compare lifestyle habits and health-related quality of life (HRQoL) as a function of academic training. METHODS: A cross-sectional study with a volunteer convenience sample of 707 undergraduate participants aged (21.98 ± 3.50 years). Students were divided into four different groups according to their area of academic training. Socio-demographic variables, adherence to the Mediterranean diet (MD), physical activity (PA) engagement and HRQoL were recorded. RESULTS: PA and sport science students reported better scores in PA (6342.39 ± 2313.99 metabolic equivalents [METs]; P = 0.000), MD adherence (6.33 ± 2.69; P = 0.000) and HRQoL in physical and mental health (MH; 54.85 ± 9.18; 53.70 ± 13.6; P = 0.000). In contrast, non-health-related sciences (NHRS) students reported the lowest scores on assessed items. Students with a medium/high monthly salary reported better MD adherence (6.16 ± 3.07; P = 0.012). In addition, females reported better scores (6.41 ± 2.65; P = 0.000) than males. Further, males indicated better perceptions of MH (46.52 ± 18.84; P = 0.014). Moreover, university students with a high level of MD adherence were revealed to engage in more PA (5181.17 ± 2813.35 METs; P = 0.000) and have better HRQoL with regards to both physical (54.76 ± 8.84; P = 0.000) and MH (48.11 ± 16.73; P = 0.000). CONCLUSIONS: Outcomes point to differences in MD adherence, PA and HRQoL according to academic training. NHRS students who did not know healthy habits reported lower scores for all studied items. This indicates the need for health interventions at universities.

Analysis of the psychometric properties of the five-factor self-concept questionnaire (AF-5) in Spanish students during the COVID-19 lockdown.

The present research aims to analyse the psychometric properties of the AF5 questionnaire for its adaptation for use with young people during a lockdown period. Research was conducted with a sample of 534 students aged between 13 and 17 years (M = 14.49; SD = 1.805). Exploratory factor analysis was conducted using the FACTOR program and confirmatory factor analysis was conducted using the M-PLUS 7 program. Results indicate that a four-dimensional model is most appropriate for bringing together the emotional and physical dimensions. Further, 11 items were removed due to poor factor loadings. The majority of factors were directly and positively correlated (99%; p < .01). The data obtained supports conclusions that the AF-5 meets validity and reliability requirements for it to be considered a useful instrument for use with young people during the COVID-19 lockdown period.

Association of lifestyle behaviours with self-esteem through health-related quality of life in Spanish adolescents.

The present research examined the association of Mediterranean diet adherence and physical activity with self-esteem through five components of health-related quality of life. Data were collected from 456 adolescents attending one of five schools in Granada, Spain using a cluster-randomised design. Participants completed questionnaires on Mediterranean diet adherence, physical activity, self-esteem and health-related quality of life (HRQoL). Models were constructed to identify associations between Mediterranean diet adherence and physical activity on self-esteem. Mediational analysis using bootstrapped confidence intervals examined possible mediation by five components of HRQoL. Mediterranean diet adherence and physical activity engagement were associated with four components of HRQoL: more positive physical wellbeing, psychological wellbeing, family relationships and autonomy support and perceptions of the school environment. Both lifestyle behaviours were positively associated with self-esteem. Both relationships were mediated through positive psychological wellbeing and perceptions of the school environment. Physical wellbeing was also a mediator of the relationship between physical activity and self-esteem. CONCLUSION: Interventions promoting Mediterranean diets or physical activity to adolescents may facilitate improvements in self-esteem in addition to wider health benefits previously identified. Approaches within such interventions targeting improvements in physical wellbeing, psychological wellbeing and positive perceptions of the school environment may improve their efficacy. What is Known: • It is known that engagement in lifestyle behaviours such as physical activity is positively linked with psychological health. • Whilst its consumption is declining, the Mediterranean diet is nutritionally recommended and remains popular in parts of Greece, Southern Italy and Spain. Research into Mediterranean diet adherence and psychological health is lacking. What is New: • The present research furthers this knowledge by examining potential mechanisms through which two lifestyle behaviours (physical activity and following a Mediterranean diet) may be associated with self-esteem. • Implications for the promotion of positive mental health in young people. Mediterranean diet and physical activity were positively associated with self-efficacy via positive psychological self-concept and perceptions of the school environment. These novel findings can contribute to the development of more efficacious interventions targeting positive self-esteem in young people.

