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1.
Curr Opin Clin Nutr Metab Care ; 22(6): 413-417, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31577639

RESUMO

PURPOSE OF REVIEW: Postpartum weight retainment is common in women, increasing the long-term likelihood of overweight and/or obesity. On the other hand, breastfeeding entails a high energy cost that contributes to the total energy expenditure of the mother, increasing the chances of a negative energy equilibrium that could potentially lead to weight loss. This review explores this association as depicted in the latest literature available. RECENT FINDINGS: Several studies reported a positive association between breastfeeding and postpartum weight loss while others reported no significant association. Several potential mechanisms, metabolic pathways and determinants have been described. SUMMARY: Even though several studies support the potentially beneficial role of breastfeeding in postpartum weight loss, more studies with robust designs are needed to reach a reliable conclusion. Healthcare providers should encourage breastfeeding, not only for its health benefits for both the mother and the offspring but also for its potential role in weight loss.

2.
Clin Nutr ; 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31500937

RESUMO

AIM: From a nutrigenetics perspective, we aim to investigate the moderating role of the Mediterranean diet and each of its subgroups in the association between C-reactive protein (CRP) gene polymorphisms and CRP blood concentration in adolescents. METHODS: In 562 adolescents (13-17 y) of the European HELENA study, data was available on circulating CRP levels as inflammatory biomarker, three CRP gene SNPs (rs3093068, rs1204, rs1130864), food intake determined by a self-administered computerized 24 h-dietary recall for 2 days, and body composition. A 9-point Mediterranean diet score and each food subgroup were tested as moderator via SNP*diet interaction. Analyzes were adjusted for age, sex, puberty, adiposity and socioeconomic status. RESULTS: The minor allele frequencies of rs3093068 and rs1130864 SNPs (GG and TT, respectively) were associated with higher CRP concentrations, while rs1205 (CT/TT) was associated with lower CRP concentrations. There were significant interactions between rs3093068 and Mediterranean diet (B = -0.1139, p = 0.011), or the fish food subgroup (B = -0.0090, p = 0.022), so that those with the highest genetic CRP risk underwent the highest CRP attenuation by a healthier diet. Although the effect of diet and SNP was substantial, the explained variance by interaction was only 1%. CONCLUSION: Greater adherence to the Mediterranean diet and particularly its fish component was associated with a lower CRP blood concentrations especially in those at highest genetic risk due to the rs3093068 SNP.

3.
Eur J Public Health ; 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31501880

RESUMO

BACKGROUND: Preschool children spend a significant proportion of their waking hours being sedentary. Parents play a critical role in developing and shaping their children's lifestyle behaviours, particularly in the early years of life. This study aims to assess parental perceptions, attitudes and knowledge of their preschool children's sedentary behaviours and the association with children's television (TV)/video/DVDs viewing and total screen time. METHODS: Data were obtained from a sample of 4836 children (3.5-5.5 years), participating in the multi-centre ToyBox-study at baseline (T0) and at 1-year follow-up (T1) periods. Data on children's sedentary behaviours were collected via a standardized proxy-administered primary caregiver's questionnaire. RESULTS: Regarding total screen time, 66.6% of the children at T0 and 71.8% at T1 in the control group exceeded the recommendations, whereas the proportion in the intervention group varied from 69.7% at T0 to 72.5% at T1. The odds of exceeding total screen time recommendations were significantly higher when parental perceptions towards limiting the total screen time were negative [(both T0 and T1 and in the intervention and control groups (P < 0.05)]. Similarly, the odds of exceeding TV/video/DVDs viewing recommendations were significantly higher (both T0 and T1 is observed in both groups) when parental knowledge of recommendation were absent. CONCLUSIONS: Preschool children whose caregivers stated rules limiting their sedentary screen time were less likely to spend a high amount of time watching TV/video/DVDs. Interventions to increase parental practices may be a promising approach to decrease total screen time of preschool children but studies are needed to confirm this.

