Evaluation of the Validity of a Food Frequency Questionnaire and 24-Hour Dietary Recall to Assess Dietary Iron Intake in Children and Adolescents from the South American Youth/Child Cardiovascular and Environmental Study.

BACKGROUND: A food frequency questionnaire (FFQ) for South American children and adolescents was developed, but its validity for assessing dietary iron intake has not been evaluated. OBJECTIVE: To evaluate the validity of the FFQ and 24-hour dietary recalls (24h-DR) for assessing dietary iron intake in children and adolescents. DESIGN: The South American Youth/Child Cardiovascular and Environmental study is a multicenter observational study, conducted in five South American cities: Buenos Aires (Argentina), Lima (Peru), Medellin (Colombia), Sao Paulo, and Teresina (Brazil). The FFQ assessed dietary intake over the previous 3 months, and the 24h-DR was completed three times (2 weekdays and 1 weekend day) with a minimum 5-day interval between recalls. Blood samples were collected to assess serum iron, ferritin, and hemoglobin levels. PARTICIPANTS AND SETTING: Data of 99 children (aged 3 to 10 years) and 50 adolescents (aged 11 to 17 years) from public and private schools were collected during 2015 to 2017. MAIN OUTCOME MEASURES: Dietary iron intake calculated from the FFQ (using the sum of daily iron intake in all food/food groups) and 24h-DR (mean of 3 days using the multiple source method). STATISTICAL ANALYSES PERFORMED: Dietary iron intake in relation to blood biomarkers were assessed using Spearman rank correlations adjusted for sex, age, and total energy intake, and the quadratic weighted κ coefficients for agreement. RESULTS: Spearman correlations showed very good coefficients (range = 0.78 to 0.85) for the FFQ in both age groups; for the 24h-DR, the coefficients were weak in children and adolescents (range = 0.23 to 0.28). The agreement ranged from 59.9% to 72.9% for the FFQ and from 63.9% to 81.9% for the 24h-DR. CONCLUSION: The South American Youth/Child Cardiovascular and Environmental study FFQ exhibited good validity to rank total dietary iron intake in children and adolescents, and as well as the 24h-DR, presented good strength of agreements when compared with serum iron and ferritin levels.

Prácticas y creencias habituales en la preparación de la alimentación complementaria infantil en una muestra española: estudio transversal / Common practices and beliefs in the preparation of complementary infant feeding in a Spanish sample: a cross-sectional study

Introducción: la alimentación complementaria junto con la leche materna debe permitir cubrir las necesidades nutricionales de los niños a partir de los 6 meses de edad. Las prácticas alimentarias inadecuadas determinan una ingesta nutricional deficiente. El objetivo de este estudio fue conocer las prácticas alimentarias en los hogares españoles en relación con la preparación y elaboración de la alimentación infantil. Metodología: se realizó un estudio transversal mediante una encuesta online en adultos residentes en España y no institucionalizados, encargados de la preparación de la alimentación infantil de menores de 2 años. Resultados: la encuesta fue respondida por 1944 personas (37,4 ± 6 años; 65,5 % mujeres). El 72 % de los encuestados prepara principalmente triturados y el 21 % utiliza papillas comerciales frecuentemente. El calabacín (39 %), el pollo (62 %), la merluza (64 %) y el plátano (44 %) son los alimentos más utilizados. El hervido (63 %) y la congelación (59 %) son las técnicas culinarias y de conservación más practicadas. Se identificó el uso inadecuado de la sal y algunos alimentos no seguros (pescados de gran tamaño y acelgas), así como un uso por debajo de las recomendaciones para el aceite de oliva y el huevo. Conclusión: los españoles encargados de la alimentación de los niños menores de 2 años prefieren los alimentos triturados. Aunque son conscientes de que la alimentación preparada en casa es nutricionalmente mejor, en ciertas ocasiones ofrecen papillas comerciales. Además, se han detectado algunas prácticas inadecuadas, por lo que parecen necesarias políticas de educación nutricional destinadas a los responsables de la elaboración de la alimentación infantil. (AU)

Introduction: complementary feeding together with breast milk should cover the nutritional needs of children from 6 months onwards. Thus, inadequate dietary practices can lead to poor nutritional intake. The objective of this study was to examine infant food handling and cooking in Spanish households. Methodology: a cross-sectional study was carried out using an online survey in non-institutionalized adults living in Spain who usually prepare infant food for children under 2 years of age. Results: a total of 1,944 people (37.4 ± 6 years; 65.5 % women) answered the survey. Of these, 72 % prepared mainly mashed foods and 21 % used store-bought baby cereals frequently. Zucchini (39 %), chicken (62 %), hake (64 %) and banana (44 %) were the most commonly used foods. Boiling (63 %) and freezing (59 %) were the most widely used culinary and preservation practices. An inappropriate use of salt and some unsafe foods (large fish and chard) was identified, whereas olive oil and eggs were offered below the current nutritional recommendations. Conclusion: the population surveyed preferred to use mashed foods to feed children under 2 years of age. Even though they were aware that homemade food is nutritionally better, on certain occasions they offer store-bought baby cereal. Furthermore, some inappropriate feeding practices were detected, highlighting the need to implement nutritional education policies regarding infant food preparation. (AU)

[Common practices and beliefs in the preparation of complementary infant feeding in a Spanish sample: a cross-sectional study]. / Prácticas y creencias habituales en la preparación de la alimentación complementaria infantil en una muestra española: estudio transversal.

