BUSCADOR RECOLECTA

Aim: Adipokines seem to play a role in bone morphogenesis, although this also depends on the mechanical forces applied to the skeleton. The aim was to assess the
relationships of resting leptin and adiponectin with bone parameters and whether
high muscular fitness levels affect these relationships in children with overweight or
obesity.
Methods: This cross-sectional study took part from 2014 to 2016 in Granada, Spain.
Participants were recruited from University Hospitals, and we also used advertisements in local media and school contacts in the city. Adipokines were analysed in
plasma. Muscular fitness was assessed by one repetition maximum in bench and leg
press tests. Dual-energy X-ray absorptiometry was used to measure bone parameters.
Results: We included 84 children (10.0 ± 1.2y; 63% boys) in this analysis. Leptin was
negatively associated with lumbar spine bone mineral content (β = −0.162, p = 0.053).No significant interaction was found for muscular fitness. Simple slope estimates suggested that children performing more than 133.3 kg in leg press test ameliorated the
negative association between leptin and lumbar spine bone mineral content.
Conclusion: Leptin levels were negatively associated with lumbar spine bone mineral
content in children with overweight or obesity. A high muscular fitness at the lower
body could counteract this association., This study was mainly supported by grants from the Spanish Ministry of Economy and Competitiveness (DEP2013-47540, DEP2016-79512-R, DEP2017-91544-EXP and RYC-2011-09011), European Regional Development Fund (ERDF) of the European Commission (No 667302) and the Alicia Koplowitz Foundation. Additional funding was obtained from the Andalusian Operational Programme supported with ERDF (FEDER in Spanish, B-CTS-355-UGR18). Additional support was obtained from University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence, Unit of Excellence on Exercise and Health, the Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades (SOMM17/6107/UGR); the EXERNET Research Network on Exercise and Health in Special populations (DEP2005-00046/ACTI); and the HL-PIVOT network - Healthy Living for Pandemic Event Protection. Funding for open access charge: Universidad de Granada / CBUA.

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.

Incluye material complementario, Obesity and metabolic syndrome (MetS) are worldwide major health challenges. The Mediterranean diet (MD) is associated with a better cardiometabolic profile, but these beneficial effects may be influenced by genetic variations, modulating the predisposition to obesity or MetS. The aim was to assess whether interaction effects occur between an obesity genetic risk score (obesity-GRS) and the MD on adiposity and MetS in European adolescents. Multiple linear regression models were used to assess the interaction effects of an obesity-GRS and the MD on adiposity and MetS and its components. Interaction effects between the MD on adiposity and MetS were observed in both sex groups (p < 0.05). However, those interaction effects were only expressed in a certain number of adolescents, when a limited number of risk alleles were present. Regarding adiposity, a total of 51.1% males and 98.7% females had lower body mass index (BMI) as a result of higher MD adherence. Concerning MetS, only 9.9% of males with higher MD adherence had lower MetS scores. However, the same effect was observed in 95.2% of females. In conclusion, obesity-related genotypes could modulate the relationship between MD adherence and adiposity and MetS in European adolescents; the interaction effect was higher in females than in males., Miguel Seral-Cortes, the corresponding author, has received funding from the Iberus Talent Pre-doctoral fellowships 2018, under the European Union’s H2020 research and innovation programme under Marie Sklodowska-Curie grant agreement No 801586. Pilar de Miguel-Etayo was supported by ISCIII-CB15/00043 (Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, CIBERObn). This work was part of the HELENA Study (http://www.helenastudy.com/). We gratefully acknowledge financial support of the European Community Sixth RTD Framework Programme (contract FOOD-CT-2005-007034). The data for this study were gathered under the auspices of the HELENA project, and further analysis was additionally supported by the Spanish Ministry of Economy and Competitiveness (Grants RYC-2010-05957 and RYC-2011-09011), the Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn).