4.
Eur Psychiatry ; 61: 79-84, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31377686

RESUMO

BACKGROUND: There is an increasing focus on lifestyle as a factor in the pathogenesis of mental health disorders; however, this has been relatively underexplored in child populations. This study aimed to assess the relationships between behavioural lifestyle factors and emotional functioning in a large, population-representative sample of schoolchildren in Greece. METHODS: A representative sample of 2,240 schoolchildren, aged 9-13 years, participated in the Healthy Growth Study during 2007-2010. Emotional functioning was measured using the Dartmouth COOP Functional Health Assessment charts/World Organization of Family Doctors Charts. A score of 3 or higher out of 5 indicated poorer emotional functioning. Participants self-reported dietary intake via three 24-h dietary recalls; fruit, vegetable and soft drink consumption were the dietary variables of interest. Participants' self-reported daily time spent in moderate to vigorous physical activity, and watching TV or playing video games were used to assess physical activity and sedentary behaviour. RESULTS: In fully adjusted models, females were at a greater risk of experiencing impaired emotional functioning compared to males (OR 1.76, 95%CI 1.44, 2.15, p < 0.01). Overweight/obesity compared to normal body weight (OR 1.52, 95%CI 1.31, 1.77, p < 0.01) was associated with poorer emotional functioning. Three hours or more of daily average physical activity compared to less than one hour (OR 0.59, 95%CI 0.40, 0.86, p < 0.01) was associated with improved emotional functioning. Consuming soft drinks compared to non-consumption (OR 1.24, 95%CI 1.02, 1.51) was associated with poorer emotional functioning; this became non-significant after corrections for multiple comparisons were made. Clustering of municipalities was accounted for in all models. CONCLUSIONS: Whilst findings were cross-sectional and causality cannot be inferred, this study highlights the interdependence of emotional and physical functioning in schoolchildren. This points to the potential for targeting shared risk factors for both physical chronic diseases and emotional and mental health conditions among children. Further longitudinal evidence will identify the potential for such shared intervention targets. Adopting a comprehensive, integrated approach to children's emotional, mental, and physical health is warranted.

5.
J Am Coll Nutr ; : 1-11, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31287966

RESUMO

Objective: The aim of this study was to identify dietary patterns (DPs) in European adolescents and to examine the association between perceptions of healthy eating and the obtained DPs. Method: A multinational cross-sectional study was carried out in adolescents aged 12.5 to 17.5 years and 2,027 (44.9% males) were considered for analysis. A self-reported questionnaire with information on food choices and preferences, including perceptions of healthy eating, and two 24-hour dietary recalls were used. Principal component analysis was used to obtain sex-specific DPs, and linear analyses of covariance were used to compare DPs according to perceptions of healthy eating. Results: Three and four DPs for boys and girls were obtained. In boys and girls, there were significant associations between some perceptions about healthy food and the Breakfast-DP (p < 0.05). In boys, Breakfast-DP and Healthy Beverage-DP were associated with the perception of the own diet as healthy (p < 0.05). Healthy Beverage-DP was associated with those disliking fruits and vegetables (p < 0.05). Girls considering the own diet as healthy were associated with Mediterranean-DP, Breakfast-DP, and Unhealthy Beverage and Meat-DP (p < 0.05). The perception of snacking as a necessary part of a healthy diet was associated with Breakfast-DP in both genders (p < 0.05). Conclusions: In European adolescents, perceptions of healthy eating were mainly associated with a DP characterized by foods consumed at breakfast. Future studies should further explore these findings in order to implement health promotion programs to improve healthy eating habits in adolescents.

6.
Public Health Nutr ; 22(13): 2381-2397, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31204628

RESUMO

OBJECTIVE: To investigate whether adherence to the adapted Mediterranean Diet Score for Adolescents (MDS_A) and the adapted Mediterranean Diet Quality Index for Adolescents (KIDMED_A) is associated with better food/nutrient intakes and nutritional biomarkers. DESIGN: The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study is a cross-sectional study aiming to obtain comparable data on a variety of nutritional and health-related parameters in European adolescents aged 12·5-17·5 years. SETTING: Nine European countries. PARTICIPANTS: European adolescents (n 2330) recruited to the HELENA study. Dietary intake was obtained with 24 h dietary recalls, an FFQ and a Food Choices and Preferences questionnaire. MDS_A was calculated as a categorical variable using cut-offs (MDS_A), as a continuous variable (zMDS_A) and with energy adjustments (zEnMDS_A). The KIDMED_A score was also calculated. RESULTS: Multilevel linear regression analysis showed positive associations for zMDS_A and KIDMED_A with serum levels of vitamin D, vitamin C, plasma folate, holo-transcobalamin, ß-carotene and n-3 fatty acids, while negative associations were observed with trans-fatty acid serum levels. For categorical indices, blood biomarkers showed few significant results. zMDS_A and KIDMED_A showed positive associations with vegetables and fruits intake, and negative associations with energy-dense and low-nutritious foods. zMDS_A and KIDMED_A were positively associated with all macronutrients, vitamins and minerals (all P < 0·0001), except with monosaccharides and PUFA for KIDMED_A and cholesterol for both indices (P < 0·05). CONCLUSIONS: zMDS_A and KIDMED_A have shown the strongest associations with the dietary indicators and biomarkers that have been associated with the Mediterranean diet before, and are therefore considered the most appropriate and valid Mediterranean diet scores for European adolescents.

