Comparison of international height and BMI-for-age growth references and their correlation with adiposity in Brazilian schoolchildren.

This study verified the diagnostic accuracy of the nutritional status classified by the international height and BMI references of the World Health Organization (WHO) (WHO/2007), International Obesity Task Force (IOTF/2012) and MULT (2023). The data pool was composed by 22 737 subjects aged five to 16 years from the Santos and Porto Alegre surveys. A correlation matrix between the z-scores of the BMI references and the skinfold measurements was calculated through the Pearson correlation coefficient (r), and the subject's nutritional status was classified according to the international growth references. The accuracy for diagnosing obesity was performed separately by sex and using the 95th percentile of the triceps and subscapular skinfold sum, while Lin's concordance coefficient, Bland-Altman method and the Cohen's Kappa coefficient (Kappa) were used to verify the concordance and reliability among the BMI references. The correlation matrix showed a high positive correlation among the BMI z-scores (r ≥ 0·99) and among the skinfold measurements (r ≥ 0·86). The prevalence of stunting was higher when applying the MULT reference (3·4 %) compared with the WHO reference (2·3 %). The Bland-Altman plots showed the lowest critical difference (CD) between the height references of WHO and MULT (CD = 0·22). Among the BMI references, the WHO obesity percentile presented lower performance than MULT for boys, presenting a lower +LR value (WHO = 6·99/MULT 18 years = 10·99; 19 years = 8·99; 20 years = 8·09) for the same -LR values (0·04). Therefore, MULT reference holds promise as a valuable tool for diagnosing childhood obesity, particularly when considering sex differences. This enhances its suitability for assessing the nutritional status of Brazilian schoolchildren.

Association between parental feeding styles, body mass index, and consumption of fruits, vegetables and processed foods with mothers´ perceptions of feeding difficulties in children.

BACKGROUND: Feeding difficulties (FDs) are complex phenomena influenced by parental factors, feeding behaviour, and cultural factors. However, studies of the influences of these factors on FDs incidence are scarce. Thus, this study aimed to identify the associations between mothers' perceptions of FDs in children and parental feeding styles, body mass index, and the consumption of fruits, vegetables and processed foods. METHOD: Two hundred and fifty-seven mothers of children aged 1 to 6 years and 11 months participated in this cross-sectional study and self-completed electronic questionnaires on sociographic variables, parental feeding styles, the consumption of fruits, vegetables and processed foods and FDs. Nutritional status was classified by body mass index (kg/m2). RESULTS: The prevalence of FDs in children was 48.2%, and the mean age was 43.8 (± 17.6) months. The indulgent parental feeding style was the most common (40.1%), followed by the authoritative (31.1%), authoritarian (23.7%), and uninvolved (5.1%) styles. An indulgent parental feeding style (OR: 4.66; 95% CI: 2.20-9.85), a high body mass index (OR: 1.35; 95% CI: 1.09-1.68), and the consumption of processed foods (OR: 5.21; 95% CI: 2.85-9.53) were positively associated with increased odds of the absence of FDs in children. The associations of authoritarian and uninvolved parental feeding styles and the consumption of fruits and vegetables with FDs in children were not significant. CONCLUSION: This study identified multiple factors that are possibly associated with feeding behaviours in young children. However, further studies need to be undertaken to evaluate how such behaviours affect FDs.

Are the different cut-off points for sitting time associated with excess weight in adults? A population based study in Latin America.

BACKGROUND: Excess weight is increasing worldwide, and in Latin America more than half of the population is excess weight. One of the reasons for this increase has been excessive sitting time. Still, it remains to be seen whether there is an excessive amount of that time in Latin American adults. This study aimed to associate different sitting time cut-off points with the excess weight. METHODS: Data from the Latin American Study of Nutrition and Health (ELANS), a cross-sectional population-based survey conducted in eight Latin American countries, were used. The excess weight indicators used were body mass index, and waist and neck circumferences. Sitting time was obtained using questionnaires and categorized at different cut-off points. Differences between sitting time categories (< 4 or ≥ 4; < 6 or ≥ 6; and < 8 or ≥ 8 hours/day) and excess weight were obtained by Student's t test for independent samples and the association between sitting time categories and different indicators of excess weight were obtained by logistic regression. RESULTS: The median of the sitting time was 420 min/day (IQR: 240-600). There were no significant differences between body mass index (kg/m2) and waist circumference (cm) with categories of sitting time. The mean values of neck circumference (cm) were significantly higher in ≥4, ≥6 and ≥ 8 hours/day than < 4, < 6, and < 8 hours/day of sitting time in the pooled sample. Some distinct differences by country were observed. There were significant differences among excess weight by body mass index (63.2% versus 60.8) with < 8 vs ≥8 hours/day of sitting time. The proportion of excess weight by neck circumference was higher in participants who reported ≥4, ≥6, and ≥ 8 hours/day compared to < 4, < 6, and < 8 hours/day of sitting time. Considering ≥8 hours/day of sitting time, higher odds of excess weight were found evaluated by body mass index (OR: 1.10; 95% CI: 1.01, 1.20) and neck circumference (OR: 1.13; CI 95%: 1.03, 1.24) overall. CONCLUSIONS: Sitting time above 8 hours/day was associated with higher odds of excess weight, even though there were no differences in waist circumference between sitting time categories. TRIAL REGISTRATION: Clinical Trials NCT02226627. (27/08/2014).