Concurrent training has been postulated as an appropriate time-efficient strategy to improve physical fitness, yet whether the exercise-induced adaptations are similar in men and women is unknown. An unblinded randomized controlled trial was conducted to investigate sex-specific dose–response effects of a 24-week supervised concurrent exercise training program on cardiorespiratory fitness and muscular strength in young adults. One hundred and forty-four sedentary adults aged 18–25 years were assigned to either (i) a control group (n = 54), (ii) a moderate intensity exercise group (MOD-EX, n = 46), or (iii) a vigorous intensity exercise group (VIG-EX, n = 44) by unrestricted randomization. Cardiorespiratory fitness (VO2max), hand grip strength, and one-repetition maximum of leg press and bench press were evaluated at baseline and after the intervention. A total of 102 participants finished the intervention (Control, n = 36; 52% women, MOD-EX, n = 37; 70% women, and VIG-EX, n = 36; 72% women). In men, VO2max significantly increased in the MOD-EX (~8%) compared with the control group and in the VIG-EX group after the intervention (~6.5%). In women, VO2max increased in the MOD-EX and VIG-EX groups (~5.5%) compared with the control group after the intervention. There was a significant increment of leg press in the MOD-EX (~15.5%) and VIG-EX (~18%) groups compared with the control group (~1%) in women. A 24-week supervised concurrent exercise was effective at improving cardiorespiratory fitness and lower body limbs muscular strength in young women—independently of the predetermined intensity—while only at moderate intensity improved cardiorespiratory fitness in men., The study is supported by the Spanish Ministry of Economy and Competitiveness, Fondo de Investigación Sanitaria del Instituto de Salud Carlos III (PI13/01393), Fondos Estructurales de la Unión Europea (FEDER), by the Spanish Ministry of Science and Innovation (RYC-2010-05957, RYC-2011-09011, FJC2020-043385-I), by the Spanish Ministry of Education (FPU 13/04365, and Beca de Colaboración Ref. 11727189), by the University of Granada (Beca de Iniciación a la Investigación), by the Fundación Iberoamericana de Nutrición (FINUT), by the Redes Temáticas de Investigación Cooperativa RETIC (Red SAMID RD12/0026/0015), by AstraZeneca HealthCare Foundation, and by Vegenat®.

Objective To evaluate the associations of parent-reported sleep-disordered breathing (SDB) and deviceassessed sleep behaviors with behavioral and emotional functioning in pediatric patients with overweight/ obesity. Study design A total of 109 children with overweight/obesity (mean age, 10.0 (±) 1.1 years) were included in this cross-sectional study. We used the Spanish version of the Pediatric Sleep Questionnaire (PSQ) to assess SDB and its subscales (ie, snoring, daytime sleepiness, and inattention/hyperactivity). Device-assessed sleep behaviors (ie, wake time, sleep onset time, total time in bed, total sleep time, and waking after sleep onset) were estimated using wrist-worn accelerometers. We used the Behavior Assessment System for Children, second edition to assess behavioral and emotional functioning (ie, clinical scale: aggressiveness, hyperactivity, behavior problems, attention problems, atypicality, depression, anxiety, retreat, and somatization; adaptive scale: adaptability, social skills, and leadership). Results SDB was positively associated with all clinical scale variables (all b > 0.197, P ≤ .041) and with lower adaptability and leadership (all b < 0.226, P < .021). Specifically, the PSQ subscale relating to daytime sleepiness was associated with higher attention problems, depression, anxiety, and retreat (all b > 0.196, P ≤ .045) and lower adaptability (b = 0.246, P = .011). The inattention/hyperactivity subscale was significantly associated with the entire clinical and adaptive scales (all b > |0.192|, P ≤ .046) except for somatization. The snoring subscale and device-assessed sleep behaviors were not related to any behavioral or emotional functioning variables. Conclusions Our study suggests that SDB symptoms, but not deviceassessed sleep behaviors, are associated with behavioral and emotional functioning in children with overweight/obesity. Specifically, daytime sleepiness, a potential SDB symptom, was related to higher attention problems, depression, anxiety, and retreat and lower adaptability. (J Pediatr 2022;246:170-8)., The ActiveBrains project was funded by the Spanish Ministry of Economy and Competitiveness and the Fondo Europeo de Desarrollo Regional (DEP2013-47540, DEP2016-79512-R, DEP2017-91544-EXP, and RYC-2011-09011). L.V.T.-L. is supported by a grant from the Spanish Ministry of Science, Innovation and Universities (FPU17/04802). C.C.-S. is supported by the Spanish Ministry of Science and Innovation (FJC2018-037925-I). J.H.M. is supported by a grant from the Spanish Ministry of Education, Culture, and Sport (FPU15/02645). Additional support was provided by the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence, Scientific Excellence Unit on Exercise and Health, by the Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades, and European Regional Development Fund (SOMM17/6107/UGR). Funding was also provided by the SAMID III network, RETICS , funded by the PNI + D + I 2017-2021 (Spain), ISCIII Sub-Directorate General for Research Assessment and Promotion, the European Regional Development Fund (RD16/0022 ), the EXERNET Research Network on Exercise and Health ( DEP2005-00046/ACTI ; 09/UPB/19; 45/UPB/20; 27/UPB/21), the European Union's 2020 Research and Innovation Program under Grant Agreement 667302, and the HL-PIVOT network Healthy Living for Pandemic Event Protection . Additional funding was obtained from the Andalusian Operational Programme supported with European Regional Development Fund (project B-CTS-355-UGR18).

