Blood pressure measurement in pediatric population: comparison between automated oscillometric devices and mercury sphygmomanometers-a systematic review and meta-analysis.

With the progressive elimination of mercury column devices for blood pressure (BP) measurement in children and adolescents, valid alternatives are needed. Oscillometric devices provide a replacement without mercury, are fully automated, and have excellent reliability among evaluators. Here, the goal was to test the accuracy of automatic blood pressure monitor devices compared to the mercury sphygmomanometer for BP measurement in children and adolescents. Electronic databases are EMBASE, MEDLINE (PubMed), SCOPUS, and Web of Science. We selected 8974 potentially eligible articles and two authors independently. We separately reviewed 370 full papers. Potentially eligible articles were selected according to the following criteria: (a) articles published in Portuguese, English, and Spanish; (b) screening of titles; (c) screening of abstracts; and (d) retrieval and screening of the full article to determine whether it met the inclusion criteria. We included 45 articles for analysis, 28 of which were selected for meta-analysis. The systolic BP measured by automatic blood pressure monitors presents 1.17 mmHg on average (95% CI 0.85; 1.48); for diastolic BP, it produced -0.08 mmHg (95% CI -0.69; 0.54) compared with a mercury sphygmomanometer. There is high heterogeneity between studies (> 90%) in the meta-analysis, partly explained by the device model, study environment, and observer training. Only articles that reported BP measurement by both methods were included.Conclusion: Automatic blood pressure monitors have strong measurement validity when compared with the mercury column. Thus, these can be safely used in blood pressure measurements of children and adolescents in clinical and epidemiological studies. What is Known: •The "gold standard" for indirect BP measurement is the mercury sphygmomanometer. •The accuracy of the automatic device is critical to any blood pressure measurement method. What is New: •Oscillometric or automatic devices can be a suitable alternative to auscultation for initial screening, consistent with current pediatric guidelines. •The automatic devices compared to the mercury column have a good validity of measurements, which can be used in blood pressure measurements of children and adolescents in clinical and epidemiological settings, provided that international protocols are followed.

Reliability and validity of a sedentary behavior questionnaire for South American pediatric population: SAYCARE study.

BACKGROUND: Multicenter studies from Europe and the United States have developed specifically standardized questionnaires for assessing and comparing sedentary behavior, but they cannot be directly applied for South American countries. The aim of this study was to assess the reliability and validity of the South American Youth Cardiovascular and Environmental (SAYCARE) sedentary behavior questionnaire. METHODS: Children and adolescents from seven South American cities were involved in the test-retest reliability (children: n = 55; adolescents: n = 106) and concurrent validity (children: n = 93; adolescents: n = 94) studies. The SAYCARE sedentary behavior questionnaire was administered twice with two-week interval and the behaviors were parent-reported for children and self-reported for adolescents. Questions included time spent watching television, using a computer, playing console games, passive playing (only in children) and studying (only in adolescents) over the past week. Accelerometer was used for at least 3 days, including at least one weekend day. We compared values of sedentary time, using accelerometers, by quartiles of reported sedentary behavior time and their sum. RESULTS: The reliability of sedentary behavior time was moderate for children (rho ≥0.45 and k ≥ 0.40) and adolescents (rho ≥0.30). Comparisons between the questionnaire and accelerometer showed a low overall agreement, with the questionnaire systematically underreporting sedentary time in children (at least, - 332.6 ± 138.5 min/day) and adolescents (at least, - 399.7 ± 105.0 min/day). CONCLUSION: The SAYCARE sedentary behavior questionnaire has acceptable reliability in children and adolescents. However, the findings of current study indicate that SAYCARE questionnaire is not surrogate of total sedentary time.

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.

Sex and ethnicity modify the associations between individual and contextual socioeconomic indicators and ideal cardiovascular health: MESA study.