How parents' feeding styles, attitudes, and multifactorial aspects are associated with feeding difficulties in children.

BACKGROUND: Parental complaints about feeding difficulties (FD) during childhood are frequent in pediatrics. Behavioral factors about children's feeding and parental aspects are fundamental in solving these problems, but research in this area lacks information considering the joint presence of fathers and mothers. Thus, this study aimed to investigate the features of children, parents and mealtime practices related to FD reported by fathers and mothers and to identify parenting styles, mealtime actions, practices and factors associated with FD in children. METHODS: 323 parents (226 mothers and 97 fathers) of children aged 1 to 7 years were recruited in the emergency waiting room at Sabará Hospital Infantil, in São Paulo, Brazil, and self-completed electronic questionnaires on parenting style (Caregiver's Feeding Styles Questionnaire), parents' mealtime actions (Parent Mealtime Action Scale), socioeconomic information, personal and children's health data and routine meal practices. RESULTS: The prevalence of FD in children was 26.6%. Indulgent parenting style was the most frequent (44.2%), followed by authoritarian (25.1%), authoritative (23.8%), and uninvolved (6.9%) styles. Most parents (75.8%) reported presence during meals, and 83.6% used distractions. Regression analyses after adjustments showed, as factors associated with FD, female children (OR: 2.06; 95%CI: 1.19-3.58), parents' FD history (OR: 3.16; 95%CI: 1.77-5.64), and greater frequency of parents' behavior of offering many food options (OR: 2.69; 95%CI: 1.18-6.14). Parents with indulgent styles had decreased chances of reporting FD in their children (OR: 0.13; 95%CI: 0.06-0.27). Furthermore, the practice of children sharing the family menu (OR: 0.43; 95%CI: 0.18-0.99) and higher frequency of parents' behavior of setting snack limits (OR: 0.44; 95%CI: 0.23-0.85) were inversely associated with FD. CONCLUSIONS: This study reinforces the multifactorial aspects involved in the feeding difficulties context. It points out the importance of expanding knowledge of the individual role of fathers and mothers to compose a scenario that can guide future studies and interventions. TRIAL REGISTRATION: CAAE #99221318.1.0000.5567 with registration number 2,961,598.

Total and whole grain intake in Latin America: findings from the multicenter cross-sectional Latin American Study of Health and Nutrition (ELANS).

PURPOSE: Understanding whole-grain intake and its associated factors is essential to tackle the double burden of malnutrition faced by Latin American countries. This study aimed to characterize total and whole grain intake in Latin American countries and to investigate foods contributing to these intake in the region. METHODS: Data were obtained from the multicenter cross-sectional survey Latin American Study of Nutrition and Health (ELANS), including 9128 participants residing in urban areas of eight Latin American countries. Data collection was performed via two household visits using a standardized questionnaire and two 24 h dietary recalls. Usual dietary intake of total grain foods and foods containing whole grains was estimated. The association between the intake of grain food groups and sociodemographic variables was investigated using multiple linear regression models with random intercepts. RESULTS: Mean intake of total grain foods and foods containing whole grains was 318.6 g/d and 14.7 g/d, respectively. Total grain foods were less consumed by participants at older ages (-9.8 g/d), and females (-9.9 g/d), and more consumed by those in the lowest socioeconomic category (24.8 g/d). Foods containing whole grains were more consumed by participants at older ages (3.3 g/d), and females (4.0 g/d), while those in the lowest socioeconomic category consumed 2.9 g/d less. Major contributors to energy provided from foods containing whole grains were oatmeal, masa harina, whole-wheat bread, corn chips, and wheat crackers. CONCLUSION: The intake of grain foods represented a substantial part of the Latin American population's diet, but the intake of foods containing whole grains was extremely low in all assessed countries.

Prevalence and sociodemographic correlates of meeting the Canadian 24-hour movement guidelines among latin american adults: a multi-national cross-sectional study.