Approximately 4–11% of children suffer from sleep-disordered breathing (SDB), and children with obesity are at increased risk. Both obesity and SDB have been separately associated with poorer brain health, yet whether SDB severity affects brain health in children with obesity remains unanswered. This study aimed to examine associations of SDB severity with academic performance and brain structure (i.e., total brain and gray and white matter volumes and gray matter volume in the hippocampus) in children with overweight/obesity. One hundred nine children aged 8–12 years with overweight/obesity were included. SDB severity and its subscales (i.e., snoring, daytime sleepiness, and inattention/hyperactivity) were evaluated via the Pediatric Sleep Questionnaire (PSQ), and academic performance was evaluated with the Woodcock-Muñoz standardized test and school grades. Brain structure was assessed by magnetic resonance imaging. SDB severity was not associated with academic performance measured by the standardized test (all |β|> 0.160, P > 0.076), yet it was associated with the school grade point average (β = -0.226, P = 0.007) and natural and social science grades (β = -0.269, P = 0.024). Intention/hyperactivity seemed to drive these associations. No associations were found between SDB severity and the remaining school grades (all β < -0.188, P > 0.065) or brain volumes (all P > 0.05). Conclusion: our study shows that SDB severity was associated with lower school grades, yet it was not associated with the standardized measurement of academic performance or with brain volumes in children with overweight/obesity. SDB severity may add to academic problems in children beyond the effects contributed by overweight/obesity status alone.What is Known:• Sleep-disordered breathing (SDB) may affect brain structure and academic performance in children.• Children with overweight/obesity are at higher risk for the development of SDB, yet the comorbid obesity-SDB relationship with brain health has not been investigated thus far. What is New:• To our knowledge, this is the first study examining the associations of comorbid obesity-SDB severity with brain volumes and academic performance in children.• SDB symptoms may adversely affect academic performance at school in children with overweight/obesity, beyond the effects of weight status alone., The ActiveBrains project was funded by the Spanish Ministry of Economy and Competitiveness and the ‘Fondo Europeo de Desarrollo Regional (FEDER)’ (DEP2013-47540, DEP2016-79512-R, DEP2017-91544-EXP and RYC-2011–09011). L.V.T.-L. is supported by a Grant from the Spanish Ministry of Science, Innovation and Universities (FPU17/04802). J.H.M. is supported by a Grant from the Spanish Ministry of Education, Culture and Sport (FPU15/02645). C.C.-S. is supported by the Spanish Ministry of Science and Innovation (FJC2018-037925-I). IEC is supported by the Spanish Ministry of Science and Innovation (RYC2019-027287-I). Additional support was obtained from the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence, Scientific Excellence Unit on Exercise and Health (UCEES), by the Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades, and European Regional Development Funds (ref. SOMM17/6107/UGR). In addition, funding was provided by the SAMID III network, RETICS, funded by the PNI + D + I 2017–2021 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion, the European Regional Development Fund (ERDF) (Ref. RD16/0022), the EXERNET Research Network on Exercise and Health (DEP2005-00046/ACTI; 09/UPB/19; 45/UPB/20; 27/UPB/21), the European Union’s 2020 research and innovation program under grant agreement No.667302, and the HL-PIVOT network-Healthy Living for Pandemic Event Protection. Additional funding was obtained from the Andalusian Operational Programme supported with European Regional Development Funds (ERDF in English, FEDER in Spanish, project ref: B-CTS-355-UGR18).

