BUSCADOR RECOLECTA

On behalf of the HELENA project group., Objectives To examine the association of health-related physical fitness components and accurate measures of fatness with attention in European adolescents. Design Cross-sectional study. Methods A sub-sample of 444 adolescents from the HELENA study (14.5 ± 1.2 years) from 6 different countries participated in this study. Adolescents underwent evaluations of fitness (20 m shuttle run, handgrip strength, standing long jump and 4 × 10 m shuttle run tests), fatness (body mass index, skinfold thicknesses, bioelectrical impedance, Bod Pod and dual-energy X-ray absorptiometry) and attention (d2-test). Results Higher cardiorespiratory fitness was positively associated with better attention capacity (β = 0.1, p = 0.03). Body mass index and fat mass index measured by Bod Pod and dual-energy X-ray absorptiometry in a subset were negatively associated with attention (β = −0.11, p = 0.02; β = −0.36, p = 0.02; β = −0.34, p = 0.03; respectively). All models were adjusted for age, sex, family-affluence scale and mother education. When these models were additionally adjusted for cardiorespiratory fitness when fatness was the main predictor and vice versa, the associations were somewhat attenuated and were no longer statistically significant. Muscular strength, speed-agility and body fatness markers measured by bioelectrical impedance and skinfolds were not associated with attention. The fit and non-overweight adolescents presented the highest values of attention capacity whilst their unfit and overweight peers showed the lowest values of attention (47.31 ± 2.34 vs. 33.74 ± 4.39; p < 0.01). Conclusions Our results support that both cardiorespiratory fitness and fatness are associated with attention, yet these associations are not independent. A combined effect was also observed, with fit and non-overweight adolescents showing the highest levels of attention and those unfit and overweight the lowest., The HELENA Study was carried out with the financial support of the European Community Sixth RTD Framework Programme (Contract FOOD-CT-2005-007034) and of the Stockholm County Council. FBO and JRR are supported by grants from the Spanish Ministry of Science and Innovation (RYC-2011-09011 and RYC-2010-05957, respectively). CCS is supported by grants from the University of Granada and Spanish Ministry of Economy and Competitiveness (FPU2013/55, BES-2014-068829). In addition, this study takes place under the umbrella of the ActiveBrains project, funded by the Spanish Ministry of Economy and Competitiveness (Ref. DEP2013-47540); and it was further supported by the SAMID III network, RETICS, funded by the PN I+D+I 2017-2021 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF) (Ref. RD16/0022). This work is part of a Ph.D. Thesis conducted in the Biomedicine Doctoral Studies of the University of Granada, Spain., Peer Reviewed

On behalf of the HELENA study group., [Background and aims] Inflammation may influence the cardio-metabolic profile which relates with the risk of chronic diseases. This study aimed to assess the inflammatory status by metabolic health (MH)/body mass index (BMI) category and to assess how inflammatory markers can predict the cardio-metabolic profile in European adolescents, considering BMI. [Methods and results] A total of 659 adolescents (295 boys) from a cross-sectional European study were included. Adolescents were classified by metabolic health based on age- and sex-specific cut-off points for glucose, blood pressure, triglycerides, high density cholesterol and BMI. C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), interleukin (IL-6), complement factors (C3, C4) and cell adhesion molecules were assessed. [Results] Metabolically abnormal (MA) adolescents had higher values of C3 (p < 0.001) and C4 (p = 0.032) compared to those metabolically healthy (MHy). C3 concentrations significantly increased with the deterioration of the metabolic health and BMI (p < 0.001). Adolescents with higher values of CRP had higher probability of being in the overweight/obese-MH group than those allocated in other categories. Finally, high C3 and C4 concentrations increased the probability of having an unfavorable metabolic/BMI status. [Conclusions] Metabolic/BMI status and inflammatory biomarkers are associated, being the CRP, C3 and C4 the most related inflammatory markers with this condition. C3 and C4 were associated with the cardio-metabolic health consistently., The HELENA Study was supported by the European Community Sixth RTD Framework Programme (Contract FOOD-CT-2005-007034) and the Stockholm County Council. This analysis was also supported by the Spanish Ministry of Science and Innovation (JCI-2010-07055) and the gs4:European Regional Development Fund (FEDER). CCS is supported by the Spanish Ministry of Economy and Competitiveness (BES-2014-068829). FBO is supported by a grant from the Spanish Ministry of Science and Innovation (RYC-2011-09011). AIR was funded by a Juan de la Cierva-Formación stipend from the Ministry of Economy and Competitiveness of the Spanish Government (FJCI-2014-19795)., Peer Reviewed