BACKGROUND: 24-hour movement behaviors, including moderate-to-vigorous physical activity (MVPA), sedentary time (ST), and sleep duration, have important implications for health across the lifespan. However, no studies exist that have examined the integration of these 24-hour movement behaviors in Latin America. The purpose of this study was to examine the prevalence of meeting the Canadian 24-Hour Movement Guideline recommendations and sociodemographic correlates of meeting the guidelines in adults from eight Latin American countries. METHODS: This was a multi-national cross-sectional study of 2338 adults aged 18 to 64 years from the Latin American Study of Nutrition and Health. MVPA and ST data were collected using accelerometers. Sleep duration was self-reported using a daily log. Socio-demographic correlates included sex, age, education level, and marital status. Meeting the 24-hour movement guidelines was defined as: ≥150 min/week of MVPA; ≤8 h/day of ST; and between 7 and 9 h/day of sleep. Logistic regression models were estimated on pooled data. RESULTS: The prevalence of adults who met the MVPA, ST, sleep duration, and integrated recommendations was 48.3, 22.0, 19.4, and 1.6%, respectively. Overall, being a woman (OR: 0.72; 95%CI: 0.55,0.93) and having a middle (0.63; 0.47,0.85) or high education level (0.31; 0.17,0.56) was associated with lower odds of meeting all three of the 24-hour movement guideline recommendations. Being married (1.70; 1.25,2.29) was associated with greater odds of meeting all three recommendations. Being a woman (0.46; 0.39,0.55), aged 50-64 years (0.77; 0.60,0.97), and married (0.79; 0.65,0.96) were associated with lower odds of meeting the MVPA recommendation. Having a middle (0.64; 0.50,0.80) or high (0.36; 0.23,0.55) education level was associated with lower odds and being married (1.86; 1.46,2.36) was associated with greater odds of meeting the ST recommendation. Being a woman (0.63; 0.51,0.78) was associated with lower odds; whereas being aged 50-64 years (1.40; 1.04,1.88) and having a middle education level (1.37; 1.09,1.73) were associated with greater odds of meeting the sleep duration recommendation. CONCLUSIONS: Overall, the proportion of Latin American adults achieving healthy levels of 24-hour movement behaviors was low. Further efforts are needed to promote more MVPA, less ST, and sufficient sleep in Latin American adults. TRIAL REGISTRATION: Clinical Trials NCT02226627 . Retrospectively registered on August 27, 2014.

Relationship between socio-demographic correlates and human development index with physical activity and sedentary time in a cross-sectional multicenter study.

BACKGROUND: Socio-demographic correlates and human development index (HDI) are associated with self-reported physical activity, but only a few studies have focused on device-measured physical activity and sedentary time in Latin America. We examined the relationship between socio-demographic correlates and HDI with physical activity and sedentary time in a cross-sectional study. METHODS: We based our analyses on 2522 (53.1% women; 18-65 years [mean age 38.3 years]) adults drawn from the eight Latin America countries. Physical activity (light, moderate, vigorous, and moderate-to-vigorous intensity and steps) and sedentary time were assessed using Actigraph GT3X + accelerometers. Sex, age, and race/ethnicity were self-reported. The HDI country information was obtained from the United Nations Development Program. RESULTS: For the age, ethnicity, vigorous physical activity and steps/day, there were significant differences between high and very high HDI countries. Women and younger age presented lower sedentary time than men and older. In moderate-to-vigorous physical activity, we found lower duration in women (-13.4 min/week), younger age (-0.1 min/week), and white/caucasian (-2.7 min/week) than men, older ages and mixed ethnicity. Women (-1266.5 steps/week) and very high HDI (-847.3 steps/week) presented lower steps than men and high HDI. Black (2853.9 steps/week), other (1785.4 steps/week), and white/caucasian ethnicity (660.6 steps/week) showed higher steps than mixed ethnicity. CONCLUSIONS: Different socio-demographic correlates are associated with physical activity intensity; however, HDI is associated with vigorous physical activity and steps in the Latin American region, which can in turn guide policies to promote physical activity in the region. TRIAL REGISTRATION: ClinicalTrials.Gov NCT02226627 . Retrospectively registered on August 27, 2014.

Walking and cycling, as active transportation, and obesity factors in adolescents from eight countries.