We acknowledge Wiley and the Arthritis and Rheumatology for publishing our scientific article: Segura-Jiménez, V., Álvarez-Gallardo, I. C., Estévez-López, F., Soriano-Maldonado, A., Delgado-Fernández, M., Ortega, F. B., Aparicio, V. A., Carbonell-Baeza, A., Mota, J., Silva, P., & Ruiz, J. R. (2015). Differences in sedentary time and physical activity between female patients with fibromyalgia and healthy controls: The al-Ándalus project. Arthritis and Rheumatology, 67(11), 3047-3057. https://doi.org/10.1002/ART.39252, Objective To characterize the levels of objectively measured time spent in sedentary activities (sedentary time) and physical activities in female patients with fibromyalgia and compare them with the levels in age-matched healthy control women. Methods The study comprised 413 female patients with fibromyalgia (mean ± SD age 51.9 ± 7.4 years) and 188 female control subjects (age 50.9 ± 7.5 years). Sedentary time, the amount of time spent engaged in physical activity, and step counts were measured using triaxial accelerometry. The amounts of time (minutes/day) during which the participants were engaged in sedentary behaviors as well as in physical activity of different intensities (light, moderate, and moderate-to-vigorous) and the step counts were calculated. Results The amount of time spent in sedentary behavior was longer in patients with fibromyalgia compared with controls (estimated mean ± SEM difference 39 ± 8 minutes/day; P < 0.001). The patients with fibromyalgia spent less time than controls engaged in light physical activity (mean ± SEM difference -21 ± 7 minutes/day; P = 0.005), moderate physical activity (mean ± SEM difference -17 ± 3 minutes/day; P < 0.001), and moderate-to-vigorous physical activity (mean ± SEM difference -19 ± 3 minutes/day; P < 0.001). The patients with fibromyalgia took fewer steps/day compared with the control subjects (mean ± SEM difference -1,881 ± 262 steps/day; P < 0.001). Only 20.6% of the patients with fibromyalgia and 46.3% of the control subjects fulfilled the recommendation for 150 minutes/week of moderate-to-vigorous physical activity in bouts of at least 10 minutes/bout (χ2 = 41.8, P < 0.001). Similarly, only 16.0% of the patients fulfilled the recommendation for ≥10,000 steps/day compared with 44.7% of the control subjects (χ2 = 56.8, P < 0.001). Both the patients and the control subjects were more active (physical activity of all intensities and numbers of steps) on weekdays than on weekend days (all P ≤ 0.001). Conclusion Female patients with fibromyalgia spent more time in sedentary behaviors and were less physically active than age-matched controls. The low proportions of female patients with fibromyalgia and control subjects who met the physical activity and step count recommendations is worrisome.