INTRODUCTION: Introduction: complementary feeding together with breast milk should cover the nutritional needs of children from 6 months onwards. Thus, inadequate dietary practices can lead to poor nutritional intake. The objective of this study was to examine infant food handling and cooking in Spanish households. Methodology: a cross-sectional study was carried out using an online survey in non-institutionalized adults living in Spain who usually prepare infant food for children under 2 years of age. Results: a total of 1,944 people (37.4 ± 6 years; 65.5 % women) answered the survey. Of these, 72 % prepared mainly mashed foods and 21 % used store-bought baby cereals frequently. Zucchini (39 %), chicken (62 %), hake (64 %) and banana (44 %) were the most commonly used foods. Boiling (63 %) and freezing (59 %) were the most widely used culinary and preservation practices. An inappropriate use of salt and some unsafe foods (large fish and chard) was identified, whereas olive oil and eggs were offered below the current nutritional recommendations. Conclusion: the population surveyed preferred to use mashed foods to feed children under 2 years of age. Even though they were aware that homemade food is nutritionally better, on certain occasions they offer store-bought baby cereal. Furthermore, some inappropriate feeding practices were detected, highlighting the need to implement nutritional education policies regarding infant food preparation.

INTRODUCCIÓN: Introducción: la alimentación complementaria junto con la leche materna debe permitir cubrir las necesidades nutricionales de los niños a partir de los 6 meses de edad. Las prácticas alimentarias inadecuadas determinan una ingesta nutricional deficiente. El objetivo de este estudio fue conocer las prácticas alimentarias en los hogares españoles en relación con la preparación y elaboración de la alimentación infantil. Metodología: se realizó un estudio transversal mediante una encuesta online en adultos residentes en España y no institucionalizados, encargados de la preparación de la alimentación infantil de menores de 2 años. Resultados: la encuesta fue respondida por 1944 personas (37,4 ± 6 años; 65,5 % mujeres). El 72 % de los encuestados prepara principalmente triturados y el 21 % utiliza papillas comerciales frecuentemente. El calabacín (39 %), el pollo (62 %), la merluza (64 %) y el plátano (44 %) son los alimentos más utilizados. El hervido (63 %) y la congelación (59 %) son las técnicas culinarias y de conservación más practicadas. Se identificó el uso inadecuado de la sal y algunos alimentos no seguros (pescados de gran tamaño y acelgas), así como un uso por debajo de las recomendaciones para el aceite de oliva y el huevo. Conclusión: los españoles encargados de la alimentación de los niños menores de 2 años prefieren los alimentos triturados. Aunque son conscientes de que la alimentación preparada en casa es nutricionalmente mejor, en ciertas ocasiones ofrecen papillas comerciales. Además, se han detectado algunas prácticas inadecuadas, por lo que parecen necesarias políticas de educación nutricional destinadas a los responsables de la elaboración de la alimentación infantil.

Comparison of multidirectional jump performance and lower limb passive range of motion profile between soccer and basketball young players.

This study was performed aimed at comparing multidirectional bilateral and unilateral jump performance and passive range of motion (ROM) of lower limbs between soccer and basketball young players and evaluating associations between inter-limb ROM asymmetry and bilateral jump performance. A total of 67 young male athletes participated in this study, who were classified as soccer (n = 40; 15.55 ± 1.5 y; 1.76 ± 0.12 m; 58.15 ± 10.82 kg; 19.84 ± 2.98 kg·m2) and basketball (n = 27; 15.7 ± 1.66 y; 1.76 ± 0.12 m; 62.33 ± 16.57 kg; 19.84 ± 2.98 kg·m2) players. Participants were asked to perform bilateral and unilateral multidirectional jumps, and passive ROM of hip (flexion, extension and abduction), knee (flexion) and ankle (dorsiflexion) joints was also assessed. Significant between-group differences were observed for hip extension with flexed knee ROM in dominant (soccer: 142.43 ± 7.74°; basketball: 148.63 ± 8.10°) and non-dominant (soccer: 144.38 ± 8.36°; basketball: 148.63 ± 6.45°) legs; hip flexion with flexed knee ROM in dominant (soccer: 13.26 ± 4.71°; basketball: 9.96 ± 3.42°) and non-dominant (soccer: 12.86 ± 4.55°; basketball: 9.70 ± 3.62°) legs; and for the ratio of hip abduction (soccer: 1.02 ± 0.08; basketball: 0.97 ± 0.11). However, no significant between-group differences were observed for bilateral and unilateral jump capacity, or for inter-limb asymmetries (dominant vs. non-dominant leg). Finally, no associations were observed between ROM ratio (dominant vs. non-dominant leg) and bilateral jump performance. These findings lead to the suggestion that differences on passive ROM values in young male athletes may be sport-specific. Additionally, there seems to be need for the implementation of training strategies specifically aimed at improving bilateral or unilateral jump ability, or at diminishing inter limb passive ROM differences in order to improve multidirectional jump performance for neither soccer nor basketball youth male players.