7.
Am J Prev Med ; 57(2): 209-219, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31248745

RESUMO

INTRODUCTION: This study tested the hypothesis that providing personalized nutritional advice and feedback more frequently would promote larger, more appropriate, and sustained changes in dietary behavior as well as greater reduction in adiposity. STUDY DESIGN: A 6-month RCT (Food4Me) was conducted in seven European countries between 2012 and 2013. SETTING/PARTICIPANTS: A total of 1,125 participants were randomized to Lower- (n=562) or Higher- (n=563) Frequency Feedback groups. INTERVENTION: Participants in the Lower-Frequency group received personalized nutritional advice at baseline and at Months 3 and 6 of the intervention, whereas the Higher-Frequency group received personalized nutritional advice at baseline and at Months 1, 2, 3 and 6. MAIN OUTCOME MEASURES: The primary outcomes were change in dietary intake (at food and nutrient levels) and obesity-related traits (body weight, BMI, and waist circumference). Participants completed an online Food Frequency Questionnaire to estimate usual dietary intake at baseline and at Months 3 and 6 of the intervention. Overall diet quality was evaluated using the 2010 Healthy Eating Index. Obesity-related traits were self-measured and reported by participants via the Internet. Statistical analyses were performed during the first quarter of 2018. RESULTS: At 3 months, participants in the Lower- and Higher-Frequency Feedback groups showed improvements in Healthy Eating Index score; this improvement was larger in the Higher-Frequency group than the Lower-Frequency group (Δ=1.84 points, 95% CI=0.79, 2.89, p=0.0001). Similarly, there were greater improvements for the Higher- versus Lower-Frequency group for body weight (Δ= -0.73 kg, 95% CI= -1.07, -0.38, p<0.0001), BMI (Δ= -0.24 kg/m2, 95% CI= -0.36, -0.13, p<0.0001), and waist circumference (Δ= -1.20 cm, 95% CI= -2.36, -0.04, p=0.039). However, only body weight and BMI remained significant at 6 months. CONCLUSIONS: At 3 months, higher-frequency feedback produced larger improvements in overall diet quality as well as in body weight and waist circumference than lower-frequency feedback. However, only body weight and BMI remained significant at 6 months. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT01530139.