We acknowledge Elsevier and the Seminars in Arthritis and Rheumatism for publishing our scientific article: Segura-Jiménez, V., Álvarez-Gallardo, I. C., Carbonell-Baeza, A., Aparicio, V. A., Ortega, F. B., Casimiro, A. J., & Delgado-Fernández, M. (2015). Fibromyalgia has a larger impact on physical health than on psychological health, yet both are markedly affected: The al-Ándalus project. Seminars in Arthritis and Rheumatism, 44(5), 563-570.
https://doi.org/10.1016/J.SEMARTHRIT.2014.09.010, Objectives: To characterize a representative sample of fibromyalgia women based on a set of relevant factors known to be related to this disease. To distinguish specific factors of the disease from other symptoms that might also exist in non-fibromyalgia women. To test whether fibromyalgia affects more severely physical or psychological outcomes.
Methods: A total of 459 fibromyalgia women vs. 214 non-fibromyalgia (control) women from southern Spain (Andalusia) took part in this cross-sectional study. Several instruments were used to assess tenderness, impact of fibromyalgia, fatigue, health-related quality of life, mental health and cognitive performance.
Results: Overall, fibromyalgia women showed a worse status in pain, fatigue, health-related quality of life, depression and anxiety than controls (P<0.01). In general, the observed associations presented very large effect sizes (Cohen’s d from ~1 to ~5.5). No differences between fibromyalgia and controls were observed in cognitive and memory performance, except for delayed recall, but the observed effect size was low (~0.25). The effect size observed for the global physical component (~3.3) was larger than that for the global psychological component (~1.3), all P<0.001.
Conclusions: Our results reinforce the understanding of fibromyalgia as a polysymptomatic distress condition with pain as its main symptom. Our findings support that fibromyalgia seems to have a greater impact on physical than on psychological outcomes, though both are largely affected.

We acknowledge Wiley-Blackwell and Scandinavian Journal of Medicine and Science in Sports for publishing our scientific article: Álvarez-Gallardo, I. C., Carbonell-Baeza, A., Segura-Jiménez, V., Soriano-Maldonado, A., Intemann, T., Aparicio, V.A., Estévez-López, F., Camiletti-Moirón, D., Herrador-Colmenero, M., Ruiz, J.R., Delgado-Fernández, M., & Ortega, F.B. (2017). Physical fitness reference standards in fibromyalgia: The al-Ándalus project. Scandinavian Journal of Medicine and Science in Sports, 27(11), 1477-1488.
https://doi.org/10.1111/SMS.12741, We aimed (1) to report age-specific physical fitness levels in people with fibromyalgia of a representative sample from Andalusia; and (2) to compare the fitness levels of people with fibromyalgia with non-fibromyalgia controls. This cross-sectional study included 468 (21 men) patients with fibromyalgia and 360 (55 men) controls. The fibromyalgia sample was geographically representative from southern Spain. Physical fitness was assessed with the Senior Fitness Test battery plus the handgrip test. We applied the Generalized Additive Model for Location, Scale and Shape to calculate percentile curves for women and fitted mean curves using a linear regression for men. Our results show that people with fibromyalgia reached worse performance in all fitness tests than controls (P < 0.001) in all age ranges (P < 0.001). This study provides a comprehensive description of age-specific physical fitness levels among patients with fibromyalgia and controls in a large sample of patients with fibromyalgia from southern of Spain. Physical fitness levels of people with fibromyalgia from Andalusia are very low in comparison with age-matched healthy controls. This information could be useful to correctly interpret physical fitness assessments and helping health care providers to identify individuals at risk for losing physical independence.

This study aimed to analyse the association between socioeconomic status (SES) and fatness and fitness in preschoolers. 2,638 preschoolers (3–5 years old; 47.2% girls) participated. SES was estimated from the parental educational and occupational levels, and the marital status. Fatness was assessed by body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR). Physical fitness components were assessed using the PREFIT battery. Preschoolers whose parents had higher educational levels had lower fatness (P < 0.05). BMI significantly differed across occupational levels of each parent (P < 0.05) and WHtR across paternal levels (P = 0.004). Musculoskeletal fitness was different across any SES factor (P < 0.05), except handgrip across paternal occupational levels (P ≥ 0.05). Preschoolers with high paternal occupation had higher speed/agility (P = 0.005), and those with high or low maternal education had higher VO2max (P = 0.046). Odds of being obese and having low musculoskeletal fitness was lower as SES was higher (P < 0.05). Those with married parents had higher cardiorespiratory fitness than single-parent ones (P = 0.010). School-based interventions should be aware of that children with low SES are at a higher risk of obesity and low fitness already in the first years of life.

