The relationship between social capital and inflammatory biomarkers in early adulthood: A longitudinal study.

Higher levels of social capital (SC) are associated with better health status. However, there is little evidence of the impact of SC on biological health outcomes in the early ages. To identify the association between SC in adolescence and inflammation levels in early adulthood. Prospective study using data from 2435 participants from the Epidemiological Health Investigation of Teenagers in Porto cohort. SC was assessed at age 17 through a self-administered questionnaire, and high-sensitivity C-reactive protein (hs-CRP) and leucocytes were measured in a fasting blood sample at 17 and 21 years-old. A principal components analysis was performed to identify the domains of SC. Simple linear regressions were performed to assess the association between SC components and inflammatory status at 17 and 21 years old. Pathway analysis was performed to assess the direct, indirect, and total effects of SC on hs-CRP and leucocyte levels. We did not find a significant total effect between SC at 17 years-old and hs-CRP at 21 years-old. However, the Trust/Reciprocity dimension showed a significant direct effect between SC and hs-CRP levels at 21 (ß = -0.065, 95% CI: -0.129; -0.001), as well as a significant total effect (ß = -0.075, 95% CI: -0.139; -0.011). Regarding leucocyte levels, total SC at 17 years-old was associated with leucocytes levels at 21 (ß = -0.115, 95% CI: -0.205; -0.024). Significant direct (ß = -0.104, 95% CI: -0.194; -0.014) and total effect (ß = -0.107, 95% CI: -0.199; -0.015) of Trust/Reciprocity on leucocyte levels were observed. Adolescents with higher SC have a low inflammatory level in early adulthood, especially those with greater levels of trust/reciprocity.

The emergence of socioeconomic inequalities in smoking during adolescence and early adulthood.

BACKGROUND: While it is known that educational inequalities in smoking start during early and middle adolescence, it is unknown how they further develop until adulthood. The aim of this article is to map, in the Portuguese context, how educational inequalities in smoking emerge from pre-adolescence until young adulthood. METHODS: This study used longitudinal data from the EPITeen Cohort, which recruited adolescents enrolled in schools in Porto, Portugal. We included the 1,038 participants followed at ages 13 (2003/2004), 17, 21, and 24 years. We computed the odds ratio (OR) for the prevalence of smoking states (never smoking, experimenter, less-than-daily, daily and former smoker) and the incidence of transitions between these states, as function of age and education, stratified by sex. We also added interaction terms between age and education. RESULTS: Educational inequalities in daily smoking prevalence, with higher prevalence among those with lower educational level, emerged at 17 years old and persisted until higher ages. They were formed in a cumulative way by the increased risk of experimenting between 13 and 17 years, and increased risk of becoming daily smoker between 17 and 21 years. The incidence of smoking cessation was higher among the higher educated. Inequalities were formed similarly for women and men, but with lower level and showed no significance among women. CONCLUSIONS: These results highlight that actions to prevent smoking should also take in account the potential impact in smoking inequalities, and should focus not only on middle adolescence but also on late adolescence and early adulthood.

White blood cells in a healthy adolescent population according to social and health characteristics.

BACKGROUND: The immune system constitutes a sensory system both for heritable and non-heritable factors. Among the latter, social and environmental determinants of health may influence and shape the immune system in early life. To study the relationship between leukocytes and determinants of health in adolescence, we assessed total and differential white blood cells (WBC) according to social and environmental determinants of health in a healthy adolescent population. METHODS: As part of the population-based cohort Epidemiological Health Investigation of Teenagers in Porto (EPITeen), 1213 adolescents were evaluated at the age of 13. Total and differential WBC were evaluated through a venous blood sample using an automated blood counter (Sysmex®XE-5000, Hyogo, Japan). Sociodemographic, behavioral, and clinical data were collected through self-administered questionnaires. RESULTS: Participants with better socioeconomic conditions (enrolled at private schools or higher parental education) had significantly lower total WBC levels, and the latter showed a lower percentage of neutrophils and higher percentage of lymphocytes. Those who practiced sports had significantly lower total WBC levels and neutrophil percentage, as well as a significantly higher percentage of eosinophils and lymphocytes. Adolescents with chronic disease, chronic medication, or allergic diseases had a significantly higher percentage of eosinophils and a lower percentage of monocytes. With increasing body mass index and systemic inflammation, we found a significant increase in total WBC levels. CONCLUSION: WBC linked to different immune response patterns are associated with several social and environmental determinants of health in adolescence.