9.
JAMA ; 321(17): 1702-1715, 2019 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-31063572

RESUMO

Importance: Both low and high gestational weight gain have been associated with adverse maternal and infant outcomes, but optimal gestational weight gain remains uncertain and not well defined for all prepregnancy weight ranges. Objectives: To examine the association of ranges of gestational weight gain with risk of adverse maternal and infant outcomes and estimate optimal gestational weight gain ranges across prepregnancy body mass index categories. Design, Setting, and Participants: Individual participant-level meta-analysis using data from 196 670 participants within 25 cohort studies from Europe and North America (main study sample). Optimal gestational weight gain ranges were estimated for each prepregnancy body mass index (BMI) category by selecting the range of gestational weight gain that was associated with lower risk for any adverse outcome. Individual participant-level data from 3505 participants within 4 separate hospital-based cohorts were used as a validation sample. Data were collected between 1989 and 2015. The final date of follow-up was December 2015. Exposures: Gestational weight gain. Main Outcomes and Measures: The main outcome termed any adverse outcome was defined as the presence of 1 or more of the following outcomes: preeclampsia, gestational hypertension, gestational diabetes, cesarean delivery, preterm birth, and small or large size for gestational age at birth. Results: Of the 196 670 women (median age, 30.0 years [quartile 1 and 3, 27.0 and 33.0 years] and 40 937 were white) included in the main sample, 7809 (4.0%) were categorized at baseline as underweight (BMI <18.5); 133 788 (68.0%), normal weight (BMI, 18.5-24.9); 38 828 (19.7%), overweight (BMI, 25.0-29.9); 11 992 (6.1%), obesity grade 1 (BMI, 30.0-34.9); 3284 (1.7%), obesity grade 2 (BMI, 35.0-39.9); and 969 (0.5%), obesity grade 3 (BMI, ≥40.0). Overall, any adverse outcome occurred in 37.2% (n = 73 161) of women, ranging from 34.7% (2706 of 7809) among women categorized as underweight to 61.1% (592 of 969) among women categorized as obesity grade 3. Optimal gestational weight gain ranges were 14.0 kg to less than 16.0 kg for women categorized as underweight; 10.0 kg to less than 18.0 kg for normal weight; 2.0 kg to less than 16.0 kg for overweight; 2.0 kg to less than 6.0 kg for obesity grade 1; weight loss or gain of 0 kg to less than 4.0 kg for obesity grade 2; and weight gain of 0 kg to less than 6.0 kg for obesity grade 3. These gestational weight gain ranges were associated with low to moderate discrimination between those with and those without adverse outcomes (range for area under the receiver operating characteristic curve, 0.55-0.76). Results for discriminative performance in the validation sample were similar to the corresponding results in the main study sample (range for area under the receiver operating characteristic curve, 0.51-0.79). Conclusions and Relevance: In this meta-analysis of pooled individual participant data from 25 cohort studies, the risk for adverse maternal and infant outcomes varied by gestational weight gain and across the range of prepregnancy weights. The estimates of optimal gestational weight gain may inform prenatal counseling; however, the optimal gestational weight gain ranges had limited predictive value for the outcomes assessed.


Assuntos
Índice de Massa Corporal , Ganho de Peso na Gestação , Complicações na Gravidez , Resultado da Gravidez , Adulto , Peso ao Nascer , Cesárea/estatística & dados numéricos , Diabetes Gestacional , Feminino , Humanos , Hipertensão Induzida pela Gravidez , Recém-Nascido , Obesidade , Gravidez , Nascimento Prematuro
10.
Nutrients ; 11(5)2019 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-31083368

RESUMO

Lifestyle behavioral habits such as excess screen time (ST), a lack of physical activity (PA), and high energy-dense food consumption are associated with an increased risk of children being overweight or obese. This study aimed to (1) track longitudinal adherence to PA and ST recommendations at baseline (T0) and follow-up (T1) and (2) assess the association between changes in adherence to PA and ST recommendations and food and beverage consumption at follow-up. The present study included 2321 preschool children (3.5 to 6) participating in the multicenter ToyBox-study. A lineal mixed effects model was used to examine the association between different types of food and beverages and their relationship with changes in adherence to PA and ST recommendations. Approximately half of the children (50.4%) did not meet the PA and ST recommendations at both baseline and follow-up. However, only 0.6% of the sample met both PA and ST recommendations. Preschool children who met both recommendations consumed fewer fizzy drinks, juices, sweets, desserts, and salty snacks and consumed more water, fruits and vegetables, and dairy products than did those not meeting both recommendations. In conclusion, the proportion of European preschool children adhering to both PA and ST recommendations was very low and was associated with a low consumption of energy-dense foods.

11.
J Sci Med Sport ; 22(8): 929-934, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31060964

RESUMO

OBJECTIVES: To determine whether handgrip strength (HG) and/or standing long jump (SLJ) are capable of detecting risk of metabolic syndrome (MetS) in European adolescents, and to identify age- and sex-specific cut points for these tests. DESIGN: Cross-sectional study. METHODS: Participants included 969 (aged 12.5-17.5 years old) adolescents from 9 European countries (n = 520 girls). Absolute and relative HG and SLJ tests were used to assess upper and lower muscle strength, respectively. MetS status was determined using the age- and sex-specific cut points proposed by Jolliffe and Janssen´s, Additionally, we computed a continuous cardiometabolic risk index with the average z-score of four cardiometabolic risk factors: Wait circumference, mean arterial pressure, triglycerides/high-density lipoprotein cholesterol, and fasting insulin. RESULTS: The prevalence of MetS was 3.1% in European adolescents. Relative HG and absolute SLJ were the best tests for detecting the presence of MetS (Area under the receiver operating characteristic (AUC) = 0.799, 95%CI:0.773-0.824; and AUC = 0.695 95%CI:0.665-0.724), respectively) and elevated cardiometabolic risk index (AUC = 0.873, 95%CI:0.838-0.902; and AUC = 0.728 95%CI:0.698-0.756), respectively) and, regardless of cardiorespiratory fitness. We provide age- and sex-specific cut points of upper and lower muscle strength for European adolescents to identify the presence of MetS and elevated cardiometabolic risk index. CONCLUSIONS: The proposed health-related cut points could be used as a starting point to define health-related levels of upper and lower muscle strength in adolescents. Likewise, the diagnostic statistics provided herein can be used to offer feedback to adolescents, parents, and education and health professionals about what it means to meet or fail test standards.