Reliability and validity of an FFQ for South American children and adolescents from the SAYCARE study.

OBJECTIVE: The purpose of this study was to analyse the reliability and validity of a semi-quantitative FFQ to assess food group consumption in South American children and adolescents. DESIGN: The SAYCARE (South American Youth/Child cARdiovascular and Environmental) study is an observational, multicentre, feasibility study performed in a sample of 3- to 18-year-old children and adolescents attending private and public schools from six South American countries. Participants answered the FFQ twice with a two-week interval and three 24-h dietary recalls. Intraclass and Spearman's correlations, weighted Cohen's kappa (κw), percentage of agreement and energy-adjusted Pearson's correlation coefficients were calculated. SETTING: Seven cities in South America (Buenos Aires, Lima, Medelin, Montevideo, Santiago, Sao Paulo and Teresina). SUBJECTS: A sample of 200 children and 244 adolescents for reliability analyses and 252 children and 244 adolescents for validity analyses were included. RESULTS: Depending on the food group, for children and adolescents, reliability analyses resulted in Spearman's coefficients from 0·47 to 0·73, intraclass correlation coefficients from 0·66 to 0·99, κw coefficients from 0·35 to 0·63, and percentage of agreement between 72·75 and 83·52 %. In the same way, validity analyses resulted in Spearman's coefficients from 0·17 to 0·37, energy-adjusted Pearson's coefficients from 0·17 to 0·61, κw coefficients from 0·09 to 0·24, and percentages of agreement between 45·79 and 67·06 %. CONCLUSION: The SAYCARE FFQ achieved reasonable reliability and slight-moderate validity for almost all food groups intakes. Accordingly, it can be used for the purpose of ranking the intake of individuals within a population.

Acute Effects of Caffeine Supplementation on Movement Velocity in Resistance Exercise: A Systematic Review and Meta-analysis.

BACKGROUND: Several studies investigated the effects of caffeine supplementation on movement velocity in resistance exercise. However, these studies presented inconsistent findings. OBJECTIVE: This paper aimed to: (a) review the studies that explored the effects of caffeine supplementation on movement velocity in resistance exercise; and (b) pool their results using a meta-analysis. METHODS: A search for studies was performed through seven databases. Random-effects meta-analyses of standardized mean differences (SMD) were performed to analyze the data. Sub-group meta-analyses explored the effects of caffeine on different velocity variables (i.e., mean and peak velocity), different loads (i.e., low, moderate, and high loads), and upper- and lower-body exercises. RESULTS: Twelve studies met the inclusion criteria. In the main meta-analysis, in which we pooled all available studies, the SMD favored the caffeine condition (SMD = 0.62; 95% confidence interval [CI]: 0.39-0.84; p < 0.001). Sub-group analyses indicated that caffeine significantly enhances mean (SMD = 0.80; 95% CI: 0.48-1.12; p < 0.001) and peak velocity (SMD = 0.41; 95% CI: 0.08-0.75; p = 0.014), movement velocity with low loads (SMD = 0.78; 95% CI: 0.41-1.14; p < 0.001), moderate loads (SMD = 0.58; 95% CI: 0.25-0.91; p = 0.001), and high loads (SMD = 0.70; 95% CI: 0.33-1.07; p < 0.001), as well as in lower-body (SMD = 0.82; 95% CI: 0.42-1.23; p < 0.001) and upper-body exercises (SMD = 0.59; 95% CI: 0.37-0.82; p < 0.001). CONCLUSION: Acute caffeine supplementation is highly ergogenic for movement velocity in resistance exercise. Sub-group analyses indicated that caffeine ingestion is ergogenic: (a) for both mean and peak velocity; (b) for movement velocity when exercising with low, moderate and high loads, and (c) for movement velocity in both lower- and upper-body exercises. Previous meta-analyses that explored the effects of caffeine on various aspects of resistance exercise performance (i.e., muscular strength and endurance) reported trivial to moderate ergogenic effects (effect size range: 0.16-0.38). In the present meta-analysis, the pooled effect size ranged from 0.41 to 0.82. From a resistance exercise performance standpoint, this suggests that caffeine has the most pronounced performance-enhancing effects on movement velocity.

Intra-observer reliability of the anthropometric measurements in South American children and adolescents: the SAYCARE Study / Confiabilidad intraobservador de mediciones antropométricas en niños y adolescentes sudamericanos: Estudio SAYCARE

Introduction: the South American Youth/Child Cardiovascular and Environmental (SAYCARE) feasibility study aims to develop valid and reliable indicators to investigate health-related behavior and nutritional status in children and adolescents. Anthropometric measurements are one of the evaluated indicators in the study. The accuracy of the anthropometric data is very important and relies in the quality of the measurements. Objective: to describe the intra-observer reliability of ten anthropometric measurements: weight, height, circumferences (neck, arm, waist, hip) and skinfolds (triceps, subscapular, biceps and suprailiac) of children and adolescents from six South American cities: Lima, Medellin, Montevideo, Santiago, San Pablo and Teresina. Methods: prior to the study, fieldworkers from the seven centers participated in central training to ensure the application of standardized procedures in the anthropometric measurements. Intra-observer precision, technical error of measurement (TEM) and coefficient of reliability (R) were estimated for each measurement. Results: reliability of weight and height was above 99% in almost all cities. TEM for skinfold thickness was below 1.4 mm in children and 2.13 mm in adolescents, while reliability was above 95% in most of the skinfold measurements. TEM for circumferences was below 1.8 cm in children and 0.64 cm in adolescents, while reliability was above 99% in almost all circumferences. Conclusions: reliability of the anthropometric measurements in this study was high. In comparison with similar European or American studies, the reliability of the measurements taken in our study was, in most cases, similar or even higher