BACKGROUND: Low socioeconomic status (SES) is associated with cardiovascular disease (CVD) risk, but its association with different markers of SES may be heterogeneous by sex and race/ethnicity. METHODS: We have examined the relationships of four SES markers (education, family income, occupation and neighborhood SES) to ideal cardiovascular health (ICH), an index formed by seven variables. A total of 6792 cohort participants from six regions in the USA: Baltimore City and Baltimore County, MD; Chicago, IL; Forsyth County, NC; Los Angeles County, CA; New York, NY; and St. Paul, MN of the Multi-Ethnic Study of Atherosclerosis (MESA) (52.8% women) were recruited at baseline (2000-2) and included in the present analysis. RESULTS: ICH was classified as poor, intermediate or ideal. Level of education was significantly and inversely associated with ICH in non-Hispanic White men and women, in Chinese-American and Hispanic American men and African-American women. Family income was inversely and significantly associated with poor ICH in African-American men only. CONCLUSIONS: We conclude that the strength of the associations between some SES markers and ICH differ between sexes and race/ethnic groups.

Is Self-Reported Physical Fitness Useful for Estimating Fitness Levels in Children and Adolescents? A Reliability and Validity Study.

Background and objective: The assessment of physical fitness has become a necessary issue in epidemiological studies, since a reduction in fitness is directly associated with early mortality. Therefore, the development of simple, accurate, and inexpensive methods is necessary to measure physical fitness. This study aimed to determine the reliability and validity of the criteria and constructs of the International Fitness Scale (IFIS), Portuguese version, in Brazilian pediatric populations. Methods: A total of 190 children aged 3-10 years and 110 adolescents aged 11-17 years were enrolled in an observational study of reliability and validity. For reliability, the participants completed a questionnaire twice (with an interval of 15 days). To test the criterion validity, we analyzed the agreement between the questionnaire and physical tests (20-m shuttle run test, handgrip strength, standing long jump tests, 4 × 10-m shuttle run test, and back-saver sit and reach test), and the construct validity was estimated by agreement between the questionnaire and high blood pressure. The reliability was analyzed by kappa coefficients. The agreement between the testing and retesting of the questionnaire was evaluated by kappa coefficients. We applied a 2 × 2 table to estimate the specificity, sensitivity, and accuracy of the questionnaire. Results: The mean age of the children was 6.7 years (n = 190), and for the adolescents it was 14.6 years (n = 110). The questionnaire reliability showed an almost perfect score (κ ≥ 0.93 in children and κ ≥ 0.88 in adolescents). The questionnaire showed moderate criterion validity (κ ≥ 0.40 in children and adolescents) as well as moderate construct validity (κ ≥ 0.40) in the components of general conditioning, cardiorespiratory capacity, muscular strength, and speed/agility in children and in the components of cardiorespiratory capacity, muscle strength, and speed/agility in adolescents. The questionnaire was a sensitive method for measuring physical fitness. Conclusions: The Portuguese version of the IFIS is a reliable and valid method for measuring physical fitness in pediatric populations.

Soft tissues, areal bone mineral density and hip geometry estimates in active young boys: the PRO-BONE study.

PURPOSE: Soft tissues, such as fat mass (FM) and lean mass (LM), play an important role in bone development but this is poorly understood in highly active youths. The objective of this study was to determine whether FM or LM is a stronger predictor of areal bone mineral density (aBMD) and hip geometry estimates in a group of physically active boys after adjusting for height, chronological age, moderate-to-vigorous physical activity (MVPA), FM, and LM. METHODS: Participants included 121 boys (13.1 ± 1.0 years) from the PRO-BONE study. Bone mineral content (BMC) and aBMD were measured at total body, femoral neck and lumbar spine using dual-energy X-ray absorptiometry (DXA), and hip structural analysis was used to estimate bone geometry at the femoral neck. Body composition was assessed using DXA. The relationships of FM and LM with bone outcomes were analysed using simple and multiple linear regression analyses. RESULTS: Pearson correlation coefficients showed that total body (less head) aBMD was significantly correlated with LM but not FM. Multiple linear regression analyses showed that FM, after accounting for height, age, MVPA and LM had no significant relationship with aBMD or hip geometry estimates, except for arms aBMD. By contrast, there were positive associations between LM and most aBMD and hip geometry estimates, after accounting height, age, MVPA and FM. CONCLUSIONS: The results of this study suggest that LM, and not FM, is the stronger predictor of aBMD and hip geometry estimates in physically active boys. TRIAL REGISTRATION: ClinicalTrials.gov ISRCTN17982776.