A lower energy intake contributes to a better cardiometabolic profile in adolescence: Data from the EPITeen cohort.

Caloric restriction has been associated with improved cardiometabolic health. Available data in humans are commonly based on short follow-up periods, specific diets, or population groups. We hypothesized that participants of a population-based cohort (Epidemiological Health Investigation of Teenagers in Porto) with a dietary pattern characterized by a lower energy intake during adolescence have a better cardiometabolic profile in adolescence and young adulthood than other dietary patterns. At aged 13 and 21 year evaluations, diet, anthropometric, and cardiometabolic measures were assessed. Diet was assessed through a food frequency questionnaire and, at 13 years, summarized in dietary patterns identified by cluster analysis. The lower intake dietary pattern included 40% of the participants. The energy intake misreport was estimated using the Goldberg method. Analysis of variance and analysis of covariance were used to compare cardiometabolic risk factors according to dietary patterns. The mean energy intake was 2394 and 2242 Kcal/d for the total sample at aged 13 years (n = 962) and 21 years (n = 862), respectively. Those belonging to the lower intake dietary pattern showed a 25% and 5% lower energy intake, respectively. In the cross-sectional analysis at aged 13, adolescents belonging to the lower intake dietary pattern presented lower glucose, insulin, triglycerides, and blood pressure values after adjusting for body mass index and parents' education level. Among the plausible reporters, differences were only statistically significant for glucose and systolic blood pressure. Our data support that a dietary pattern characterized by a lower energy intake may contribute to a better cardiometabolic profile in adolescents. However, no significant effect was found in young adulthood.

MULT: New height references and their efficiency in multi-ethnic populations.

OBJECTIVES: To develop new height references (MULT) based on longitudinal data of multi-ethnic populations and to compare them to the height references from the Dutch Growth Study, from the Centers for Disease Control and Prevention (CDC) and from the World Health Organization (WHO). METHODS: The MUL height references were developed through the LMS method and the Generalized Additive Models for Location Scale and Shape. They were constructed based on 2611 subjects (15 292 measurements) from the advantaged quintile of the Young Lives (Younger Cohort), Millennium Cohort Study, Adolescent Nutritional Assessment Longitudinal Study, and Epidemiological Health Investigation of Teenagers in Porto studies. The M, S curves were described to compare the growth trajectory of the MULT, DUTCH, CDC and WHO height references. For the population comparative analysis, we used the total sample of the studies (91 063 observations, 17 641 subjects). The Lin's concordance correlation coefficient (CCC) and Cohen's kappa coefficient (K) were used to verify the agreement between MULT, WHO and CDC height references. RESULTS: The MULT height references showed taller boys for the periods of 61-174 months and 196-240 months and taller girls for 61-147 and 181-240 months, when compared to CDC and WHO height references. There was an almost perfect agreement between WHO and MULT height references (CCC >0.99) for the subjects aged 2 to 5 years. CONCLUSIONS: MULT height references presented a taller population and a high agreement with WHO growth charts, especially for children under 5 years, indicating that it could be useful to assess nutritional status of multi-ethnic populations.

Socioeconomic factors and intergenerational differences in height of Portuguese adults born in 1990: results from the EPITeen cohort.