Introducción: el estudio piloto South American Youth/Child cARdiovascular and Environmental (SAYCARE) tiene como objetivo desarrollar indicadores válidos y confiables para investigar el estado nutricional y las conductas vinculadas a la salud en niños y adolescentes. Uno de estos indicadores son las mediciones antropométricas. La precisión de los datos antropométricos es muy importante y se basa en la calidad con que se toman las mediciones. Objetivos: describir la confiabilidad intraobservador de diez mediciones antropométricas: peso, talla, circunferencias (cuello, brazo, cintura, cadera) y pliegues (trÍceps, subscapular, bÍceps y suprailIaco) de niños y adolescentes de seis ciudades de Sudamérica: Lima, Medellín, Montevideo, Santiago, San Pablo and Teresina. Métodos: previo al estudio, los trabajadores de campo de los seis centros participaron de un entrenamiento centralizado, para asegurar la aplicación de procedimientos estandarizados en la toma de las mediciones antropométricas. Para determinar la precisión intraobservador, se estimó el error técnico de medición (TEM) y el coeficiente de confiabilidad (R) para cada medición. Resultados: la confiabilidad de las medidas de peso y la talla estuvo por encima del 99% en casi todas las ciudades. El TEM para el grosor de los pliegues estuvo debajo de 1,4 mm en los niños y de 2,13 mm en los adolescentes, mientras que la confiabilidad fue superior al 95% en la mayoría de las mediciones de los pliegues. El TEM para las circunferencias estuvo por debajo de 1,8 cm en los niños y de 0,64 cm en los adolescentes, mientras que la confiabilidad fue superior al 99% en casi todas las circunferencias. Conclusiones: la confiabilidad de las mediciones antropométricas en este estudio fue alta. Comparada con estudios similares realizados en Europa y Estados Unidos, la confiabilidad de las medidas tomadas en nuestro estudio es, en la mayoría de los casos, similar o aún más elevada

Intra-observer reliability of the anthropometric measurements in South American children and adolescents: the SAYCARE Study.

INTRODUCTION: Introduction: the South American Youth/Child Cardiovascular and Environmental (SAYCARE) feasibility study aims to develop valid and reliable indicators to investigate health-related behavior and nutritional status in children and adolescents. Anthropometric measurements are one of the evaluated indicators in the study. The accuracy of the anthropometric data is very important and relies in the quality of the measurements. Objective: to describe the intra-observer reliability of ten anthropometric measurements: weight, height, circumferences (neck, arm, waist, hip) and skinfolds (triceps, subscapular, biceps and suprailiac) of children and adolescents from six South American cities: Lima, Medellin, Montevideo, Santiago, San Pablo and Teresina. Methods: prior to the study, fieldworkers from the seven centers participated in central training to ensure the application of standardized procedures in the anthropometric measurements. Intra-observer precision, technical error of measurement (TEM) and coefficient of reliability (R) were estimated for each measurement. Results: reliability of weight and height was above 99% in almost all cities. TEM for skinfold thickness was below 1.4 mm in children and 2.13 mm in adolescents, while reliability was above 95% in most of the skinfold measurements. TEM for circumferences was below 1.8 cm in children and 0.64 cm in adolescents, while reliability was above 99% in almost all circumferences. Conclusions: reliability of the anthropometric measurements in this study was high. In comparison with similar European or American studies, the reliability of the measurements taken in our study was, in most cases, similar or even higher.

INTRODUCCIÓN: Introducción: el estudio piloto South American Youth/Child cARdiovascular and Environmental (SAYCARE) tiene como objetivo desarrollar indicadores válidos y confiables para investigar el estado nutricional y las conductas vinculadas a la salud en niños y adolescentes. Uno de estos indicadores son las mediciones antropométricas. La precisión de los datos antropométricos es muy importante y se basa en la calidad con que se toman las mediciones. Objetivos: describir la confiabilidad intraobservador de diez mediciones antropométricas: peso, talla, circunferencias (cuello, brazo, cintura, cadera) y pliegues (trÍceps, subscapular, bÍceps y suprailIaco) de niños y adolescentes de seis ciudades de Sudamérica: Lima, Medellín, Montevideo, Santiago, San Pablo and Teresina. Métodos: previo al estudio, los trabajadores de campo de los seis centros participaron de un entrenamiento centralizado, para asegurar la aplicación de procedimientos estandarizados en la toma de las mediciones antropométricas. Para determinar la precisión intraobservador, se estimó el error técnico de medición (TEM) y el coeficiente de confiabilidad (R) para cada medición. Resultados: la confiabilidad de las medidas de peso y la talla estuvo por encima del 99% en casi todas las ciudades. El TEM para el grosor de los pliegues estuvo debajo de 1,4 mm en los niños y de 2,13 mm en los adolescentes, mientras que la confiabilidad fue superior al 95% en la mayoría de las mediciones de los pliegues. El TEM para las circunferencias estuvo por debajo de 1,8 cm en los niños y de 0,64 cm en los adolescentes, mientras que la confiabilidad fue superior al 99% en casi todas las circunferencias. Conclusiones: la confiabilidad de las mediciones antropométricas en este estudio fue alta. Comparada con estudios similares realizados en Europa y Estados Unidos, la confiabilidad de las medidas tomadas en nuestro estudio es, en la mayoría de los casos, similar o aún más elevada.