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.

Effects of clustering of multiple lifestyle-related behaviors on blood pressure in adolescents from two observational studies.

BACKGROUD: Several lifestyle-related behaviors are associated with cardiovascular health outcomes in adolescents. To examine the associations between clustered lifestyle-related behaviors and blood pressure (BP) levels in adolescents. METHODS: Participants were recruited by multistage random cluster in two cross-sectional studies; one conducted in 2006 and 2007 in ten cities from nine European countries: Athens and Heraklion in Greece, Dortmund in Germany, Ghent in Belgium, Lille in France, Pécs in Hungary, Rome in Italy, Stockholm in Sweden, Vienna in Austria, and Zaragoza in Spain; and another conducted in 2007 one city in Brazil (Maringá/PR). Systolic BP (SBP) and diastolic BP (DBP) (outcomes) and clustered behaviors (weekly consumption of fruits and vegetables, weekly consumption of sugar-sweetened beverages, sleep duration, screen time and physical activity) were analyzed. RESULTS: The Healthy Eating cluster was negatively associated with DBP in European girls, ß=-2.46 (-4.62; -0.30), and with SBP in Brazilian boys, ß=-2.79 (-3.10; -0.15). Furthermore, the Unhealthy Eating cluster was associated with increased SBP in European girls, ß=4.54 (1.29; 7.79), and in Brazilian boys, ß=4.10 (0.80; 7.40). CONCLUSION: The Healthy Eating cluster was associated with lower blood pressure, whereas the Unhealthy Eating cluster was associated with increased SBP in adolescents.

Dietary protein and amino acids intake and its relationship with blood pressure in adolescents: the HELENA STUDY.

OBJECTIVE: To analyze the association between dietary protein and amino acids intake and systolic (SBP) and diastolic (DBP) blood pressure in European adolescents. METHODS: Participants were from the cross-sectional study performed in Europe, Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA study; n = 1605; 12.5-17.5 years; 833 girls) selected by complex sampling. The associations between dietary protein and amino acids intake and SBP/DBP were examined by multilevel linear regression models (context variable by school); the analysis being stratified by sex. Cities, seasonality, age, socioeconomic level, parental education level, body mass index, waist circumference, Tanner stage and physical activity were used as covariates. RESULTS: In boys, we found an inverse association between protein (animal and vegetable) intake and DBP; and a positive association between histidine and SBP. In girls, we observed a positive association among tryptophan, histidine with SBP and methionine with DBP. On the other hand, we observed an inverse association between tyrosine and both SBP and DBP levels in girls. CONCLUSIONS: The association between amino acids and BP levels is controversial and depends on the type of amino acids, and protein intake can help control the DBP in boys.

Family socioeconomic factors are negatively associated with blood pressure in European boys, but not girls, and Brazilian adolescents: Results from two observational studies.

OBJECTIVE: We aimed to estimate the attributable fraction of systolic (SBP) and diastolic blood pressure (DBP) that can be explained by family socioeconomic factors (FSFs) in adolescents using two observational studies. METHODS: Participants were recruited by multistage random cluster in two cross-sectional studies performed in Europe [Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, n = 3308] and Brazil [Brazilian Cardiovascular Adolescent Health (BRACAH) study, n = 991]. SBP and DBP were measured, and FSFs (socioeconomic status and parental education) were self-reported in both studies. The correlations of SBP and DBP with FSFs were examined by multilevel linear regression through two different models (hierarchical and fully adjusted). The generalized attributable fractions of the FSFs were estimated by comparing the models. RESULTS: Our results showed a significant inverse relationship between parental education (father and mother) and SBP in European boys. The higher generalized attributable fraction to SBP was observed in boys (13.2-22.4%). In girls, we found lower generalized attributable fractions to DBP (10.8-12.1% in Brazilian girls and 3.1-3.8% in European girls). CONCLUSIONS: Our findings revealed a significant inverse relationship between parental education and SBP in European boys. FSF also significantly influenced blood pressure in adolescents, mainly in Brazilian adolescents.