12.
PLoS One ; 14(4): e0214454, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30958868

RESUMO

INTRODUCTION: Understanding context and how this can be systematically assessed and incorporated is crucial to successful implementation. We describe how context has been assessed (including exploration or evaluation) in Global Alliance for Chronic Diseases (GACD) implementation research projects focused on improving health in people with or at risk of chronic disease and how contextual lessons were incorporated into the intervention or the implementation process. METHODS: Using a web-based semi-structured questionnaire, we conducted a cross-sectional survey to collect quantitative and qualitative data across GACD projects (n = 20) focusing on hypertension, diabetes and lung diseases. The use of context-specific data from project planning to evaluation was analyzed using mixed methods and a multi-layered context framework across five levels; 1) individual and family, 2) community, 3) healthcare setting, 4) local or district level, and 5) state or national level. RESULTS: Project teams used both qualitative and mixed methods to assess multiple levels of context (avg. = 4). Methodological approaches to assess context were identified as formal and informal assessments, engagement of stakeholders, use of locally adapted resources and materials, and use of diverse data sources. Contextual lessons were incorporated directly into the intervention by informing or adapting the intervention, improving intervention participation or improving communication with participants/stakeholders. Provision of services, equipment or information, continuous engagement with stakeholders, feedback for personnel to address gaps, and promoting institutionalization were themes identified to describe how contextual lessons are incorporated into the implementation process. CONCLUSIONS: Context is regarded as critical and influenced the design and implementation of the GACD funded chronic disease interventions. There are different approaches to assess and incorporate context as demonstrated by this study and further research is required to systematically evaluate contextual approaches in terms of how they contribute to effectiveness or implementation outcomes.

13.
Sci Rep ; 9(1): 6380, 2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31011180

RESUMO

Adolescence is a critical stage of development and has an important influence on energy balance-related behaviours (EBRBs). When adolescents are associated with obesity it can lead to increased cardiometabolic risk. Here we assess if EBRBs adopted by adolescents included in a subsample are associated with markers of total and abdominal adiposity in a multicentre European study, Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA-CSS) and a Brazilian study, Brazilian Cardiovascular Adolescent Health (BRACAH study), and whether sleep duration influence the association between skipping breakfast, physical activity and sedentary behaviours, with total and abdominal obesity (AO). Multilevel linear regression models using fixed and random intercepts were used to analyse the association between markers of obesity and EBRBs. Skipping breakfast was the prevalent behaviour in association with obesity among European and Brazilian boys besides European girls, even after stratification by sleep time. Moreover, European boys who slept properly and skipped breakfast had an increased waist circumference (WC), while body mass index (BMI) increased in Brazilian boys. Among Brazilian boys less sleep was protective for total obesity (ß = -0.93 kg/m2; 95% CI: -1.80; -0.07). European girls when they were more sedentary, showed an increase in WC, especially for those who reported they slept adequately. Skipping breakfast was associated with total and AO in adolescents independent of sleep duration.