Average adult height is an indicator of population health and a marker of socioeconomic inequalities. This study aimed to assess how socioeconomic differences affect intergenerational height increase between adults born in 1990 and their parents. Data from a population-based cohort of subjects born in 1990 (EPITeen) were analysed. Participants' adult height was objectively measured. Parental height, education, and occupation were reported by the parents. The height difference between daughters and their mothers (n=707), and sons and their fathers (n=647) was calculated. A generalised linear model was used to assess the association between parental education and occupation, separately, and the intergenerational height difference, adjusted for maternal age at birth, smoking during pregnancy, birthweight adjusted for gestational age, and birth order. Females were on average 1.46cm (SD=6.62) taller than their mothers, and males 3.00cm (SD=7.26) taller than their fathers. The highest height gain was shown in those with less advantaged socioeconomic background. In the adjusted model, sons whose mothers had 0-6 years of education grew 3.9cm taller (ß=3.894; 95%CI:2.345;5.443) and daughters 1.5cm taller (ß=1.529; 95%CI:0.180;2.878) (compared to >12y maternal education); for paternal education, sons and daughters grew 3.5cm (ß=3.480; 95%CI:1.913;5.047) and 1.9cm taller (ß=1.895; 95%CI:0.526;3.265), respectively. A higher height increase was found in participants with less advantaged maternal and paternal occupational level. Adults born in 1990 are taller than their parents, and height gain was higher in males than females. Adults from a lower socioeconomic status experienced the highest height gain, suggesting a reduction in height inequality.

Early life exposures are associated with appetitive traits in infancy: findings from the BiTwin cohort.

PURPOSE: To determine the stability of appetitive traits during infancy and their association with early life exposures. METHODS: Participants were from the BiTwin birth cohort (longitudinal study of Portuguese infants). Appetitive traits at 3 months were measured using the Baby Eating Behaviour Questionnaire (n = 347) and at 12 months with the Children's Eating Behaviour Questionnaire for toddlers (n = 325). Stability was assessed with multi-level models. The association of early life exposures (weight for gestational age, mode of feeding, prematurity, smoking during pregnancy, maternal pre-pregnancy BMI, gestational weight gain, and diabetes mellitus diagnosis) with infant appetitive traits was estimated by multivariable linear regression models. RESULTS: Appetite traits showed limited stability (ICCs: 0.25-0.34). Associations with early life exposures varied by age. At 3 months, infants of mothers with higher pre-pregnancy BMI and excessive gestational weight gain had low Satiety Responsiveness. In contrast, infants small for gestational age scored high in this trait (ß̂ = 0.241; 95% CI 0.056-0.425). Exclusively formula-fed infants presented weak food approach traits at this age, namely low Enjoyment of Food (ß̂ = - 0.145; 95% CI - 0.270 to - 0.019) and Food Responsiveness (ß̂ = - 0.415; 95% CI - 0.618 to - 0.212). At 12 months, infants who were small for gestational age had low Food Responsiveness (ß̂ = - 0.297; 95% CI - 0.523 to - 0.072), in contrast, infants of mothers who gained excessive gestational weight had high scores in this trait. Formula feeding was related to rapid eating (Slowness in Eating: ß̂ = - 0.252; 95% CI 0.451 to - 0.054). CONCLUSION: Early life exposures may play a role in the development of infants' appetitive traits, which then change during the first year of life. Interventions focussed on maternal and infant health may have the potential to shape appetite in infancy.

Are problematic eating behaviors from 4- to 7-year-old explained by genetic, shared factors or individual characteristics? A longitudinal twin study.

Studies based on twins are ideal to disentangle the relative contribution of different factors in the development of eating behaviors. This study aims to evaluate if changes in problematic eating behaviors from 4 to 7 years old are more influenced by the genetics, the shared environment of twins, or by individual characteristics of each twin. A total of 86 caregivers (mostly mothers) of twins from the Generation XXI birth cohort provided information on eating behaviors at 4 and 7 years of age. A score of problematic eating behaviors was developed. The Common fate model and the ACE model were used to estimate the effect of shared, individual, and genetic characteristics on changes in eating behaviors. At the dyadic level (shared), the eating behavior score at 4 years old was significantly and positively associated with the eating behavior at 7 years of age (ß = 0.402, 95% CI 0.063;0.657). At the individual level, no significant association was observed (ß = 0.020, 95% CI -0.078;0.125). The ACE model also showed the shared environment as the major responsible for the changes in eating behaviors from 4 to 7 years old. It also showed that genetic characteristics decreased their relevance overtime. This study supports that changes in eating behaviors from 4 to 7 years of age are mostly associated with the shared environment rather than individual characteristics of each twin. These results are important to improve future strategies to promote healthy environments.

The effect of non-participation on the prevalence of food insecurity in a population-based cohort in Portugal.