BACKGROUND: Evidence has shown that active transportation decreases obesity rates, but considering walking or cycling as separate modes could provide additional information on the health benefits in adolescents. This study aimed to examine the associations between walking and cycling as form active transportation and obesity indicators in Latin American adolescents. METHODS: Population-based study with 671 adolescents (mean age: 15.9 [standard deviation: 0.8] years) from eight countries participating in the Latin American Study of Nutrition and Health/Estudio Latino Americano Nutrition y Salud (ELANS). Walking and cycling for active transportation were measured using the International Physical Activity Questionnaire long version. Body mass index, waist circumference, neck circumference, and relative fat mass were used as obesity indicators. Associations were estimated using logistic regression models for the pooled data adjusted for country, sex, age, socio-economic levels, race/ethnicity, leisure-time physical activity and energy intake. RESULTS: Mean time spent walking and cycling was 22.6 (SD: 33.1) and 5.1 (SD: 24.1) min/day, respectively. The median values were 12.8 (IQR: 4.2; 25.7) and 0 (IQR: 0; 6.2) for walking and cycling. Participants reporting ≥ 10 min/week of walking or cycling for active transportation were 84.2% and 15.5%, respectively. Costa Rica (94.3% and 28.6%) showed the highest prevalence for walking and cycling, respectively, while Venezuela (68.3% and 2.4%) showed the lowest prevalence. There was no significant association between walking for active transportation and any obesity indicator. In the overall sample, cycling for ≥ 10 min/week was significantly associated with a lower likelihood of overweight/obesity based on BMI (OR: 0.86; 95%CI: 0.88; 0.94) and waist circumference (OR: 0.90; 95%CI: 0.83; 0.97) adjusted for country, sex, age, socio-economic level, race/ethnicity, leisure-time physical activity and energy intake compared to cycling for < 10 min/week. There were no significant associations between cycling for active transportation and neck circumference as well as relative fat mass. CONCLUSIONS: Cycling for active transportation was negatively associated with obesity indicators, especially body mass index and waist circumference. Programs for promoting cycling for active transportation could be a feasible strategy to tackle the high obesity rates in adolescents in Latin America. TRIAL REGISTRATION: ClinicalTrials.Gov NCT02226627. Retrospectively registered on August 27, 2014.

Association between weight control behaviors and diet quality among Brazilian adolescents and young adults: Health Survey of São Paulo with Focus on Nutrition, 2015.

PURPOSE: Little is known about how behaviors to control weight are associated with diet quality among youth from low- and middle-income countries. The aim of this study was to examine associations between efforts to control weight (ECW) and diet quality among Brazilian adolescents and young adults. METHODS: Data from 731 participants (17.89 ± 4.92 years, 51.1% female) of the 2015 Health Survey of São Paulo were used for this cross-sectional study. Dietary intake was assessed using a 24 h dietary recall and diet quality was calculated using the Brazilian Healthy Eating Index-Revised (BHEI-R). Participants reported their ECW, weight satisfaction, and socio-demographics. Descriptive statistics and linear regressions were calculated to investigate associations between ECW and diet quality. RESULTS: Approximately 47.7% of participants were dissatisfied with their current weight, and 41.0% reported ECW. Reported strategies to control weight included increased physical activity, taking care of what they eat, and dieting (8.2, 3.1, and 2.5%, respectively). After adjusting for age, sex, race/ethnicity, and body mass index, reporting at least one ECW (ß = 0.08; 95% CI 0.02, 0.13), taking care of what to eat (ß = 0.15; 0.08, 0.22) and being satisfied with their weight (0.08; 0.02, 0.13) were all associated with a higher overall BHEI-R score. CONCLUSION: Overall diet quality score showed a small increase in participants reporting ECW. Further studies should be conducted to provide strategies used by adolescents from low- and middle-income countries to control their weight. Thus, developing public health policies, and behavioral-change strategies. LEVEL V: Cross-sectional descriptive study.

Sociodemographic inequities and active transportation in adults from Latin America: an eight-country observational study.

BACKGROUND: Active transportation is a crucial sort of physical activity for developing sustainable environments and provides essential health benefits. This is particularly important in Latin American countries because they present the highest burden of non-communicable diseases relative to other worldwide regions. This study aimed to examine the patterns of active transportation and its association with sociodemographic inequities in Latin American countries. METHODS: This cross-sectional study was conducted in eight countries. Participants (n = 8547, 18-65 years) self-reported their active transportation (walking, cycling, and total) using the International Physical Activity Questionnaire. Sex, age, ethnicity, socioeconomic level, education level, public and private transport use, and transport mode were used as sociodemographic inequities. RESULTS: Participants spent a total of 19.9, 3.1, and 23.3 min/day with walking, cycling, and total active transportation, respectively. Mixed and other ethnicity (Asian, Indigenous, Gypsy, and other), high socioeconomic level as well as middle and high education level presented higher walking than Caucasian, low socioeconomic and education level. Private transport mode and use of ≥ 6 days/week of private transport showed lower walking than public transport mode and ≤ 2 days/week of private transport. Use of ≥ 3 days/week of public transport use presented higher walking than ≤ 2 days/week of public transport. Men had higher cycling for active transportation than women. Use of ≥ 3 days/week of public transport use presented higher cycling than ≤ 2 days/week of public transport. ≥6 days/week showed lower cycling than ≤ 2 days/week of private transport use. Men (b: 5.57: 95 %CI: 3.89;7.26), black (3.77: 0.23;7.31), mixed (3.20: 1.39;5.00) and other ethnicity (7.30: 2.55;12.04), had higher total active transportation than women and Caucasian. Private transport mode (-7.03: -11.65;-2.41) and ≥ 6 days/week of private transport use (-4.80: -6.91;-0.31) showed lower total active transportation than public transport mode and ≤ 2 days/week of private transport use. Use of 3-5 (5.10: 1.35;8.85) and ≥ 6 days/week (8.90: 3.07;14.73) of public transport use presented higher total active transportation than ≤ 2 days/week of public transport use. Differences among countries were observed. CONCLUSIONS: Sociodemographic inequities are associated differently with active transportation across Latin American countries. Interventions and policies that target the promotion of active policies transportation essential to consider sociodemographic inequities. TRIAL REGISTRATION: ClinicalTrials.Gov NCT02226627. Retrospectively registered on August 27, 2014.