14.
Nutrients ; 11(3)2019 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-30917561

RESUMO

We examined the effectiveness of a computerised decision-support tool (DST), designed for paediatric healthcare professionals, as a means to tackle childhood obesity. A randomised controlled trial was conducted with 65 families of 6⁻12-year old overweight or obese children. Paediatricians, paediatric endocrinologists and a dietitian in two children's hospitals implemented the intervention. The intervention group (IG) received personalised meal plans and lifestyle optimisation recommendations via the DST, while families in the control group (CG) received general recommendations. After three months of intervention, the IG had a significant change in dietary fibre and sucrose intake by 4.1 and -4.6 g/day, respectively. In addition, the IG significantly reduced consumption of sweets (i.e., chocolates and cakes) and salty snacks (i.e., potato chips) by -0.1 and -0.3 portions/day, respectively. Furthermore, the CG had a significant increase of body weight and waist circumference by 1.4 kg and 2.1 cm, respectively, while Body Mass Index (BMI) decreased only in the IG by -0.4 kg/m². However, the aforementioned findings did not differ significantly between study groups. In conclusion, these findings indicate the dynamics of the DST in supporting paediatric healthcare professionals to improve the effectiveness of care in modifying obesity-related behaviours. Further research is needed to confirm these findings.


Assuntos
Técnicas de Apoio para a Decisão , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/prevenção & controle , Software , Algoritmos , Criança , Feminino , Humanos , Masculino , Refeições , Fatores de Risco , Programas de Redução de Peso
15.
Eur J Nutr ; 2019 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-30903362

RESUMO

PURPOSE: The role of polyphenol intake during adolescence to prevent metabolic syndrome (MetS) is little explored. This study aimed to evaluate the association between intake of total polyphenols, polyphenol classes and the 10 most consumed individual polyphenols with MetS risk in European adolescents. METHODS: Of the cross-sectional HELENA study, 657 adolescents (54% girls; 14.8% overweight; 12.5-17.5 year) had a fasting blood sample and polyphenol intake data from two non-consecutive 24-h recalls matched with the Phenol-Explorer database. MetS was defined via the pediatric American Heart Association definition. Multilevel linear regressions examined the associations of polyphenol quartiles with MetS components, while logistic regression examined the associations with MetS risk. RESULTS: After adjusting for all potential confounders (socio-demographics and nine nutrients), total polyphenol intake, polyphenol classes and individual polyphenols were not associated with MetS risk. From all MetS components, only BMI z-score was modestly inversely associated with total polyphenol intake. Further sub analyses on polyphenol classes revealed that flavonoid intake was significantly associated with higher diastolic blood pressure and lower BMI, and phenolic acid intake was associated with higher low-density cholesterol. For individual polyphenols, the above BMI findings were often confirmed (not independent from dietary intake) and a few associations were found with insulin resistance. CONCLUSION: Higher intakes of total polyphenols and flavonoids were inversely associated with BMI. No consistent associations were found for other MetS components.

16.
PLoS Med ; 16(2): e1002744, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30742624

RESUMO

BACKGROUND: Maternal obesity and excessive gestational weight gain may have persistent effects on offspring fat development. However, it remains unclear whether these effects differ by severity of obesity, and whether these effects are restricted to the extremes of maternal body mass index (BMI) and gestational weight gain. We aimed to assess the separate and combined associations of maternal BMI and gestational weight gain with the risk of overweight/obesity throughout childhood, and their population impact. METHODS AND FINDINGS: We conducted an individual participant data meta-analysis of data from 162,129 mothers and their children from 37 pregnancy and birth cohort studies from Europe, North America, and Australia. We assessed the individual and combined associations of maternal pre-pregnancy BMI and gestational weight gain, both in clinical categories and across their full ranges, with the risks of overweight/obesity in early (2.0-5.0 years), mid (5.0-10.0 years) and late childhood (10.0-18.0 years), using multilevel binary logistic regression models with a random intercept at cohort level adjusted for maternal sociodemographic and lifestyle-related characteristics. We observed that higher maternal pre-pregnancy BMI and gestational weight gain both in clinical categories and across their full ranges were associated with higher risks of childhood overweight/obesity, with the strongest effects in late childhood (odds ratios [ORs] for overweight/obesity in early, mid, and late childhood, respectively: OR 1.66 [95% CI: 1.56, 1.78], OR 1.91 [95% CI: 1.85, 1.98], and OR 2.28 [95% CI: 2.08, 2.50] for maternal overweight; OR 2.43 [95% CI: 2.24, 2.64], OR 3.12 [95% CI: 2.98, 3.27], and OR 4.47 [95% CI: 3.99, 5.23] for maternal obesity; and OR 1.39 [95% CI: 1.30, 1.49], OR 1.55 [95% CI: 1.49, 1.60], and OR 1.72 [95% CI: 1.56, 1.91] for excessive gestational weight gain). The proportions of childhood overweight/obesity prevalence attributable to maternal overweight, maternal obesity, and excessive gestational weight gain ranged from 10.2% to 21.6%. Relative to the effect of maternal BMI, excessive gestational weight gain only slightly increased the risk of childhood overweight/obesity within each clinical BMI category (p-values for interactions of maternal BMI with gestational weight gain: p = 0.038, p < 0.001, and p = 0.637 in early, mid, and late childhood, respectively). Limitations of this study include the self-report of maternal BMI and gestational weight gain for some of the cohorts, and the potential of residual confounding. Also, as this study only included participants from Europe, North America, and Australia, results need to be interpreted with caution with respect to other populations. CONCLUSIONS: In this study, higher maternal pre-pregnancy BMI and gestational weight gain were associated with an increased risk of childhood overweight/obesity, with the strongest effects at later ages. The additional effect of gestational weight gain in women who are overweight or obese before pregnancy is small. Given the large population impact, future intervention trials aiming to reduce the prevalence of childhood overweight and obesity should focus on maternal weight status before pregnancy, in addition to weight gain during pregnancy.