The objective of the present cross-sectional study was to examine the associations of physical activity and the adherence to the Mediterranean dietary pattern (MDP) with bone mineral content (BMC) and density (BMD) in children with overweight and obesity. A total of 177 (n = 80 girls) children with overweight and obesity aged 8 to 12 years old participated in the study. Both BMC and BMD were assessed by Dual-Energy X-ray absorptiometry. Dietary patterns were assessed by the KIDMED questionnaire and two 24-hour recalls. Physical activity was assessed by accelerometers for 7 consecutive days (24 hours/day). Low adherence to the MDP was observed in 82.4% of participants. Higher physical activity levels (of at least moderate intensity) and lower sedentary time were significantly associated with BMC and BMD in children with low adherence to the MDP (all p < 0.05). No associations were observed between physical activity and BMC and BMD in children with high adherence to the MDP. In conclusion, engaging in moderate to vigorous physical activity and reducing the time spent in sedentary behavior might be particularly beneficial for improving bone health in overweight or obese children with poor adherence to the Mediterranean dietary pattern.

This study examined 1) the association of dietary energy density from solid (EDS) and solid plus liquids (EDSL) with adiposity and cardiometabolic risk factors (CRF) in children with overweight and obesity, 2) the effect of under-reporting on the mentioned associations, and 3) whether the association between ED, and body composition and CRF is influenced by levels of physical activity. In a cross-sectional design, 208 children with overweight and obesity (8 to 12-year- old; 111 boys) completed two non-consecutive 24-hour recalls. ED was calculated using two different approaches: EDS and EDSl- Under-reporters were determined with the Goldberg method. Body composition, anthropometry and fasting blood sample measurements were performed. Moderate-to-vigorous physical activity (MVPA) was registered with accelerometers (7-day-register). Linear regressions were performed to evaluate the association of ED with the previously mentioned variables. Neither EDS nor EDSL were associated with body composition nor CRF. However, when under-reporters were excluded, EDS was positively associated with BMI (p=.019), body fat percentage (p=.005), abdominal fat (p=.008) and fat mass index (p=.018), while EDSL was positively associated with body fat percentage (p=.008) and fat mass index (p=.026). When stratifying the group according to physical activity recommendations, the aforementioned associations were only maintained for non-compliers. Cluster analysis showed that the low-ED and high-MVPA group presented the healthiest profile for all adiposity and CRF. These findings could partly explain inconsistencies in literature, as we found that different ED calculations entail distinct results. Physical activity levels and excluding under-reporters greatly influence the associations between ED and adiposity in children with overweight and obesity.

The association between vitamin D [25(OH)D] and bone health has been widely studied in children. Given that 25(OH)D and bone health are associated with muscular fitness, this could be the cornerstone to understand this relationship. Hence, the purpose of this work was to examine if the relation between 25(OH)D and areal bone mineral density (aBMD) was mediated by muscular fitness in children with overweight/obesity. Eighty-one children (8-11 years, 53 boys) with overweight/obesity were included. Body composition was measured with dual energy X-ray Absorptiometry (DXA), 25(OH)D was measured in plasma samples and muscular fitness was assessed by handgrip and standing long jump tests (averaged z-scores were used to represent overall muscular fitness). Simple mediation analyses controlling for sex, years from peak height velocity, lean mass and season were carried out. Our results showed that muscular fitness z-score, handgrip strength and standing long jump acted as mediators in the relationship between 25(OH)D and aBMD outcomes (percentages of mediation ranged from 49.6% to 68.3%). In conclusion, muscular fitness mediates the association of 25(OH)D with aBMD in children with overweight/obesity. Therefore, 25(OH)D benefits to bone health could be dependent on muscular fitness in young ages.