Contribution of food groups to energy, grams and nutrients-to-limit: the Latin American Study of Nutrition and Health/Estudio Latino Americano de Nutrición y Salud (ELANS).

OBJECTIVE: To quantify the energy, nutrients-to-limit and total gram amount consumed and identify their top food sources consumed by Latin Americans. DESIGN: Data from the Latin American Study of Nutrition and Health (ELANS). SETTING: ELANS is a cross-sectional study representative of eight Latin American countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru and Venezuela. PARTICIPANTS: Two 24-h dietary recalls on non-consecutive days were used to estimate usual dietary intake of 9218 participants with ages between 15-65 years. 'What We Eat in America' food classification system developed by United States Department of Agriculture was adapted and used to classify all food items consumed by the ELANS population. Food sources of energy, added sugars, SFA, Na and total gram amount consumed were identified and ranked based on percentage of contribution to intake of total amount. RESULTS: Three-highest ranked food categories of total energy consumed were: rice (10·3%), yeast breads (6·9%), and turnovers and other grain-based items (6·8 %). Highest ranked food sources of total gram amount consumed were fruit drinks (9·6%), other 100% juice (9·3%) and rice (8·3%). Three highest ranked sources for added sugars were other 100% juice (24·1 %), fruit drinks (16·5%), and sugar and honey (12·4%). SFA ranked foods were turnovers and other grain-based (12·6 %), cheese (11·9%), and pizza (10·3%). Three top sources of Na were rice (13·9%), soups (9·1 %) and rice mixed dishes (7·3 %). CONCLUSION: Identification of top sources of energy and nutrients-to-limit among Latin Americans is critical for designing strategies to help them meet nutrient recommendations within energy needs.

Food intake, physical activity and body composition of adolescents and young adults: data from Brazilian Study of Nutrition and Health.

BACKGROUND: Lifestyle acquired in youth can determine the individual's health. Constant vigilances in all aspects related to the health of the young population is essential, and evaluate their health parameters is important. The objective of this study was to describe and to compare food intake, physical activity (PA) practice, nutritional status and body composition between adolescents and young adults. METHODS: Four hundred seventy-six individuals from the Brazilian Study of Nutrition and Health (EBANS) were analyzed. Food intake was evaluated by applying two 24-h Dietary Recall. The PA and sitting time (ST) were measured by the International Physical Activity Questionnaire in minutes/week and metabolic equivalent task (METs). Body weight and waist circumference (WC) were measured. Body mass index (BMI) and waist circumference to height ratio (WHtR) were calculated. Mann-Whitney and Chi-Square tests were used. RESULTS: Energy and macronutrients intake, number of meals, and breakfast skippers weren't different between age groups. 48% of adolescents and 53% of young adults didn't meet the PA recommendation, and adolescents practiced more PA than young adults (total PA: p = 0.006; METs: p < 0.001; leisure PA: p = 0.001); the individuals who studied practiced more PA (total PA: p = 0.034; METs: p = 0.029; leisure PA: p < 0.001) and had ST significantly higher (p = 0.009) than those who worked. Almost 30% of adolescents and 45% of young adults had excess weight; presenting difference according to nutritional status, WC and WHtR (p < 0.001). CONCLUSION: There is a high prevalence of excess weight among young Brazilians and differences were observed between age groups regarding nutritional status, body composition and PA practice. TRIAL REGISTRATION: ClinicalTrials.Gov NCT02226627 . Retrospectively registered on August 27, 2014.

Agreement Between Self-Reported and Device-Based Sedentary Time among Eight Countries: Findings from the ELANS.

The purpose of this study was to analyze the agreement between self-reported and device-based sedentary time among eight countries in Latin America. As part of the Latin American Study of Nutrition and Health (ELANS), data were collected from 2524 participants (18-65 years) across eight countries. Participants reported time spent sedentary in different activities (computer use at home, videogame use, reading, sitting down to chat with friends/relatives or listening to music, speaking on the phone, watching TV, and riding in a car). Overall sitting time was assessed using a single item from the International Physical Activity Questionnaire (IPAQ). Device-based sedentary time was assessed using Actigraph GT3X accelerometers. Self-reported overall sitting time (227.1 min/day) produced the lowest values of the three assessment methods, followed by self-reported sum of different types of sedentary behavior (364.1 min/day) and device-based sedentary time (568.6 min/day). Overall, correlation coefficients and ICC varied from weak to moderate (rho: 0.25-0.39; ICC: 0.21:0.39) between self-reported sum of different types of sedentary behavior, self-reported overall sitting time, and device-based sedentary time. The Bland-Altman plots indicated low to moderate agreement between self-reported overall sitting time and device-based sedentary time by sex. Self-report measures underestimate sedentary behavior and overall sitting time when compared with device-based measures. The weak and moderate level of agreement between methods indicates that caution is required when comparing associations between different self-report and device-based measures of sedentary behavior with health outcomes.