Physical activity modifies the associations between genetic variants and blood pressure in European adolescents.

We hypothesized that physical activity and sedentary behavior could modify the associations between known genetic variants blood pressure-associated genes in European adolescents. Meeting current physical activity recommendations (≥ 60 minutes/day) was able attenuate the deleterious effect of the NOS3 rs3918227 polymorphism on systolic blood pressure in European adolescents.

Potential biases in the classification, analysis and interpretations in cross-sectional study: commentaries - surrounding the article "resting heart rate: its correlations and potential for screening metabolic dysfunctions in adolescents".

BACKGROUND: Resting heart rate reflects sympathetic nerve activity. A significant association between resting heart rate (HR) and all causes of cardiovascular mortality has been reported by some epidemiologic studies. Despite suggestive evidence, resting heart rate (RHR) has not been formally explored as a prognostic factor and potential therapeutic outcome and, therefore, is not generally accepted in adolescents. DISCUSSION: The core of the debate is the methodological aspects used in "Resting heart rate: its correlations and potential for screening metabolic dysfunctions in adolescents"; the points are: cutoff used for cluster RHR, two different statistical models used to analyze the same set of variables, one for continuous data, and another for categorical data; interpretation of p-value < 0.05, sampling process involving two random stages, analysis of design effect and the parameters of screening tests. SUMMARY: Aspects that must be taken into account for evaluation of a screening test to measure the potential for discrimination for a common variable (population with outcome vs. no outcome population), the main indicators are: sensitivity, specificity, accuracy, positive predictive value and negative predictive value. The measures of argumentation equality (CI) or difference (p-valor) are important to validate these indicators but do not indicate quality of screening.

Prevalence of the Double Burden of Malnutrition among Adolescents: Associations with Lifestyle Behaviors and Clusters of Social Determinants.

The double burden of malnutrition (DBM) is a condition in which malnutrition coexists with overweight, reflecting a new layer of malnutrition. Our objectives were to assess prevalence; test associations between DBM and 24-hour movement behaviors; and investigate whether DBM is associated with clusters of social determinants. Methods: This multicenter cross-sectional study included 1152 adolescents (12 to 17 years old) from four Brazilian cities. Body mass index (BMI, kg/m2) was used to estimate overweight, and the adopted cutoff points took into account the curves established for age and sex: Z-score > 1 and ≤2 (overweight) and Z-score > 2 (obesity). The serum concentration of 25-hydroxyvitamin D [25(OH)D] was stratified into three levels: vitamin D deficiency ≤ 20 ng/mL; vitamin D insufficiency = 21-29 ng/mL; optimal vitamin D ≥ 30 ng/mL. We used multilevel Poisson regression models to estimate prevalence ratios (PRs) and their respective 95% confidence intervals (95%CI) and to analyze the association between DBM and covariates. A significance level of p < 0.05 was considered. Cluster analyses were performed by applying a combination of hierarchical and non-hierarchical methods. Results: A population prevalence of DBM of 7.3% (95% CI: 5.9-8.9) was revealed. A percentage of 19.2% (95% CI: 17.0-21.6) of adolescents were overweight, and 8.3% (95% CI: 6.8-10.1) were obese. A total of 41.5% (95% CI: 38.7-44.4) had vitamin D deficiency, and 25.8% (95% CI: 23.4-28.4) had vitamin D insufficiency. However, 24-hour movement behaviors were not associated with DBM. Adolescents living in the southern region of the country, from public schools whose mothers have higher education, have a 1.94 [PR = 2.94 (95% CI: 1.20-7.23)] times greater chance of developing DBM. These results highlight the importance of specific factors to improve the nutritional health of adolescents, considering the specific social determinants identified in this study.