The Validity of Children's Fruit and Vegetable Intake Using Plasma Vitamins A, C, and E: The SAYCARE Study.

Despite that fruits and vegetables are key elements for health promotion, there are limited studies validating their intake in children. We aimed to validate the SAYCARE (South American Youth/Child Cardiovascular and Environmental) Study Food Frequency Questionnaire (FFQ) and the combination of the FFQ frequency of intake with the 24 h-dietary-recall (24 h-DR) (mean of 3 days), for children's fruit and vegetable intake. The reference methods were plasma dosages of ß-carotene, retinol, ascorbic acid, and α-tocopherol, which were collected in the school environment. It is a validity study in a subsample of 45 children aged 6-10 years participating in the SAYCARE Study, from São Paulo (Brazil). The FFQ was answered by the parents/guardians over the previous 3 months; the 24 h-DR was answered three times (two weekdays by nutritionists, one weekend day by parents/guardians). The mean fruit and vegetable intake (combined with frequency of intake) was calculated using the multiple source method (MSM). Multiple linear regression showed pooled correlation coefficients of 0.29 to 0.35 for the reported fruit and vegetable intake estimated by the FFQ and the MSM, respectively. The SAYCARE FFQ is an accurate and useful tool for ranking fruit and vegetable intake in children between 6-10 years from the SAYCARE Study.

Impact of methodological approaches in the agreement between subjective and objective methods for assessing screen time and sedentary behavior in pediatric population: a systematic review / Impacto de las decisiones metodológicas en la concordancia entre métodos subjetivos y objetivos para valorar el tiempo de comportamiento sedentario en la población pediátrica: una revisión sistemática

Introduction: sedentary behavior is an important target for health promotion. In this systematic review, we aimed to provide evidence to support decisions about measurement approach choices for subjectively assessing sedentary behavior in pediatric population, adopting objective methods as the reference. Methods: in this systematic review with meta-analysis, published studies were retrieved from electronic databases: Medline (PubMed), Web of Science, Embase, SPORTDiscus, BioMed Central and SCOPUS. We considered studies evaluating sedentary behavior agreement through questionnaire and/or diary in comparison with an objective measure. A total of six inclusion criteria were used. We synthesized the data using correlation coefficients (r) as an indicator of agreement estimates. The review protocol is registered in the PROSPERO database (CRD42014015138). Results: a total of 14 studies met the inclusion criteria with ages ranging from 3 to 17.5 years and provided 17 agreement analyses. Thirteen of these agreement analyses (76.5%) reported correlation coefficients. We found two major groups of sedentary activities: screen time (47.1%) and sedentary behaviors (52.9%). The pooled agreement between questionnaires and accelerometers for assessing self-reported screen time was negative (r = -0.15; CI 95%: -0.17 to -0.13). Conversely, when the sedentary behavior was assessed by questionnaires and accelerometers, the pooled agreement was positive for parent-reporting (r = 0.09; CI 95%: 0.04 to 0.13) and self-reporting (r = 0.43; CI 95%: 0.40 to 0.47) in children and adolescents, respectively. Conclusion: questionnaires have positive agreement with accelerometers for assessing sedentary behavior, whereas the agreement is negative for assessing screen time. Self-reported questionnaires are recommended methods to measure sedentary behavior in adolescents

Introducción: el comportamiento sedentario es un objetivo importante para la promoción de la salud. En esta revisión sistemática, nuestro objetivo fue proporcionar evidencia para apoyar las decisiones sobre las opciones metodológicas acerca de los instrumentos para medición subjetiva del comportamiento sedentario en la población pediátrica, adoptando métodos objetivos como referencia. Métodos: en esta revisión sistemática con metaanálisis, fueron recuperados estudios publicados en las bases de datos electrónicas Medline (PubMed), Web of Science, Embase, SPORTDiscus, BioMed Central y SCOPUS. Consideramos estudios que evalúan el acuerdo de comportamiento sedentario a través del cuestionario y/o diario en comparación con una medida objetiva. Se utilizaron un total de seis criterios de inclusión. Sintetizamos los datos utilizando coeficientes de correlación (r) como un indicador de las estimaciones de la concordancia. El protocolo de revisión está registrado en la base de datos PROSPERO (CRD42014015138). Resultados: un total de 14 estudios cumplieron los criterios de inclusión con edades comprendidas entre 3 y 17,5 años y proporcionaron 17 análisis de concordancia. Trece de estos análisis de concordancia (76,5%) informaron coeficientes de correlación. Encontramos dos grupos principales de actividades sedentarias: tiempo de pantalla (47,1%) y comportamiento sedentario (52,9%). La concordancia entre cuestionarios y acelerómetros para evaluar el tiempo de pantalla autorreportado fue negativa (r = -0,15; IC 95%: -0,17 a -0,13). Sin embargo, cuando se evaluó el comportamiento sedentario mediante cuestionarios y acelerómetros, el acuerdo fue positivo para el reporte de los padres (r = 0,09; IC 95%: 0,04 a 0,13) y el reporte (r = 0,43; IC 95%: 0,40 a 0.47) de niños y adolescentes, respectivamente. Conclusión: los cuestionarios tienen un acuerdo positivo con los acelerómetros para evaluar el comportamiento sedentario, mientras que el acuerdo es negativo para evaluar el tiempo de pantalla. Los cuestionarios autorreportados son métodos recomendados para medir el comportamiento sedentario en adolescentes