Non-participation can be a source of selection bias. We evaluated the effect of non-participation on food insecurity prevalence among 2942 young adults from the EPITeen cohort (Portugal), which we have followed since assembling the cohort in 2003-2004. We conducted a cross-sectional study when the cohort participants were 26 years old. To examine the effect of non-participation, we statistically imputed the missing data on food security status using multivariate imputation by chained equations based on characteristics associated with food insecurity, specifically household income perception, education and household structure from 21 or 24 years of age follow-ups. In our cohort, non-participation caused ~ 2% difference in the food insecurity prevalence: 11.0% (95% CI 9.0-13.0) for 954 participants and 12.6% (95% CI 11.1-14.1) after imputation. These estimates are close to evidence from other European countries and sustain the relevance of developing public health interventions to promote food security, especially considering the negative nutritional and health outcomes associated with food insecurity.

Influence of Social Adversity on Perceived Health Status and Depressive Symptoms among Portuguese Older People.

This study aims to investigate how exposure to poverty, food insecurity, and abuse at older ages relates to health outcomes. A questionnaire collecting data on sociodemographic and economic characteristics, health status, depressive symptoms, food insecurity, and abuse was administered to a sample of 677 older adults. Logistic regression was used to quantify the association of poverty, food insecurity, and abuse with perceived health status and depressive symptoms. If the older person only reported experiences of abuse, it was more likely to report the presence of depressive symptoms, even after adjustment for covariates. If it was only reported the experience of food insecurity, it was more likely to report a worse health status. Older people exposed to at least two factors of vulnerability were significantly more likely to report (very) poor perceived health status (OR: 7.11, 95% CI: 2.77-18.25) and the presence of relevant depressive symptoms (OR: 4.34; 95% CI: 2.04-9.22). Thus, the combined effect of vulnerabilities was significantly associated with worse health among older people. Public health policies to mitigate these adverse exposures should be developed to promote health and well-being in this population.

How the metabolic phenotype in adulthood is affected by long-lasting immunological trajectories since adolescence.

A close relationship between immune and metabolic systems has been perceived in the recent past. We aimed to assess whether the immunological trajectories of circulating white blood cells (WBC) started in adolescence, affects the metabolic phenotype in adulthood. We used data from 1183 participants of the population-based EPITeen cohort, evaluated at 13, 17, 21, 24 and 27 years of age. The Immunological trajectories from 13 to 27 years old were identified by mixed-effects models, being their association with metabolic features at 27 years old measured by logistic regression. The Higher Inflammatory Activation trajectory (HIA trajectory) had the highest percentage of individuals with metabolic syndrome, while Lowest Levels of WBC trajectory (LLWBC trajectory) showed the lowest percentage. Participants with HIA trajectory had significantly higher triglycerides, waist circumference, serum uric acid and BMI. After adjustment for sex and sports practice and hs-CRP, the odds of having one or more metabolic features in adulthood was significantly lower in LLWBC trajectory. Individuals with immunological trajectories of WBC linked with a pattern of higher immune activation showed a less favorable metabolic profile, while those with the lowest levels of WBC were less likely to have metabolic risk factors in adulthood.

Dietary exposure to artificial sweeteners and associated factors in the Portuguese population.

This study aimed to evaluate the risk of the Portuguese population's exposure to six non-nutritive intense sweeteners (NNIS) and their main associated factors. A tiered approach was used to estimate the usual exposure to the NNIS obtained from two 1-day food diaries among children and two 24-hour recalls among adults in the Portuguese national dietary survey (IAN-AF 2015-2016; age: 3-84 y; n = 5005). The tiers considered were the following: Tier 2.1 represents the most conservative tier, in which all foods reported were matched with the respective maximum permitted levels (MPLs); in Tier 2.2, the MPLs were attributed only to the foods for which the brand's label information identified the presence of an added NNIS; finally, Tier 3 was identical to Tier 2.2, but analytical NNIS occurrence data were used, instead of MPLs. The usual exposure of the Portuguese population to each NNIS was very low in all tiers across all age groups, as was the estimated prevalence of exposure above the acceptable daily intake. Soft drinks were the main source of exposure for most sweeteners, and acesulfame K and aspartame were the most consumed NNIS. The odds of exposure to at least one NNIS were higher in more highly educated adults and elderly, obese elderly, women, and people with lower healthy diet scores. The estimated risk of exceeding the safety levels of NNIS intake was very low in all evaluated population groups, even when considering the most conservative approach.