Importance: Childhood obesity is a risk factor associated with type 2 diabetes, cardiovascular disease, and mental disorders later in life. Investigation of the parallel effects of a defined exercise program on cardiometabolic and mental health in children with overweight or obesity may provide new insights on the potential benefits of exercise on overall health. Objective: To investigate the effects of a 20-week exercise program on cardiometabolic and mental health in children with overweight or obesity. Design, Setting, and Participants: This secondary analysis of a parallel-group randomized clinical trial was conducted in Granada, Spain, from November 1, 2014, to June 30, 2016. Data analyses were performed between February 1, 2020, and July 14, 2022. Children with overweight or obesity aged 8 to 11 years were eligible, and the study was performed in an out-of-school context. Intervention: The exercise program included 3 to 5 sessions/wk (90 min/session) of aerobic plus resistance training for 20 weeks. The wait-list control group continued with their usual routines. Main Outcomes and Measures: Cardiometabolic outcomes as specified in the trial protocol included body composition (fat mass, fat-free mass, and visceral adipose tissue), physical fitness (cardiorespiratory, speed-agility, and muscular), and traditional risk factors (waist circumference, blood lipid levels, glucose levels, insulin levels, and blood pressure). Cardiometabolic risk score (z score) was calculated based on age and sex reference values for levels of triglycerides, inverted high-density lipoprotein cholesterol, and glucose, the mean of systolic and diastolic blood pressure, and waist circumference. An additional cardiometabolic risk score also included cardiorespiratory fitness. Mental health outcomes included an array of psychological well-being and ill-being indicators. Results: The 92 participants included in the per-protocol analyses (36 girls [39%] and 56 boys [61%]) had a mean (SD) age of 10.0 (1.1) years. The exercise program reduced the cardiometabolic risk score by approximately 0.38 (95% CI, -0.74 to -0.02) SDs; decreased low-density lipoprotein cholesterol level by -7.00 (95% CI, -14.27 to 0.37) mg/dL (to convert to mmol/L, multiply by 0.0259), body mass index (calculated as weight in kilograms divided by height in meters squared) by -0.59 (95% CI, -1.06 to -0.12), fat mass index by -0.67 (95% CI, -1.01 to -0.33), and visceral adipose tissue by -31.44 (95% CI, -58.99 to -3.90) g; and improved cardiorespiratory fitness by 2.75 (95% CI, 0.22-5.28) laps in the exercise group compared with the control group. No effects were observed on mental health outcomes. Conclusions and Relevance: In this secondary analysis of a randomized clinical trial, an aerobic plus resistance exercise program improved cardiometabolic health in children with overweight or obesity but had no effect on mental health. Trial Registration: ClinicalTrials.gov Identifier: NCT02295072., This project was supported with grants DEP2013-47540, DEP2016-79512-R, DEP2017-91544-EXP, and RYC-2011-09011 from the Spanish Ministry of Economy and Competitiveness and the Fondo Europeo de Desarrollo Regional (FEDER) and by grant PID2020-120249RB-I00 from the MCIN/AEI /10.13039/501100011033. Additional funding was obtained from the Andalusian Operational Programme supported with grant B-CTS-355-UGR18 from the European Regional Development Fund (FEDER in Spanish). Dr Cardenas-Sanchez is supported by grant FJC2018-037925-I from the Spanish Ministry of Science and Innovation and by a grant from the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska Curie grant agreement No 101028929. Dr Migueles is supported by grant FPU15/02645 from the Spanish Ministry of Education, Culture and Sport, and grant 2012–00036 from the Swedish Research Council for Health, Working Life and Welfare. Dr Torres-Lopez is supported by grant FPU17/04802 from the Spanish Ministry of Science, Innovation and Universities. Dr Rodriquez-Ayllon was funded by grant DEP2017-91544-EXP from the Ramón Areces Foundation. Additional support was obtained from grant ALICIAK-2018 from the Alicia Koplowitz Foundation, University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence, Unit of Excellence on Exercise, Nutrition and Health, the Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades; and grant DEP2005-00046/ACTI from the EXERNET Research Network on Exercise and Health in Special Populations. This research was supported by grant CB22/03/00058 from the Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea–European Regional Development Fund.