A pilot duplicate diet study on manganese, selenium and chromium intakes in institutionalised children and adolescents from Guatemala.

Hidden hunger occurs in the presence of an otherwise nutritionally or energetically appropriate diet that is deficient in essential vitamins and minerals. Guatemala has the highest rate of child malnutrition in Latin America and the prevalence of hidden hunger is high. The aim of this study was to determine the Mn, Se and Cr dietary intakes in Guatemalan institutionalised children (4-14 years), a population group at high risk of mineral deficiency. For this purpose, the contents of Mn, Se and Cr were analysed in a duplicate diet (for 7 consecutive days) by electrothermal atomisation-atomic absorption spectrophotometry following acid digestion. Mn, Se and Cr intakes from the duplicate diets were in the range of 1·3-2·31 mg/d, 58·7-69·6 µg/d and 6·32-27·57 µg/d, respectively. Mn and Cr values were below current recommended daily intakes. A cereal- and legumes-based diet is habitually consumed by this population. Local vegetables, fruits and nutritional supplements are included daily, but the consumption of fish, meat, eggs and dairy products is very infrequent or negligible. Mean daily energy intake from the 7-d diet was 8418·2 kJ (2012 kcal), with a macronutrient energy distribution of carbohydrates 69·4 %, proteins 12·3 % and fats 18·3 %. Correlations between Mn, Se and Cr intakes and energy and other nutrient intakes were also evaluated. The present findings will help establish new nutritional strategies for this and similar population groups.

Editorial for the Special Issue "New Research in Childhood Nutrition" of the Journal Children.

Nutrition is much more than food [...].

Results of a 7-week school-based physical activity and nutrition pilot program on health-related parameters in primary school children in southern Spain.

The goal of this study was to determine the effect of nutrition education combined with sessions of vigorous extracurricular physical activity (VEPA) on the improvement of health related parameters in children in primary education. The sample group consisted of 54 children in the fifth year of primary education divided into two groups: an intervention group (IG) of 25 students and a control group (CG) of 29 students. The intervention lasted 7 weeks and consisted of 13 sessions of VEPA combined with sessions of nutritional education that were attended by the students in the IG as well as their parents. During the intervention the IG showed a decrease in the body fat percentage, total cholesterol, cholesterol linked to low- density lipoproteins and blood pressure, together with an increase in cholesterol linked to high-density lipoproteins, and an improvement in the maximum oxygen uptake and dietary intake profile compared with the CG, which showed an increase in the percentage of fats and no significant changes (p < .05) in other parameters. The results of this study provide evidence that a 7-week program of nutritional education and vigorous short-duration physical activity can improve health related parameters in children.

Lifestyle Behaviours, Self-Esteem and Academic Performance in Primary Education Students-A Structural Equation Model According to Sex and School Type.

(1) Background: The present study aimed to examine the relationship between physical activity (PA), screen time (ST), maximal oxygen uptake (VO2max), Mediterranean diet (MD) adherence, self-esteem (SE) and academic performance (AP) in primary education students. In order to address this aim, an explanatory model was developed to examine the existing relationships between PA, ST, VO2max, MD adherence, SE and AP. Further, the proposed structural model was examined via multi-group analysis as a function of sex and school type. (2) Methods: A non-experimental, descriptive, comparative and cross-sectional study was designed with a total sample of 269 Spanish students (11.29 ± 0.62). Validated questionnaires were administered to collect data on study variables. (3) Results: Relative to boys, girls reported better academic grades and showed a stronger positive relationship between MD adherence and AP, MD adherence and PA, and VO2max and SE. Likewise, girls showed a stronger negative relationship between ST and VO2max, and ST and MD adherence. At the same time, mixed funding school (MFS) students reported higher PA engagement than state school (SS) students. However, SS students reported better MD adherence, ST and AP than MFS students. Further, a stronger positive relationship was found in SS students between MD adherence or VO2max and SE than in MFS students. Also, within the former group, ST was more negatively related to MD adherence and VO2max. (4) Conclusions: Scientific and educational communities must develop future strategies that consider potential determinants in order to target more desirable outcomes.