Is the perceived neighborhood built environment associated with domain-specific physical activity in Latin American adults? An eight-country observational study.

BACKGROUND: Characteristics of the neighborhood built environment are associated with physical activity (PA). However, few studies with representative samples have examined environmental correlates of domain-specific PA in Latin America. We examined the associations of the perceived neighborhood built environment with domain-specific PA in a large sample of adults from eight Latin American countries. METHODS: This study examined data from 8185 adults (aged 18-65 years) from eight Latin American countries. The Neighbourhood Environment Walkability Survey - Abbreviated (NEWS-A) scale was used to assess perceptions of land use mix-diversity, land use mix-access, street connectivity, walking/cycling facilities, aesthetics, safety from traffic, and safety from crime. Perceived proximity from home to public open spaces (metropolitan parks, playgrounds, public squares) and to shopping centers was also measured. Transport-related and leisure-time PA were assessed using the long form of the International Physical Activity Questionnaire. Both logistic and linear regression models were estimated on pooled data. RESULTS: Perceptions of higher land use mix-access (OR: 1.40; 95% CI: 1.22,1.61), the existence of many alternative routes in the neighbourhood (1.12; 1.04,1.20), slow speed of traffic (1.19; 1.03,1.35) and few drivers exceeding the speed limits (1.09; 1.03,1.15) were associated with greater odds of reporting at least 10 min/week of transport-related PA. Perceptions of higher levels of land use mix-diversity, better aesthetics and greater safety from crime, the presence of crosswalks and pedestrian signals, and greater proximity of shopping centers were associated with more min/week of transport-related PA. Perceptions of higher land use mix-diversity (1.12; 1.05,1.20), higher land use mix-access (1.27; 1.13,1.43), more walking/cycling facilities (1.18; 1.09,1.28), and better aesthetics (1.10; 1.02,1.18) were associated with greater odds of engaging in at least 10 min/week of leisure-time PA versus none. Perceptions of higher land use mix-diversity were associated with more min/week of leisure PA. CONCLUSIONS: Different perceived neighborhood built environment characteristics were associated with domain-specific PA among adults from Latin America countries. Interventions designed to modify perceptions of the neighbourhood built environment might influence initiation or maintenance of domain-specific PA. TRIAL REGISTRATION: ClinicalTrials. Gov NCT02226627 . Retrospectively registered on August 27, 2014.

Adiponectin is Increased in Pediatric Patients With Autoimmune Hepatitis Independent of Body Weight.

OBJECTIVE: A high prevalence of obesity is reported in children and adolescents with autoimmune hepatitis (AIH). Adipokines participate in inflammatory processes. The objective of this study was to examine the relationship between excess weight and systemic inflammation, adipokines, and ghrelin in adolescents with AIH. METHOD: This case-controlled study included 27 adolescents with AIH (13 with excess weight and 14 with normal weight) and a control group. Excess weight was defined by a body mass index/age Z score >+1 standard deviation. Adipokines (adiponectin, leptin, tumor necrosis factor alpha, interleukin 6 [IL-6], and IL-10) and ghrelin were measured with Luminex technology. RESULTS: Adiponectin (µg/mL) was higher (P < 0.001) in AIH adolescents with and without excess weight (median: 35.0 and 42.1, respectively) than in normal-weight (17.5) and excess-weight (17.0) controls. Leptin was higher (P < 0.001) in excess-weight AIH patients (18.0 ng/mL) and controls (19.8 ng/mL) than in normal-weight AIH (7.7 ng/mL) and control (7.0 ng/mL) adolescents. IL-6 levels were higher in excess-weight (3.8 pg/mL) and normal-weight (3.8 pg/mL) AIH patients than in excess-weight (1.1 pg/mL) and normal-weight (0.5 pg/mL) controls. IL-10 levels were higher (5.2 pg/mL) in normal-weight AIH patients than in excess-weight (1.8 pg/mL) and normal-weight (2.1 pg/mL) controls. Ferritin levels were lower in patients with AIH than in controls. CONCLUSIONS: Independent of body weight, AIH patients had higher levels of adipokines, especially adiponectin and IL-6. Leptin levels were associated with body weight and were not influenced by AIH. IL-10 levels were associated with lean tissue in AIH.

Anthropometry, dietary intake, physical activity and sitting time patterns in adolescents aged 15-17 years: an international comparison in eight Latin American countries.