Consumption of ultra-processed foods and IL-6 in two cohorts from high- and middle-income countries.

This study evaluated the association between ultra-processed foods (UPF) on serum IL-6 and to investigate the mediation role of adiposity. Participants were 524 adults from the EPITeen Cohort (Porto, Portugal) and 2888 participants from the 1982 Pelotas Birth Cohort (Pelotas, Brazil). Dietary intake was collected using FFQ when participants were 21 years of age in the EPITeen and 23 years in the Pelotas Cohort. Serum IL-6 and body fat mass were evaluated when participants were 27 and 30 years old in the EPITeen and Pelotas, respectively. Generalised linear models were fitted to test main associations. Mediation of body fat mass was estimated using G-computation. After adjustment for socio-economic and behaviour variables, among females from the EPITeen, the concentration of IL-6 (pg/ml) increased with increasing intake of UPF from 1·31 (95 % CI 0·95, 1·82) in the first UPF quartile to 2·20 (95 % CI 1·60, 3·01) and 2·64 (95 % CI 1·89, 3·69) for the third and fourth UPF quartiles, respectively. A similar result was found among males in the Pelotas Cohort, IL-6 increased from 1·40 (95 % CI 1·32, 1·49) in the first UPF quartile to 1·50 (95 % CI 1·41, 1·59) and 1·59 (95 % CI 1·49, 1·70) in the two highest UPF quartiles. The P-value for the linear trend was < 0·01 in both findings. The indirect effect through fat mass was NS. Our findings suggest that the consumption of UPF was associated with an increase in IL-6 concentration; however, this association was not explained by adiposity.

Computerized cognitive training using virtual reality on everyday life activities for patients recovering from stroke.

PURPOSE: Recent studies argue that the use of virtual reality tasks depicting activities daily living may be effective means for cognitive rehabilitation. The aim of this study was to test an ecologically oriented approach in virtual reality resembling the demands of everyday life activities for cognitive rehabilitation following stroke. MATERIALS AND METHODS: The sample comprised 30 sub-acute stroke patients recovering from stroke in a rehabilitation hospital. They were assessed in a single-arm pre-post intervention study on global cognition, executive functions, memory and attention abilities. The intervention consisted of virtual reality in a multidomain cognitive training approach depicting everyday life tasks (preparing food, choosing clothes, shopping, etc.). RESULTS: Improvements were found in the assessed cognitive domains at 6 to 10 post-treatment sessions. In-depth analysis through reliable change scores has suggested larger treatment effects on global cognition. CONCLUSIONS: Overall results suggest that the use of virtual reality-based exercises on everyday life activities may be a useful cognitive rehabilitation approach to provide short-term gains in cognition following stroke.Implications for rehabilitationVirtual reality-based cognitive rehabilitation resembling everyday life activities may provide short-term gains in cognition of stroke patients;Consistent improvements in executive functions may require higher treatment dosage than for improvements in global cognition.

Dietary glycemic load and its association with glucose metabolism and lipid profile in young adults.

BACKGROUND AND AIM: To evaluate the association of Glycemic Load (GL) with glucose metabolism and blood lipids among young adults. METHODS AND RESULTS: This study included 1538 participants (51% females), evaluated at 21 years of age as part of the EPITeen cohort. The GL of each individual was obtained from the assessment of their dietary intake by using a 86-item semi-quantitative food frequency questionnaire. The evaluation included anthropometric measurements and a fasting blood sample was used to measure glucose, insulin, triglycerides, total cholesterol, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Insulin resistance was calculated based on the homeostasis model method (HOMA-IR). The association between the GL and the biochemical parameters was evaluated by linear regression models using ß and 95% confidence intervals (95% CI), stratified by sex and adjusted for body mass index (BMI), energy and fiber intake, and self-perceived social class. No association was found between GL and the glucose metabolism parameters after adjustment. Regarding blood lipids, a positive association was found with LDL-C (ß = 1.507, 95% CI 0.454; 2.561 for females; ß = 0.216, 95% CI -0.587; 1.020 for males) and a negative association with HDL-C (ß = -0.647, 95% CI -1.112; -0.181 for females; ß = -0.131, 95% CI -0.422; 0.160 for males). CONCLUSIONS: Our results suggest that, in healthy young subjects, a high GL diet may have a negative impact on lipid profile.