The relationship between visceral fat thickness and bone mineral density in sedentary obese children and adolescents.

BACKGROUND: Among adults, obesity has been positively related to bone mineral density. However, recent findings have pointed out that abdominal obesity could be negatively related to bone density. The above mentioned relationship is not clear among pediatric populations. Therefore, this cross-sectional study analyzed the relationship between thickness of abdominal adipose tissue and bone mineral variables in sedentary obese children and adolescents. METHODS: One hundred and seventy five obese children and adolescents (83 male and 92 female) with ages ranging from 6 to 16 years-old were analyzed. Bone mineral content and density were estimated by dual-energy X-ray absorptiometry and ultrasound equipment which estimated the thickness of the abdominal adipose tissue. Pubertal stage was self-reported by the participants. RESULTS: The mean age was 11.1 (SD=2.6). Thickness of the abdominal adipose tissue was negatively related to bone mineral density (r=-0.17 [r95%CI: -0.03;-0.32]), independent of gender, pubertal stage and other confounders (ß=-0.134±0.042 [ß95%CI: -0.217; -0.050]). CONCLUSIONS: In sedentary obese children and adolescents abdominal obesity is negatively related to bone mineral density, suggesting a potential link between abdominal obesity and osteoporosis.

Are sleep time and quality associated with inflammation in children and adolescents? A systematic review.

Sleep restriction in children can trigger the development of problems such as impaired cognition, behavioral problems, cardiovascular problems, and obesity. In addition, the inflammatory profile of children can also be influenced by sleep restriction. The aimed to review and analyze the association between time and sleep quality with inflammatory biomarkers in children and adolescents. Three electronic databases (MEDLINE, Web of Science and Scopus) were searched from August 30, 2022. The search strategy used the following descriptors: children and adolescents; sleep, and inflammatory profile. This review protocol is registered in the PROSPERO database (CRD42020188969). We obtained 2.724 results of articles with potentially relevant titles. Sixteen percent of the articles were excluded because they were duplicates, 84.3% were excluded after reading the title, and 0.9% were studied from systematic reviews or textbooks (0.9%). Accelerometers are the most commonly used method for the objective measurement of sleep time, while the PSQI questionnaire is the most commonly used subjective method to measure sleep quality. The results indicated an inconsistent association between sleep time and CRP in the literature. Sixty percent of studies used the Pittsburgh Sleep Quality Index (PSQI) for subjective assessment of sleep quality and possible sleep disorders. However, only one retrieved study showed significant association between sleep quality and CRP. Thus, sleep time does not present significant association with inflammatory biomarkers; whereas, poor sleep quality shows positive association with CRP with a lower magnitude.

Reliability and Validity Estimate of the Pro-Inflammatory/Anti-Inflammatory Food Intake Score in South American Pediatric Population: SAYCARE Study.