Nutritional Habits of Professional Cyclists during Pre-Season.

The first aim of the present study was to assess the dietary intake of professional cyclists during pre-season. The second aim was to assess the dietary habits of this population during a complete season. Fifteen elite male (age: 23.2 ± 5.4 years) and twenty-three elite female (age: 20.1 ± 7.0 years) cyclists volunteered to participate in the study. Dietary nutrient intake during pre-season was assessed using a 72 h dietary recall interview, and a 136-item food frequency questionnaire was used to assess dietary habits during the year. Protein intake exceeded the PRI's recommendation of 0.83 g/kg/day for all cycling groups. Fat exceeded RI recommendations in females in both road (43.3%) and CXO (39.8%) cycling groups, whilst males were found to follow recommendations for fat intake. CHO intake was below recommendations in all groups. Intake of all vitamins exceeded recommendations, with the exception of B9 in female road cyclists (77.8% RDA) and vitamin D in all groups. With regards to mineral intake, consumption exceeded RDA/AI recommendations in all groups except for iodine in male XCO cyclists (61.6%), female road cyclists (61.6%), and female XCO cyclists (58%) and potassium in female road cyclists (74.6%). Males consumed greater amounts of eggs and non-processed foods than females. Road cyclists consumed greater amounts of fish and seafood and had a lower intake of coffee and tea than XCO cyclists. Better knowledge of food guidelines in terms of serving and food variety is important for professional cyclists at may impact health and performance.

Influence of Confinement Due to COVID-19 on Physical Activity and Mediterranean Diet Adherence and Its Relationship with Self-Esteem in Pre-Adolescent Students.

Regular physical activity and good adherence to the Mediterranean diet are important for improving physical and mental health. Confinement due to the COVID-19 pandemic has led to a lack of exercise and poor nutrition. Preadolescent mental health, specifically regarding self-esteem, may have been affected. This is particularly relevant between the ages of 10 and 14. The influence of total confinement due to COVID-19 on physical activity and Mediterranean diet adherence, and its relationship with self-esteem was studied in third-year primary school students and first-year secondary school students in the provinces of Granada and Malaga, Spain. Validated questionnaires were administered to evaluate physical activity (PAQ-C), Mediterranean diet adherence (KIDMED) and self-esteem (Rosenberg Scale). In the same way, the FAS III test was used to evaluate socioeconomic status and an ad-hoc questionnaire was developed to collect sociodemographic data and evaluate screen time. Data were analyzed using IBM SPSS 25.0 statistical software. During the period of total confinement, statistically significant differences were found between examined variables, according to sex, school year, school type, socioeconomic status and whether or not the participant had contracted COVID-19. These data were compared with those collected during a previous time period. Those with a low socioeconomic status and girls were most affected.

Effects of an Alternative Sports Program Using Kin-Ball in Individuals with Intellectual Disabilities.

The first aim of the present work was to examine the effects of a physical activity sports program, specifically Kin-Ball, within a group of individuals with intellectual disabilities, on decreasing sedentary behavior and improving basic physical skills. The second aim was to evaluate social validity and acceptability of the intervention. In this pre-experimental study, 47 individuals participated (46.8% male and 53.2% female) with an average age of 29.85 (SD = 10.41). All participants were administered an intervention program based on the alternative sport of Kin-Ball. BMI was calculated for body composition and age-related Z-scores were interpreted with the tables provided by the WHO. Endurance was measured through a modified six-minute test, speed was analyzed using a 50 m test, and strength was estimated according to a hand-grip dynamometer. Likewise, balance and coordination were examined in line with adaptations proposed by the scientific literature. Results indicated that all cases experienced statistically significant differences following the intervention program (p = 0.000). Improvement effects were detected in all post-intervention tests (endurance, strength, speed, balance, and coordination). As a main conclusion, it is indicated that an alternative sports-based program improves physical ability and motor skills in individuals with intellectual disabilities.