Urban green spaces in the proximity of residences can reduce the effect of socioeconomic inequalities in sports practice among teenage girls.

Background: We studied if proximity of urban green spaces to residences reduces the socioeconomic inequalities in sports practice, evaluating 17-year-old girls (n = 722) from EPITeen cohort, Porto, Portugal. Methods: The shortest routes from residences to urban green spaces were calculated using the street network from Geographic Information System. Distances were classified as: ≤400, >400 to ≤800, and >800 m. Parental education was used as a proxy of socioeconomic status (SES). We used chi-square test to compare proportions of teenagers practicing sports per SES, stratified by classes of distances to urban green spaces and logistic regression to estimate the association between sports practice and SES through odds ratio (OR) and 95% confidence intervals. Results: Strong inequalities were found. Girls from low SES have ≥75% less odds of sports practice (reference: high SES), regardless of the distance to urban green spaces. As distances are lowering the socioeconomic inequalities in the sports practice between girls from high and medium SES diminishes, being the OR 0.42 (0.22-0.80) at ≥800 m, 0.51 (0.24-1.09) at ≥400 to ≤800 m, and 0.63 (0.29-1.37) at ≤400 m. Conclusion: At closer distances inequalities in the proportion of sports practice between high and medium SES vanishes, but remain to low SES.

Immunological Trajectories of White Blood Cells from Adolescence to Adulthood: Description and Determinants.

BACKGROUND: The immune system gradually matures early in life in the face of internal and external stimuli. Whether the immune responses are lasting and stable during the course of life is still unclear. METHODS: As part of the EPITeen cohort, 1183 adolescents were prospectively evaluated at the ages of 13, 17, 21, 24 and 27. Sociodemographic, behavioral and clinical data were collected by self- and face-to-face-administered questionnaires, along with a physical examination comprising anthropometric measurements and blood sample collections. Mixed-effects models were used to identify individual trajectories of white blood cells (WBC) and finite Gaussian mixture models were used to identify the clusters of individual trajectories. RESULTS: Participants were allocated into six clusters based on the individual trajectories of WBC distribution. Higher Inflammatory Activation Cluster (11.4%) had the highest total WBC count and neutrophils percentage, as well as the lowest percentage of lymphocytes. These participants had significantly higher odds of being overweight [OR = 2.44, 95%CI:1.51-3.92]. Lowest Levels of WBC Cluster (24.1%) had the lowest total WBC count, being characterized by a higher participation on sports [OR = 1.54, 95%CI:1.12-2.13]. Highest Proportion of Eosinophils Cluster (20.1%) had the highest eosinophils percentage and the highest likelihood of having been diagnosed with a chronic disease [OR = 2.11, 95%CI:1.43-3.13], namely "asthma or allergies" [OR = 14.0 (1.73, 112.2]. Lowest Proportion of Eosinophils Cluster (29.1%) had the lowest percentage of eosinophils and basophils, as well as the highest lymphocyte proportion. Participants in the Undefined Cluster (13.8%) showed the highest percentage of monocytes and basophils and were also characterized by significant lower odds of having parents with 7-9 years of schooling [OR = 0.56, (0.32, 0.99]. CONCLUSIONS: In this study we identified distinct immunological trajectories of WBC from adolescence to adulthood that were associated with social, clinical and behavioral determinants. These results suggest that these immunological trajectories are defined early in life, being dependent on the exposures.

Energy intake misreport: how different methods affect its prevalence and nutrient intake estimates.