Chronic low-grade inflammation may be associated with the development of chronic non-communicable diseases in young populations, often lasting to adulthood. Studies show that the diet is related to chronic inflammation. The Pro-inflammatory/Anti-inflammatory Food Intake Score (PAIFIS) is an indicator that measures the inflammatory potential of the diet, with the help of validated tools that assess food consumption. The validation of tools that assess inflammatory dietary patterns in young populations to produce valid and reliable results is essential to guide disease prevention strategies for adulthood. METHODS: This study aimed to estimate the Pro-inflammatory/Anti-inflammatory Food Intake Score (PAIFIS) in children and adolescents in South America and to test its reliability and validity using a food frequency questionnaire (FFQ) and an inflammatory biomarker. This work consists of a validation study in a sample of children and adolescents conducted in South America (SAYCARE Study). The habitual consumption of food contributing to calculating the PAIFIS was obtained through an FFQ and 24 h Dietary Recall (24HDR). Reliability was tested using the FFQ (FFQ1 × FFQ2), using Spearman's correlation coefficient to estimate the agreement between measurements. The validity of the PAIFIS was tested using 24HDR and the inflammatory biomarker C-reactive protein (CRP) using Spearman's correlation and multilevel linear regression. RESULTS: For children and adolescents, pro- and anti-inflammatory food groups showed Spearman's correlation coefficients ranging from 0.31 to 0.66, convergent validity ranging from 0.09 to 0.40, and criterion validity for a reliability range from -0.03 to 0.18. The PAIFIS showed Spearman's correlation coefficients for reliability ranging from 0.61 to 0.69, convergent validity from 0.16 to 0.23, and criterion validity from -0.03 to 0.24. CONCLUSION: The PAIFIS showed acceptable reliability, weak convergent validity, and weak criterion validity in children and adolescents.

Association Between Sleep Time and Pro- and Anti-Inflammatory Biomarkers Is Mediated by Abdominal Obesity Among Adolescents.

OBJECTIVES: Movement behaviors and abdominal obesity are associated with higher inflammatory biomarkers. However, the role of waist circumference as a mediating factor is still unknown. Thus, our aims were to (1) test the associations between 24-hour movement behavior variables (physical activity, sedentary behavior, and sleep), abdominal obesity, and pro- and anti-inflammatory biomarkers; and (2) investigate whether abdominal obesity had a mediating effect between the investigated associations. METHODS: This multicenter cross-sectional study included 3591 adolescents (aged 12-17 y) from 4 Brazilian cities. Waist circumference (in centimeters; at half the distance between the iliac crest and at the lower costal margin), 24-hour movement behaviors (validated questionnaire), high-sensitive C-reactive protein, and adiponectin (serum plasma) were evaluated. We used multiple mediation regression models (95% confidence interval) to determine if waist circumference mediated the association between 24-hour movement behaviors and pro- and anti-inflammatory biomarkers. RESULTS: The results revealed that screen time and moderate to vigorous physical activity were not associated with pro- or anti-inflammatory biomarkers. However, sleep duration (in hours per day) was negatively associated with pro- (C-reactive protein, ß = -0.08; 95% confidence interval, -0.38 to -0.02) and anti- (adiponectin, ß = -0.31; 95% confidence interval, -2.13 to -0.12) inflammatory biomarkers. Our results also showed that waist circumference mediated the association between sleep duration and high-sensitive C-reactive protein (2.7%), and adiponectin (2.8%). CONCLUSION: Sleep duration was inversely associated with pro- and anti-inflammatory biomarkers, and these relations were mediated by abdominal obesity. Therefore, adolescents having healthy sleep can have implications for reducing waist circumference and inflammatory indicators.

Understanding the correlates of adolescents' dietary intake patterns. A multivariate analysis.

We investigated dietary intake patterns (DIP) in adolescents (14-18 year-olds) and the association with demographic and socioeconomic characteristics and lifestyle variables. This school-based survey was carried out among high school students from the city of Maringá in the state of Paraná (PR), Brazil (2007). The sample included 991 students (54.5% girls) from high schools. DIPs were investigated by the frequency of weekly consumption of each food group: vegetables, fruit, rice, beans, fried food, sweet food, milk, soda, meat, eggs, alcoholic drinks. Independent variables were: demographic and socioeconomic characteristics and lifestyle variables. DIPs were identified using principal component analysis with orthogonal rotation (varimax). Three components were extracted. Component 1 (fried foods, sweets and soft drinks) was positively associated with not having breakfast for girls and dinner for boys. Moreover, component 2 (consumption of fruit and vegetables) was positively associated with having breakfast at home for boys and number of meals for girls. Component 3 (beans, eggs and meat) was positively associated with having lunch, employment and sedentary behavior level for girls. However, it was negatively associated with having lunch and dinner for boys. Adolescents who have healthier eating patterns also had other healthier behaviors regardless of gender. However, factors associated with dietary patterns differ between boys and girls.