Impact of methodological approaches in the agreement between subjective and objective methods for assessing screen time and sedentary behavior in pediatric population: a systematic review.

INTRODUCTION: Introduction: sedentary behavior is an important target for health promotion. In this systematic review, we aimed to provide evidence to support decisions about measurement approach choices for subjectively assessing sedentary behavior in pediatric population, adopting objective methods as the reference. Methods: in this systematic review with meta-analysis, published studies were retrieved from electronic databases: Medline (PubMed), Web of Science, Embase, SPORTDiscus, BioMed Central and SCOPUS. We considered studies evaluating sedentary behavior agreement through questionnaire and/or diary in comparison with an objective measure. A total of six inclusion criteria were used. We synthesized the data using correlation coefficients (r) as an indicator of agreement estimates. The review protocol is registered in the PROSPERO database (CRD42014015138). Results: a total of 14 studies met the inclusion criteria with ages ranging from 3 to 17.5 years and provided 17 agreement analyses. Thirteen of these agreement analyses (76.5%) reported correlation coefficients. We found two major groups of sedentary activities: screen time (47.1%) and sedentary behaviors (52.9%). The pooled agreement between questionnaires and accelerometers for assessing self-reported screen time was negative (r = -0.15; CI 95%: -0.17 to -0.13). Conversely, when the sedentary behavior was assessed by questionnaires and accelerometers, the pooled agreement was positive for parent-reporting (r = 0.09; CI 95%: 0.04 to 0.13) and self-reporting (r = 0.43; CI 95%: 0.40 to 0.47) in children and adolescents, respectively. Conclusion: questionnaires have positive agreement with accelerometers for assessing sedentary behavior, whereas the agreement is negative for assessing screen time. Self-reported questionnaires are recommended methods to measure sedentary behavior in adolescents.

INTRODUCCIÓN: Introducción: el comportamiento sedentario es un objetivo importante para la promoción de la salud. En esta revisión sistemática, nuestro objetivo fue proporcionar evidencia para apoyar las decisiones sobre las opciones metodológicas acerca de los instrumentos para medición subjetiva del comportamiento sedentario en la población pediátrica, adoptando métodos objetivos como referencia. Métodos: en esta revisión sistemática con metaanálisis, fueron recuperados estudios publicados en las bases de datos electrónicas Medline (PubMed), Web of Science, Embase, SPORTDiscus, BioMed Central y SCOPUS. Consideramos estudios que evalúan el acuerdo de comportamiento sedentario a través del cuestionario y/o diario en comparación con una medida objetiva. Se utilizaron un total de seis criterios de inclusión. Sintetizamos los datos utilizando coeficientes de correlación (r) como un indicador de las estimaciones de la concordancia. El protocolo de revisión está registrado en la base de datos PROSPERO (CRD42014015138). Resultados: un total de 14 estudios cumplieron los criterios de inclusión con edades comprendidas entre 3 y 17,5 años y proporcionaron 17 análisis de concordancia. Trece de estos análisis de concordancia (76,5%) informaron coeficientes de correlación. Encontramos dos grupos principales de actividades sedentarias: tiempo de pantalla (47,1%) y comportamiento sedentario (52,9%). La concordancia entre cuestionarios y acelerómetros para evaluar el tiempo de pantalla autorreportado fue negativa (r = -0,15; IC 95%: -0,17 a -0,13). Sin embargo, cuando se evaluó el comportamiento sedentario mediante cuestionarios y acelerómetros, el acuerdo fue positivo para el reporte de los padres (r = 0,09; IC 95%: 0,04 a 0,13) y el reporte (r = 0,43; IC 95%: 0,40 a 0.47) de niños y adolescentes, respectivamente. Conclusión: los cuestionarios tienen un acuerdo positivo con los acelerómetros para evaluar el comportamiento sedentario, mientras que el acuerdo es negativo para evaluar el tiempo de pantalla. Los cuestionarios autorreportados son métodos recomendados para medir el comportamiento sedentario en adolescentes.

Leptin and adiposity as mediators on the association between early puberty and several biomarkers in European adolescents: the HELENA Study.