BACKGROUND: Although different methods for the evaluation of energy intake (EI) misreport have been described, it is unclear which one is the most appropriate. AIM: To assess the performance of these methods in the prevalence of EI misreports and accuracy of nutrient intake estimates. METHODS: Reports of 3,639 adults from the Portuguese National Food, Nutrition and Physical Activity Survey 2015-2016 were classified using univariate (Willett; interquartile range) and multivariate (Goldberg; predicted total energy expenditure [pTEE], testing different standard deviations [SD]) methods. Self-reported intakes were compared to their respective estimates by urinary excretion in a sub-sample of 80. The effect of the exclusion of misreporters on nutrient estimates was assessed by the differences in linear regression coefficients between plausible and total sample. RESULTS: The highest prevalence of EI misreport was observed using pTEE 1SD (63.9%). Differences in the associations between nutrient self-reported intake and estimated intake using urinary biomarkers were verified with misreporters' exclusion by pTEE 1SD method (ß-protein = 0.209; 95% CI = 0.074-0.529; ß-potassium = 0.276; 95% CI = 0.060-0.560) and Goldberg 2SD (ß-protein = 0.080; 95% CI = 0.025-0.235; ß-potassium = 0.106; 95% CI = -0.048-0.246). CONCLUSIONS: Multivariate methods lead to a higher prevalence of misreports and larger differences in nutrient estimates. The application of the pTEE 1SD and Goldberg 2SD methods resulted in more accurate nutrient estimates.

Benefits of adding food education sessions to an exercise programme on cardiovascular risk factors in patients with type 2 diabetes.

To evaluate the impact of adding food education sessions to an exercise programme on cardiovascular risk factors in middle-aged and older patients with type 2 diabetes (T2D), a randomised parallel-group study was performed. Glycated haemoglobin, body mass index (BMI), waist circumference, fat mass (FM) and blood pressure were assessed at baseline and after 9 months. The recruitment was made in three primary healthcare centres from Vila Real, Portugal. Thirty-three patients (65⋅4 ± 5⋅9 years old) were engaged in a 9-month community-based lifestyle intervention programme: a supervised exercise programme (EX; n = 15; combined aerobic, resistance, agility/balance and flexibility exercise; three sessions per week; 75 min per session); or the same exercise programme plus concomitant food education sessions (EXFE; n = 18; 15-min lectures and dual-task strategies during exercise (answer nutrition questions while walking); 16 weeks). Significant differences between groups were identified in the evolution of BMI (P < 0.001, ) and FM (P < 0.001, ), with best improvements observed in the EXFE group. The addition of a simple food education dietary intervention to an exercise programme improved body weight and composition, but not glycaemic control and blood pressure in middle-aged and older patients with T2D.

The effect of impact exercise on bone mineral density: A longitudinal study on non-athlete adolescents.

PURPOSE: High impact exercise is known to induce osteogenic effects in the skeleton. However, less is known about the systemic effect of exercise practice in a potential adaptive mechanism of the skeletal accrual. This research aimed to assess the effect of impact exercise on bone mineral density (BMD) in the radius throughout adolescence. METHODS: This study evaluated 1137 adolescents, at 13 and 17 years old, as part of the population-based cohort EPITeen. BMD (g/cm2) was measured at the ultradistal and proximal radius of the non-dominant forearm by dual-energy X-ray absorptiometry (DXA) using a Lunar® Peripheral Instantaneous X-ray Image device. The practice of (extra-curricular) exercise was categorized as: no exercise, exercise with high impact and exercise with low impact. Regression coefficients (ß) and respective 95% confidence intervals (CI95%) were used to estimate the association between exercise practice categories at 13 years old and BMD at 13 and 17 years old and BMD gain between evaluations. RESULTS: In boys, at 13 years, BMD was similar between the ones not practicing exercise and those practicing exercise with low impact, and the gain of BMD was also similar in both groups. Still in boys, at 13 years, those who practiced exercise with high impact presented higher mean (standard-deviation) of BMD, comparing to the other two groups (no exercise and low impact exercise), and also significantly increased the BMD gain between 13 and 17 years (ß = 0.013; CI95%0.003;0.023). In girls, no statistically significant differences on BMD were found between the categories of exercise at 13 years and BMD at 17 years of age. CONCLUSION: This research shows that the practice of high impact exercise could help to increase BMD more than low impact exercise even in a nonweight-bearing bone during adolescence.