Anthropometric and Physical Fitness Profiles of World-Class Male Padel Players.

The aims of this study were to describe and compare the anthropometric and physical fitness attributes of male padel players according to their competitive level, and to establish a functional anthropometric and physical profile. A total of 60 males participated in the present study. Athletes were grouped according to competition level, forming an elite group (n = 25) and a subelite group (n = 35). Anthropometric variables, hand grip and lumbar isometric strength, flexibility, and lower-body muscular strength were measured. Elite padel players were significantly older and showed significantly lower values for the thigh and calf skinfolds, the sum of six and eight skinfolds, and the sum of lower-limb skinfolds than the subelite group. Elite padel players also had significantly lower values than subelite players for body fat percentage and thigh fat area, whilst showing significantly higher values for lumbar isometric strength. Somatotype of the elite padel players could be defined as endo-mesomorphic. Results suggest that training and talent identification of padel players should focus on their anthropometric characteristics and physical fitness, with these being different between elite and subelite athletes. Normative data could help coaches throughout the talent identification process and in the design of training programs when seeking to optimise sports performance.

Assessing the dietary intake of calcium, magnesium, iron, zinc and copper in institutionalised children and adolescents from Guatemala. Contribution of nutritional supplements.

In childhood and adolescence an adequate mineral intake is essential for normal growth and immune function, and to prevent chronic diseases in adulthood. The aim of this study was to analyse the dietary intake of Ca, Mg, Fe, Zn and Cu in children and adolescents from an orphanage-school in Guatemala and to assess the mineral contribution of nutritional supplements used by this population. Mineral content was analysed in nutritional supplements, bioaccesible fractions obtained after an in vitro gastrointestinal method, and diets sampled by a 7-day duplicate diet study. The average mineral content in the duplicate diets, including supplements, was (mg/d): Ca 452, Mg 230, Fe 25, Zn 8 and Cu 0.22. Especially Ca and Cu values were below recommended daily intakes. The content of these minerals in the nutritional supplements (mg/serving) was 49-112 for Ca, 1.2-3.8 for Fe, 24-47 for Mg, 0.7-4.16 for Zn and 0.08-0.23 for Cu. A great proportion of dietary minerals was provided by supplements, the contribution of which was: Ca 53.1%, Mg 58.4%, Fe 27.6%. Zn 82.2% and Cu 98.5%. Mineral bioaccessibility in supplements was particularly low for Ca and, to a lesser extent, for Fe and Zn. In spite of the high supplement consumption (up to 4 servings/d) important mineral deficiencies were detected in the diet of institutionalised children. Findings suggest that formulation and nutritional values of supplements used in Latin America should be carefully reviewed, in order to be a useful tool in the prevention and treatment of hidden hunger.

Nutritional intake and body composition changes in a UCI World Tour cycling team during the Tour of Spain.

The aim of this study was to quantify the food intake of an International Cyclist Union (UCI) World Tour professional cyclist team and to analyse changes in body composition during the Tour of Spain. Nine male professional road cyclists (31.3 ± 3.0 years) volunteered to participate in the study. Nutritional data were collected each day throughout the 3-week Tour by two trained investigators who weighed the food ingested by the cyclists. Mean nutritional intake of the cyclists was as follows: carbohydrate, 12.5 ± 1.8 g/kg/day of body weight (BW) (65.0 ± 5.9%); fat, 1.5 ± 0.5 g/kg/day BW (17.9 ± 5.6%); and protein, 3.3 ± 0.3 g/kg/day BW (17.1 ± 1.6%). Intake of all micronutrients, except for folate, vitamin D and potassium (which were 78.7%, 46% and 84% of Recommended Dietary Allowances (RDA), respectively), exceeded the RDA. Height, weight, skinfolds, circumferences and diameters were taken following the guidelines outlined by the International Society for the Advancement of Kinanthropometry. Body density, body fat percentage, muscle mass, total muscle mass and fat mass of the arms and thighs were calculated. Percentage body fat, fat mass and upper arm fat mass significantly decreased (p < .05) after the Tour independent of the equation method used in the calculations. Total muscle mass remained unchanged. Generally, this sample of cyclists consumed more protein and less fat than the recommended amount and had low weight, BMI and fat mass. It is suggested that sports nutritionists design personalised diets in order to maintain a correct proportion of nutrients as well as controlling possible anthropometrical changes that could affect performance.