Assuntos
Índice de Massa Corporal , Análise de Dados , Ganho de Peso na Gestação/fisiologia , Obesidade Pediátrica/epidemiologia , Austrália/epidemiologia , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Humanos , América do Norte/epidemiologia , Sobrepeso/diagnóstico , Sobrepeso/epidemiologia , Obesidade Pediátrica/diagnóstico , Gravidez , Fatores de Risco
17.
Diabetes Res Clin Pract ; 150: 99-110, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30796939

RESUMO

AIM: To assess the diagnostic accuracy of the FINDRISC for undiagnosed type 2 diabetes mellitus (T2DM) and dysglycaemia (i.e. the presence of prediabetes or T2DM) among early middle-aged adults from vulnerable groups in a large-scale European cohort. METHODS: Participants were recruited from low-socioeconomic areas in high-income countries (HICs) (Belgium-Finland) and in HICs under austerity measures (Greece-Spain) and from the overall population in low/middle-income countries (LMICs) (Bulgaria-Hungary). Study population comprised of 2116 parents of primary-school children from families identified at increased risk of T2DM, based on parental self-reported FINDRISC. Sensitivity (Se), specificity (Sp), area under the receiver operating characteristic curves (AUC-ROC) and the optimal cut-offs of FINDRISC that indicate an increased probability for undiagnosed T2DM or dysglycaemia were calculated. RESULTS: The AUC-ROC for undiagnosed T2DM was 0.824 with optimal cut-off ≥14 (Se = 68%, Sp = 81.7%) for the total sample, 0.839 with optimal cut-off ≥15 (Se = 83.3%, Sp = 86.9%) for HICs, 0.794 with optimal cut-off ≥12 (Se = 83.3%, Sp = 61.1%) for HICs under austerity measures and 0.882 with optimal cut-off ≥14 (Se = 71.4%, Sp = 87.8%) for LMICs. The AUC-ROC for dysglycaemia was 0.663 with optimal cut-off ≥12 (Se = 58.3%, Sp = 65.7%) for the total sample, 0.656 with optimal cut-off ≥12 (Se = 54.5%, Sp = 64.8%) for HICs, 0.631 with optimal cut-off ≥12 (Se = 59.7%, Sp = 62.0%) for HICs under austerity measures and 0.735 with optimal cut-off ≥11 (Se = 72.7%, Sp = 70.2%) for LMICs. CONCLUSION: FINDRISC can be applied for screening primarily undiagnosed T2DM but also dysglycaemia among vulnerable groups across Europe, considering the use of different cut-offs for each subpopulation.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Programas de Rastreamento , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/epidemiologia , Adulto , Criança , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Fatores de Risco
18.
Pediatr Obes ; 14(6): e12504, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30659763