Background Adolescents having early puberty (EP) are more likely to have obesity and increased cardiometabolic and inflammatory markers and atherosclerosis risk. We aimed to assess the indirect and mediated effects of leptin and adiposity on the relation between EP and cardiometabolic and inflammatory markers in European adolescents. Methods A sample of 511 adolescents with EP (12.5-17.5 years) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) cross-sectional study was studied. To assess whether leptin levels and adiposity mediate the relation between EP and several biomarkers, linear regression models for mediation analyses were performed. Results EP was positively associated with the atherogenic index (Ath-I) (ß=0.174; 95%CI 0.029-0.265) and negatively associated with the C-reactive protein (CRP) (ß=-0.284; 95%CI -0.542 to -0.028) in girls. These associations were fully mediated by leptin levels (9.5%) and adiposity (44%), respectively. Moreover, EP has indirect effects on the apolipoprotein A-1 (ApoA-1) levels through adiposity in girls (for body mass index [BMI], ß=0.014; 95%CI 0.005-0.028, and for waist circumference [WC], ß=0.011; 95%CI 0.003-0.024), and on ApoA-1 (ß=0.012; 95%CI 0.004-0.025), apolipoprotein B (ApoB) (ß=-0.004; 95%CI -0.011 to -0.0004) and CRP (ß=-0.265; 95%CI -0.819 to -0.047) through abdominal fat in boys. Conclusions Leptin levels and adiposity seem to play an important indirect and mediation role in the association between EP and cardiometabolic and inflammatory markers in adolescents. Weight control should be recommended in order to control the impaired cardiometabolic and inflammatory status arising in early pubertal adolescents.

Development of a Food Frequency Questionnaire for Assessing Dietary Intake in Children and Adolescents in South America.

OBJECTIVE: This study aimed to describe the development of a food frequency questionnaire (FFQ) to assess dietary intake in South American children and adolescents. METHODS: A total of 345 children (aged 3-10 years) and 357 adolescents (aged 11-17 years) were included for analysis. The FFQ was designed to be self-administered and to assess dietary intake over the past 3 months. It was developed in Spanish and translated into Portuguese. Multiple approaches were considered to compile the food list, and 11 food groups were included. A food photo booklet was produced as supporting material. RESULTS: The FFQ items maintained a common core list among centers (47 items) and country-specific foods. The FFQ for Buenos Aires and Lima had a total of 63 items; there were 55 items for the FFQ in Medelin, 60 items for Montevideo, 58 items for Santiago, 67 items for Sao Paulo, and 68 items for Teresina. Alcohol was also incorporated in the adolescents' FFQ. CONCLUSIONS: We developed a semiquantitative, culturally adapted FFQ to assess dietary intake in children and adolescents in South America. It has an optimal size allowing its completion in a high proportion of the population; therefore, it can be used in epidemiological studies with South American children and adolescents.

Role of fruits and vegetables in adolescent cardiovascular health: a systematic review.

Context: Levels of fruit and vegetable consumption are low among adolescents, and the possible effect of this on cardiovascular health in this age group is undefined. Objective: The aim of this systematic review was to investigate the potential role of fruit and vegetable consumption in adolescent cardiovascular health. Data Sources: Six electronic databases (BioMed Central, MEDLINE, Web of Science, CINAHL, Scopus, PsycINFO) were searched from database inception to December 2015. Study Selection: The search strategy used the following sets of descriptors: adolescents; fruits and vegetables; cardiovascular risk indicators; cross-sectional and cohort studies. Data Extraction: Potentially eligible articles were selected independently by 2 reviewers. Results: Eleven articles meeting the inclusion criteria were included (10 cross-sectional, 1 cohort). The main reasons for study exclusion (n = 71) were misclassification of individuals as adolescents, an unspecified outcome that was incongruent with the definitions provided, and assessment of fruits and vegetables as part of a food pattern. Articles evaluated fruit and vegetable intake (separately, together, only vegetables, or with fruit juice) in diverse units, using food frequency questionnaires, 24-hour dietary recalls, and food records. One-third of the studies showed significant inverse associations of fruit and vegetable intake with systolic blood pressure, abdominal obesity, triglycerides, high-density lipoprotein cholesterol, and metabolic syndrome. Conclusions: The associations between fruit and vegetable consumption and indicators of cardiovascular risk in adolescents are inconsistent, likely because of heterogeneity in the methods used to assess and classify consumption and to define cardiovascular risk in adolescents.

The lipid accumulation product is a powerful tool to predict metabolic syndrome in undiagnosed Brazilian adults.

BACKGROUND & AIMS: Lipid accumulation product (LAP) is emergent predictor of central lipid accumulation linked to diabetes risk and cardiovascular disease. In this study, our aims were (i) to assess the accuracy of the LAP for predicting metabolic syndrome (MS) in subjects without diagnosis of cardiovascular disease (CVD) and type 2 diabetes mellitus compared with other classical anthropometric parameters and (ii) to estimate the optimal LAP cut-off point to predict MS in this population. SUBJECTS/METHODS: We conducted a cross-sectional study with representative undiagnosed subjects aged 20-79 years (n = 201; 37.8% men), selected by simple random sampling. In this study, subjects without previous diagnosis of CVD and type 2 diabetes mellitus, and those who did not make use of continuous medication were included. The independent variables were body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR) and LAP. MS was defined by American Heart Association and the National Heart, Lung, and Blood Institute (AHA/NHLBI); International Diabetes Federation (IDF); and a harmonized criteria between AHA/NHLBI and IDF. RESULTS: The prevalence of MS was 78.9% and 69.6% for men and women, respectively. LAP showed better area under the curve (AUC) for MS in three different criteria than those indexes based on body mass index, waist circumference, waist-to-height ratio and waist-to-hip ratio, even after adjusting for age and sex. In the harmonized criteria, the cut-off point of 34.2 cm.mmol/L for LAP showed the highest accuracy for MS (sensitivity 0.90, specificity 0.61, positive likelihood ratio of 2.31 and negative likelihood ratio of 0.17). CONCLUSIONS: LAP is a simple and accurate predictor tool for MS in undiagnosed adults. Moreover, it has significantly higher predictability than other screening tools commonly used to find subjects at risk of CVD and type 2 diabetes mellitus development, with the best performance at the 34.2 cm.mmol/L cut-off point.