BACKGROUND: Although there is high prevalence of obesity and other cardiovascular risk factors among Latin American adolescents, there is limited evidence on dietary intake and physical activity (PA) patterns in this population. Therefore, we characterized anthropometry, dietary intake, PA and sitting time (ST) in adolescents aged 15-17 years from eight Latin American countries. METHODS: Six hundred seventy-one adolescents (41.4% girls) from the Latin American Study of Nutrition and Health (ELANS) were included. Nutritional status was classified by four BMI (kg/m2) categories. Waist circumference (WC) was categorized as above or below thresholds. Dietary intake was assessed through two non-consecutive 24-h dietary recalls. PA and ST were measured using the International Physical Activity Questionnaire (IPAQ). We calculated overall and country-specific estimates by sex and tested for differences between boys and girls. RESULTS: Differences in the prevalence of overweightness (15.1 and 21.6%) and obesity (8.5 and 6.5%) between boys and girls, respectively, were statistically insignificant (p = 0.059). Average energy intake was 2289.7 kcal/day (95% CI: 2231-2350) for boys and 1904.2 kcal/day (95% CI: 1840-1963) for girls (p < 0.001). In relation to macronutrient intake for boys and girls, respectively, the average intake (expressed as percentage of total energy) was 15.0 and 14.9% for protein; 55.4 and 54.9% for carbohydrates; 14.1 and 14.5% for added sugar; 29.5 and 30.1% for total fat; and 9.6 and 9.9% for saturated fat (p > 0.05 for all outcomes). There was no statistically significant difference in the prevalence of total energy (TE) saturated fat and added sugar (>10% of TE) between girls and boys (49.6% versus 44.8 and 81.7% versus 76.1%, respectively). Prevalence of physical inactivity was 19% in boys and 43.7% in girls (p < 0.001). Median levels of vigorous-intensity PA and total PA were significantly higher for boys than for girls (p < 0.05 for both outcomes); whereas levels of ST were similar (273.7 versus 220.0 min/day for boys and girls, respectively; p > 0.05). CONCLUSIONS: These findings highlight the high prevalence of poor dietary intake and physical inactivity in adolescents from Latin American countries. Therefore, effective and sustainable strategies and programmes are needed that promote healthier diets, regular PA and reduce ST among Latin American adolescents. TRIAL REGISTRATION: Clinical Trials NCT02226627. Retrospectively registered on August 27, 2014.

Association of moderate-to-vigorous physical activity with neck circumference in eight Latin American countries.

BACKGROUND: Physical activity is a cornerstone in the prevention and treatment of obesity. There are relatively few studies that explore the effect of accelerometer-determined moderate-to-vigorous physical activity (MVPA) on neck circumference (NC), most of them confined to single high-income countries. The present study investigated the association of accelerometer-determined MVPA with NC in adolescents and adults from eight Latin American countries, which are mostly upper-middle income countries. METHODS: The sample consisted of 2370 participants (47.8% male) from the Latin American Study of Nutrition and Health, a multicenter cross-sectional nutrition and health surveillance study of a nationally representative sample from eight Latin American countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela). Times (min/day) in MVPA (defined as time accumulated at ≥1952 activity counts/min) was assessed by ActiGraph GT3X+ accelerometer over 7 days. NC for adolescent was categorized as abnormal if circumference was > 34.5 cm for boys and > 31.25 for girls, whereas for adults the cut-off points for abnormal were > 39 cm for men and > 35 cm women. Multilevel logistic models, including country and region as random effects and adjusted for sex, age, socioeconomic level, and educational level, were used to study the association between MVPA and NC. RESULTS: The average time of MVPA was 34.88 min/day, ranging from 31.16 in Venezuela to 40.27 in Chile. Concerning NC, 37.0% of the sample was classified as having elevated NC. Chile was the country with the highest percentage of people with elevated NC (56.9%), and Colombia had the lowest percentage (24.8%). Overall, the MVPA (min/day) was associated with elevated NC (OR = 0.994, CI95% = 0.990-0.998). In Costa Rica and Peru, there were significant associations between MVPA and NC when analyzed by country. CONCLUSIONS: The present study provided evidence of significant associations between MVPA and NC in adolescents and adults from Latin America, independent of sex, age, socioeconomic level, and educational level. This analysis of accelerometry data and NC represents the first examination of these associations in eight Latin America countries. Further research is required to understand the differences between countries in the observed associations. TRIAL REGISTRATION: ClinicalTrials.Gov NCT02226627 . Retrospectively registered on August 27, 2014.

Original research Socio-demographic patterning of self-reported physical activity and sitting time in Latin American countries: findings from ELANS.