Correction: Relationship of resilience, anxiety and injuries in footballers: Structural equations analysis.

[This corrects the article DOI: 10.1371/journal.pone.0207860.].

Brown Adipose Tissue Response to Cold Stimulation Is Reduced in Girls With Autoimmune Hypothyroidism.

OBJECTIVE: The interaction between thyroid status and brown adipose tissue (BAT) activation is complex. We assessed the effect of autoimmune hypothyroidism (ATD) in female children on BAT activation, measured using infrared thermography. DESIGN: Twenty-six female participants (14 with ATD and 12 healthy controls) between 5 and 17 years of age attended a single study session. Thermal images were taken of the supraclavicular region before, and after, the introduction of a cool stimulus. RESULTS: Participants with ATD had lower resting (hypothyroid, 34.9 ± 0.7°C; control, 35.4 ± 0.5°C; P = 0.03) and stimulated (hypothyroid, 35.0 ± 0.6°C; control, 35.5 ± 0.5°C; P = 0.04) supraclavicular temperatures compared with controls, but there was no difference between groups in the temperature increase with stimulation. BAT activation, calculated as the relative temperature change comparing the supraclavicular temperature to a sternal reference region, was reduced in participants with ATD (hypothyroid, 0.1 ± 0.1°C; control, 0.2 ± 0.2°C; P = 0.04). Children with ATD were frequently biochemically euthyroid due to replacement therapy, but, despite this, increased relative supraclavicular temperature was closely associated with increased TSH (r = 0.7, P = 0.01) concentrations. CONCLUSIONS: Girls with ATD had an attenuated thermogenic response to cold stimulation compared with healthy controls, but, contrary to expectation, those with suboptimal biochemical control (with higher TSH) showed increased BAT activation. This suggests that the underlying disease process may have a negative effect on BAT response, but high levels of TSH can mitigate, and even stimulate, BAT activity. In summary, thyroid status is a complex determinant of BAT activity in girls with ATD.

Differences in Mediterranean Diet Adherence between Cyclists and Triathletes in a Sample of Spanish Athletes.

Adherence to the Mediterranean diet (MD) has rapidly declined in Mediterranean countries due to the increasing introduction of the Western diet. The aim of this study was to describe adherence to the MD within a sample of athletes from Spain. A second aim was to predict adherence to various components of the MD according to region, sex, and sport discipline. A cross-sectional study was conducted with a sample of 4037 (34.14 ± 9.28 years old) cyclists and triathletes (men: 90.1%). Participants self-reported their sex, date of birth, the number of years they had been practicing their sport, height, weight, sport discipline (cyclist, triathlon), and region. Mediterranean Diet Adherence Screener (MEDAS) was used to determine level of adherence to the MD. Women reported a higher MEDAS score and body mass index (BMI) (p ˂ 0.000) than men. Cyclists reported a lower MEDAS score (7.44, SD 2.12 vs. 7.85, SD 2.08), and older age (37.72, SD 9.67 vs. 34.54, SD 8.58) and BMI (23.74, SD 2.69) vs. 22.85, SD 2.28) than triathletes. The study showed that a large proportion of the surveyed athletic population were not meeting the MD guidelines, with particularly low consumption amongst men and cyclists. There were no regional effects. Nutritional guidelines for athletes should be individual rather than general and follow specifications identified by the present research.

Relationship of resilience, anxiety and injuries in footballers: Structural equations analysis.