Serum oxidized low-density lipoprotein levels are related to cardiometabolic risk and decreased after a weight loss treatment in obese children and adolescents.

BACKGROUND AND AIMS: The oxidation of low-density lipoprotein (LDL) cholesterol particles is an early atherogeninic event. Obese pediatric populations have higher levels of oxidized LDL (oxLDL) than normal weight children. The aim of this study was to evaluate the effect of a weight loss program on the biochemical profile and oxLDL levels in Spanish obese children and adolescents. METHODS: Forty obese children (mean age 11 years, 51% boys) followed a 10-week weight loss program. They were dichotomized at the median of body mass index-standard deviation score (BMI-SDS) change, as high (HR) and low responders (LR) after the intervention. The intervention included a moderate energy-restricted diet, nutritional education, and family involvement. Anthropometric and biochemical measurements were performed at the beginning and during the follow up. A cardiometabolic risk score (CMS) was calculated considering metabolic risk factors. RESULTS: Higher baseline oxLDL levels were associated with a higher CMS in obese children (P < .001). After the intervention, oxLDL significantly decreased in the HR group. Moreover, a positive correlation between changes in oxLDL and BMI-SDS (r = 0.385, P = .015) was found after the weight loss program. Interestingly, multiple-adjusted regression models showed an association between changes in total cholesterol [B: 0.127, 95% confidence interval (CI): 0.06 to 0.20] and LDL-cholesterol (B: 0.173, 95% CI: 0.08 to 0.26) with changes in oxLDL. CONCLUSIONS: Higher baseline oxLDL levels were associated with a higher CMS in obese children. After the weight loss program, a decrease in oxLDL levels was found in HR subjects and the oxLDL levels were associated with BMI-SDS and cholesterol levels.

Cross-sectional, school-based study of 14-19 year olds showed that raised blood pressure was associated with obesity and abdominal obesity.

AIM: Gaining weight has been directly associated with an increased probability of developing high blood pressure (HBP) and metabolic abnormalities. We examined the independent and combined effects of overweight, obesity and abdominal obesity on blood pressure in adolescents. METHODS: This cross-sectional school-based study evaluated 869 adolescents (53.4% girls) from 14 to 19 years of age, and the data were collected in 2013 in the city of Imperatriz, Maranhão, Brazil. The outcome was HBP. The independent variables were overweight and obesity classified by body mass index, abdominal obesity classified by the waist-to-height ratio and the combination of obesity and overweight and abdominal obesity. The potential confounding variables were age, the socio-economic status of the family, parental education, type of school and physical activity levels. RESULTS: The prevalence ratios of HBP were higher when male and female adolescents were overweight (1.61-3.11), generally obese (3.20-4.70), had abdominal obesity (2.18-3.02) and were both generally obese and had abdominal obesity (3.28-5.16) compared with normal weight adolescents. CONCLUSION: Obesity or abdominal obesity increased the risk of HBP in adolescents aged 14-19. However, adolescents who were both generally obese and had abdominal obesity showed an even higher risk of having HBP.

Abdominal obesity and cardiometabolic risk in children and adolescents, are we aware of their relevance?

Obesity prevalence has increased worldwide over the last decades and has reached alarming rates in low middle-income countries. Childhood has been affected by this epidemic, leading to premature dramatic health problems. Adipose tissue is currently considered as an endocrine organ modulating an inflammatory state and important metabolic processes (insulin resistance, hypertension, glucose intolerance) leading to consequences of the cardiovascular system. This situation may be worst if the excess of body fat distribution such as abdominal obesity (AO) is involved because it is associated with a more atherogenic risk profile determining the cardiometabolic risks mainly in children and adolescents. Hence, the knowledge regarding the association between AO and cardiometabolic factors aims to prevent and treat the obesity in this young population, avoiding early harmful consequences of adulthood health.

Validity and reliability of sleep time questionnaires in children and adolescents: A systematic review and meta-analysis.

Sleep duration has been associated with several health outcomes in children and adolescents. As an extensive number of questionnaires are currently used to investigate sleep schedule or sleep time, we performed a systematic review of criterion validation of sleep time questionnaires for children and adolescents, considering accelerometers as the reference method. We found a strong correlation between questionnaires and accelerometers for weeknights and a moderate correlation for weekend nights. When considering only studies performing a reliability assessment of the used questionnaires, a significant increase in the correlations for both weeknights and weekend nights was observed. In conclusion, moderate to strong criterion validity of sleep time questionnaires was observed; however, the reliability assessment of the questionnaires showed strong validation performance.