Validity and Reliability of Questionnaires That Assess Barriers and Facilitators of Sedentary Behavior in the Pediatric Population: A Systematic Review.

We systematically reviewed the literature about the validity and reliability of barriers and facilitators of sedentary behavior questionnaires for children and adolescents, considering accelerometers as the reference method. We included studies that assessed the agreement between the barriers and facilitators of sedentary behavior through a questionnaire and an objective measure (e.g., accelerometry). We searched four electronic databases (MEDLINE/PubMed, CINAHL, Web of Science, and SCOPUS): these databases were searched for records from inception to 5 March 2021, and updated to November 2022. The search strategy used the following descriptors: children and adolescents; barriers or facilitators; questionnaires; accelerometers; and validation or reliability coefficient. Studies identified in the search were selected independently by two reviewers. The inclusion criteria were: (i) population of children and adolescents, (ii) original studies, (iii) subjective and objective measurement methods, (iv) studies that report validity or reliability, and (v) population without specific diseases. Seven studies were eligible for our review. The main exclusion reasons were studies that did not report validity or reliability coefficients (56.6%) and non-original studies (14.5%). The participants' ages in the primary studies ranged from 2 to 18 years. Cronbach's alpha coefficient was the most reported reliability assessment among the eligible articles, while Pearson and Spearman's coefficients were prevalent for validity. The reliability of self-report questionnaires for assessing sedentary behavior ranged from r = 0.3 to 1.0. The validity of the accelerometers ranged from r = -0.1 to 0.9. Family environment was the main factor associated with sedentary behavior. Our findings suggest that questionnaires assessing the barriers and facilitators of sedentary behavior are weak to moderate. PROSPERO Registration (CRD42021233945).

Longitudinal Associations of Physical Activity Patterns and the Environment: An 18-Year Follow-Up to the MESA Study.

Introduction: Cross-sectional association between the neighborhood-built environment and physical activity (PA) has been demonstrated previously, indicating the importance of neighborhood perception characteristics such as walkability, safety, and the connectivity of streets on PA levels. Our study aimed to assess the longitudinal data from participants of the Multi-Ethnic Study of Atherosclerosis (MESA) to evaluate the potential relationship between perceived environment and PA patterns. Methods: We analyzed data from a subset of participants (n = 3097) with available PA data who participated in a prospective cohort conducted from 2000 to 2018. The exposure variables were the perceived aspects of the neighborhood environment and the perception of safety, and the outcome was patterns of PA. Patterns were defined as categories reflecting meeting versus not meeting PA guidelines over time. We created the following categories: adopters (individuals who did not meet guidelines at baseline but met guidelines at Exam 6), relapsers (individuals who met guidelines at baseline but did not meet guidelines at Exam 6), maintainers (individuals who met guidelines both at baseline and Exam 6), and insufficiently active (individuals who did not meet guidelines at either baseline or Exam 6). The maintainers' group was considered the reference category. We estimated the relative risk to assess the magnitude effect of the association between environmental perceptions and the outcome. Results: Individuals who reported that lack of parks and playgrounds was "not a problem" in their neighborhood had a 2.3-times higher risk of decreasing their physical activity (i.e., the "relapser" category) compared to maintainers. After full adjustment, perceiving poor sidewalks as "somewhat a serious problem" was associated with a 64% lower risk of becoming an adopter than a maintainer. When compared to those who perceive the neighborhood as "very safe", perception of the neighborhood as "safe" to "not at all safe" (ratings 3, 4, and 5, respectively, on the perceived safety scale) was significantly associated with being classified in the adopter category. Conclusions: As the first longitudinal study of the association of perceived environment and physical activity within the MESA cohort, we conclude that a few aspects are longitudinally associated with being physically active among adults.