Resilience is a psychological characteristic which enhances personal assets and protects individuals from potential negative effects of various stressors. While this topic has been considered in the separate context of sports injuries and anxiety states, these issues have rarely been considered together. The objective of this study is to analyse the association between motivation to overcome injuries in football and the state of anxiety caused by those injuries. One hundred and eighty-five footballers from Spain were analysed by way of the Connor-Davidson Resilience Scale, the State-Trait Anxiety Inventory questionnaires, and an injury self-registration sheet. Statistical analyses were performed using structural equations. Results showed a direct and positive relationship between the capacity to face up to injuries or potential injuries and to adapt successfully to them for injured footballers, especially when anxiety was considered as a transitory emotional state. In addition, this relationship was stronger in non-injured sportspersons because their resilience capacity was not being impaired by the experience of an injury.

Adherence to the Mediterranean Diet Is Associated with Physical Activity, Self-Concept and Sociodemographic Factors in University Student.

(1) Background: The aim of this study was to assess adherence to the Mediterranean diet (MD) and to examine the relationship between MD adherence, physical activity, self-concept, and other sociodemographic factors; (2) Methods: A cross-sectional study (N = 597; 18.99 ± 0.64 years) was conducted in a sample of university students from Ceuta, Melilla, and Granada (Spain). Religious beliefs and place of residence were directly reported, while physical activity and adherence to the MD were self-reported using the Physical Activity Questionnaire for Adolescents (PAQ-A) and the Mediterranean Diet Quality Index (KIDMED) respectively. Self-concept was evaluated using the Five-Factor Self-Concept Scale; (3) Results: Of those students reporting high levels of habitual physical activity, 82.3% also reported high adherence to the MD, with 17.7% reporting a medium adherence. Of students reporting no physical activity, 25.7% also reported medium adherence to the MD. No significant associations were found between the MD and religious beliefs. It was observed that the university campus was associated with the level of adherence to the MD (p = 0.030), with adherence being lowest in Ceuta and Melilla. Finally, the MD was associated with academic (p = 0.001) and physical self-concept (p = 0.005); 4) Conclusions: The MD should be promoted to university students, particularly those studying at Ceuta and Melilla, given the present findings of lower MD adherence. In addition, as higher MD adherence was also highlighted with more positive self-concept, its promotion would be beneficial in wider educational contexts.

Mediterranean diet adherence is associated with lifestyle, physical fitness, and mental wellness among 10-y-olds in Chile.

OBJECTIVE: The aim of this study was to assess adherence to the Mediterranean diet (MD) within a population of children from Santiago, Chile. A secondary aim was to examine the relationship between MD adherence, body composition, physical fitness, self-esteem, and other lifestyle factors. METHODOLOGY: A cross-sectional study of a sample of children (N = 515; 10.6 ± 0.5 y) was conducted. Weight, body mass index, skinfolds, and waist circumference were measured. Physical fitness was determined using aspects of the Assessing Levels of Physical Activity health fitness test battery for children. Adherence to the MD was assessed using the Mediterranean Diet Quality Index for children and adolescents questionnaire. Self-esteem was evaluated using the Rosenberg scale and the Five-Factor Self-Concept Questionnaire measured self-concept. Participants completed the Physical Activity Questionnaire for Older Children and also were asked to report the number of hours per day they spent watching various screen-based devices. RESULTS: All findings were significant at the level P < 0.001. Adherence to an MD was consistently and negatively associated with percentage body fat (r = -0.302) and subscapular skinfold thickness (r = -0.329). Positive associations were found with PAQ-C (r = 0.277), self-esteem (r = 0.301) and self-concept (r = 0.234), and for physical fitness, especially for explosive power of the legs (r = 0.355). Positive correlations with handgrip strength were found in boys (r = 0.323), whereas negative correlations with screen time were found in girls (r = -0.511). CONCLUSION: Given its relation to a healthier body composition, physical fitness, healthier lifestyle behaviors, and mental wellness, the MD should be promoted amongst youngsters.