BACKGROUND: Low levels of physical activity (PA) and prolonged sitting time (ST) increase the risk of non-communicable diseases and mortality, and can be influenced by socio-demographic characteristics. The aim of this study was to use self-report data to characterise socio-demographic patterns of PA and ST in eight Latin American countries. METHODS: Data were obtained from the Latin American Study of Nutrition and Health (ELANS), a household population-based, multi-national, cross-sectional survey (n = 9218, aged 15-65 years), collected from September 2014 to February 2015. Transport and leisure PA and ST were assessed using the International Physical Activity Questionnaire-long version. Overall and country-specific mean and median levels of time spent in transport and leisure PA and ST were compared by sex, age, socioeconomic and education level. RESULTS: Mean levels of transport and leisure PA were 220.3 min/week (ranging from 177.6 min/week in Venezuela to 275.3 min/week in Costa Rica) and 316.4 min/week (ranging from 272.1 min/week in Peru to 401.4 min/week in Ecuador). Transport and leisure PA were higher (p < 0.005) in men than women with mean differences of 58.0 and 34.0 min/week. The mean and median for transport PA were similar across age groups (15-29 years: mean 215.5 and median 120 min/week; 30-59 years: mean 225.0 and median 120 min/week; ≥60 years: mean 212.0 and median 120 min/week). The median time spent in transport and leisure PA between three strata of socioeconomic and education levels were similar. The prevalence of not meeting PA recommendations were 69.9% (95% CI: 68.9-70.8) for transport and 72.8% (95% CI: 72.0-73.7) for leisure. Men, younger people (15-29 years), individuals with higher socioeconomic and education levels spent significantly (p < 0.001) more time sitting than women, older people (30-59 years and ≥ 60 years) and those in the middle and low socioeconomic and education groups, respectively. CONCLUSIONS: Transport and leisure PA and ST range widely by country, sex, and age group in Latin America. Programs for promoting leisure and transport PA and reducing ST in Latin America should consider these differences by age and gender and between countries. TRIAL REGISTRATION: ClinicalTrials.Gov NCT02226627. Retrospectively registered on August 27, 2014.

Nurturing Children's Healthy Eating: Position statement.

The relationship between eating a healthy diet and positive health outcomes is well known; nurturing healthy eating among children therefore has the potential to improve public health. A healthy diet occurs when one's usual eating patterns include adequate nutrient intake and sufficient, but not excessive, energy intake to meet the energy needs of the individual. However, many parents struggle to establish healthy eating patterns in their children due to the pressures of modern life. Moreover, healthcare providers often do not have the time or the guidance they need to empower parents to establish healthy eating practices in their children. Based on existing evidence from epidemiologic and intervention research, the Nurturing Children's Healthy Eating collaboration, established by Danone Institute International, has identified four key themes that encourage and support healthy eating practices among children in the modern Western world. The first - positive parental feeding - explores how parenting practices and styles, such as avoiding food restriction, allowing children to make their own food choices, and encouraging children to self-limit their portion sizes, can influence children's dietary intake. The second - eating together - highlights the link between eating socialization through regular family meals and healthful diet among children. The third - a healthy home food environment - explores the impact on eating practices of family resources, food availability/accessibility, parental modeling, and cues for eating. The fourth - the pleasure of eating - associates children's healthy eating with pleasure through repeated exposure to healthful foods, enjoyable social meals, and enhancement of the cognitive qualities (e.g. thoughts or ideas) of healthful foods. This paper reviews the evidence leading to the characterization of these nurturing themes, and ways in which recommendations might be implemented in the home.

Energy intake and food sources of eight Latin American countries: results from the Latin American Study of Nutrition and Health (ELANS).

OBJECTIVE: Few previous studies in Latin America (LA) have provided data on dietary intake composition with a standardized methodology. The present study aimed to characterize energy intake (EI) and to describe the main food sources of energy in representative samples of the urban population from eight LA countries from the Latin American Study in Nutrition and Health (ELANS). DESIGN: Cross-sectional study. Usual dietary intake was assessed with two non-consecutive 24 h dietary recalls. SETTING: Urban areas from eight countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, Venezuela), September 2014 to July 2015. SUBJECTS: Adolescents and adults aged 15-65 years. Final sample comprised 9218 individuals, of whom 6648 (72·1 %) were considered plausible reporters. RESULTS: Overall, mean EI was 8196 kJ/d (1959 kcal/d), with a balanced distribution of macronutrients (54 % carbohydrate, 30 % fat, 16 % protein). Main food sources of energy were grains, pasta and bread (28 %), followed by meat and eggs (19 %), oils and fats (10 %), non-alcoholic homemade beverages (6 %) and ready-to-drink beverages (6 %). More than 25 % of EI was provided from food sources rich in sugar and fat, like sugary drinks, pastries, chips and candies. Meanwhile, only 18 % of EI was from food sources rich in fibre and micronutrients, such as whole grains, roots, fruits, vegetables, beans, fish and nuts. No critical differences were observed by gender or age. CONCLUSIONS: Public health efforts oriented to diminish consumption of refined carbohydrates, meats, oils and sugar and to increase nutrient dense-foods are a priority in the region to drive to a healthier diet.