RESUMO

AIMS: To examine the association between UCP1, UCP2, and UCP3 gene polymorphisms with adiposity markers in European adolescents and to test if there were gene interactions with objectively measured physical activity and adiposity. METHODS: A cross-sectional study that involves 1.057 European adolescents (12-18 years old) from the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study. A total of 18 polymorphisms in UCP1, UCP2, and UCP3 genes were genotyped. We measured weight, height, waist, and hip circumferences and triceps and subscapular skinfold thickness. Physical activity was objectively measured by accelerometry during 7 days. RESULTS: The C allele of the UCP1 rs6536991 polymorphism was associated with a lower risk of overweight (odds ratio [OR]: T/C + C/C vs T/T) = 0.72; 95% confidence interval [CI]: 0.53-0.98; P = 0.034; false discovery rate [FDR] = 0.048). There was a significant interaction between UCP1 rs2071415 polymorphism and physical activity with waist-to-hip ratio (P = 0.006; FDR = 0.026). Adolescents who did not meet the physical activity recommendations (less than 60 min/day of moderate to vigorous physical activity) and carrying the C/C genotype had higher waist-to-hip ratio (+ 0.067; 95% CI, 0.028-0.106; P = 0.003), while no differences across genotypes were observed in adolescents meeting the recommendations. CONCLUSIONS: Two UCP1 polymorphisms were associated with adiposity in European adolescents. Meeting the daily physical activity recommendations may overcome the effect of the UCP1 rs2071415 polymorphism on obesity-related traits.


Assuntos
Adiposidade , Obesidade/genética , Polimorfismo Genético , Proteína Desacopladora 1/genética , Adolescente , Criança , Estudos Transversais , Europa (Continente) , Exercício , Feminino , Humanos , Masculino , Proteína Desacopladora 2/genética , Proteína Desacopladora 3/genética
19.
Int J Public Health ; 2018 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-30511170

RESUMO

OBJECTIVES: To delineate the clustering of energy balance-related behaviors in adolescents and investigate whether these behaviors are associated with the household socioeconomic status and parental education level. METHODS: Two cross-sectional studies assessed information on sedentary behavior, physical activity, sugar-sweetened beverages and fruit and vegetable consumption, and sleep duration by self-reported questionnaires in adolescents (12.5-17.5 years old) from Maringá/Brazil (BRACAH Study; n = 682) and ten European cities (HELENA Study; n = 1252) from nine different countries. Gender-specific cluster analyses were performed separately for each study, applying a combination of hierarchical and non-hierarchical methods. RESULTS: Girls showed equivalent behaviors: Sedentary; Active; Unhealthy Eating; Healthy Eating; while boys differed (Brazilian: Sedentary; Active; Healthy Eating; European: Sedentary; Healthy; Unhealthy Eating). In Brazil, we found no association between socioeconomic status and parental education. In European girls, the high socioeconomic status and both parents' university degree were associated with Healthy Eating. In European boys, the high socioeconomic status was associated with Unhealthy Eating, and the mothers' university degree was associated with the Healthy cluster. CONCLUSIONS: Adolescents show Sedentary behavior, regardless of their sex, country of origin, or socioeconomic condition.

20.
Nutrients ; 11(1)2018 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-30577456

RESUMO

The present study set out to explore the option of developing food portion size for nutritional labelling purposes using two European Union (EU) dietary surveys. The surveys were selected as they differed in (a) methodologies (food diary versus food frequency questionnaire), (b) populations (Irish National Adult Nutrition Survey (NANS) versus a seven-country survey based on the pan EU study Food4Me), (c) food quantification (multiple options versus solely photographic album) and (d) duration (4 consecutive days versus recent month). Using data from these studies, portion size was determined for 15 test foods, where portion size was defined as the median intake of a target food when consumed. The median values of the portion sizes derived from both the NANS and Food4Me surveys were correlated (r = 0.823; p < 0.00) and the mean of the two survey data sets were compared to US values from the Recognized as Customarily Consumed (RACC) database. There was very strong agreement across all food categories between the averaged EU and the US portion size (r = 0.947; p < 0.00). It is concluded that notwithstanding the variety of approaches used for dietary survey data in the EU, the present data supports using a standardized approach to food portion size quantification for food labelling in the EU.


Assuntos
Rotulagem de Alimentos/estatística & dados numéricos , Política Nutricional , Inquéritos Nutricionais/estatística & dados numéricos , Tamanho da Porção/estatística & dados numéricos , Adulto , Bases de Dados Factuais , União Europeia , Feminino , Rotulagem de Alimentos/normas , Humanos , Irlanda , Masculino , Inquéritos Nutricionais/métodos , Tamanho da Porção/normas , Reprodutibilidade dos Testes
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