Objectives. Reference values are necessary for classifying children, for health screening, and for early prevention as many non-communicable diseases aggravate during growth and development. While physical fitness reference standards are available in children aged 6 and older, such information is lacking in preschool children. Therefore, the purposes of this study were (1) to provide sex-and age-specific physical fitness reference standards for Spanish preschool children; and (2) to study sex differences across this age period and to characterise fitness performance throughout the preschool period. Design. Cross-sectional. Methods. A total of 3179 preschool children (1678 boys) aged 2.8–6.4 years old from Spain were included in the present study. Physical fitness was measured using the PREFIT battery. Results. Age- and sex-specific percentiles for the physical fitness components are provided. Boys performed better than girls in the cardiorespiratory fitness, muscular strength, and speed-agility tests over the whole preschool period studied and for the different percentiles. In contrast, girls performed slightly better than boys in the balance test. Older children had better performance in all fitness tests than their younger counterparts. Conclusions. Our study provides age- and sex-specific physical fitness reference standards in preschool children allowing interpretation of fitness assessment. Sexual dimorphism in fitness tests exists already at preschool age, and these differences become larger with age. These findings will help health, sport, and school professionals to identify preschool children with a high/very low fitness level, to examine changes in fitness over time, and to analyse those changes obtained due to intervention effects.

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-a), 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.

Purpose: This study aims to compare adolescents’ cardiometabolic risk score through an integrative classification of physical activity (PA), which involves the combination of moderate-to-vigorous physical activity (MVPA) and sedentary behavior (SB).
Methods: A cross-sectional study derived from the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study database (2006–2008) was conducted in adolescents (n = 548; boys, 47.3%; 14.7 ± 1.2 years) from 10 European cities. MVPA and SB were objectively measured using accelerometry. Adolescents were divided into 4 categories according to MVPA (meeting or not meeting the international recommendations) and the median of SB time (above or below sex- and age-specific median) as follows: High-SB & Inactive, Low-SB & Inactive, High-SB & Active, and Low-SB & Active. A clustered cardiometabolic risk score was computed using the homeostatic model assessment, systolic blood pressure, triglycerides, total cholesterol/high-density lipoprotein cholesterol, sum 4 skinfolds, and cardiorespiratory fitness (CRF). Analyses of covariance were performed to discern differences on cardiometabolic risk scores among PA categories and each health component.
Results: The cardiometabolic risk score was lower in adolescents meeting the MVPA recommendation and with less time spent in SB in comparison to the high-SB & inactive group (p < 0.05). However, no difference in cardiometabolic risk score was established between high-SB or low-SB groups in inactive adolescents. It is important to note that CRF was the only variable that showed a significant modification (higher) when children were compared from the category of physically inactive with “active” but not from high-to low-SB.
Conclusion: Being physically active is the most significant and protective outcome in adolescents to reduce cardiometabolic risk. Lower SB does not exhibit a significant and extra beneficial difference.

Background and aims: The ideal cardiovascular health (iCVH) construct consists of 4 health behaviors (smoking status, body mass index, physical activity and diet) and 3 health factors (total cholesterol, blood pressure and fasting glucose). A greater number of iCVH components in adolescence are related to better cardiovascular health, but little is known about the correlates of iCVH in adolescents. Thus, the aim of the study was to examine correlates of iCVH in European adolescents.
Methods and results: The study comprised 637 European adolescents with complete iCVH data. Participants were part of the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, a cross-sectional, multicenter study conducted in 9 different European countries. Correlates investigated were sex and age, family affluence scale, maternal education, geographic location, sleep time, television viewing, duration of pregnancy, birth weight and breastfeeding. Younger adolescents, those whose mothers had medium/high education or those whowatched television less than 2 h per day had a greater number of iCVH components compared to those who were older, had a mother with low education or watched television 2 h or more daily (P <= 0.01).
Conclusion: Since in our study older adolescents had worse iCVH than younger adolescents, early promotion of cardiovascular health may be important. Future studies mayalso investigate the usefulness of limiting television viewing to promote iCVH. Finally, since adolescents of mothers with low education had poorer iCVH, it may be of special interest to tailor public health promotion to adolescents from families with low socioeconomic status.

Background & aims: Chronobiology studies periodic changes in living organisms and it has been proposed as a promising approach to investigate obesity. We analyze the association of the characteristics of the rest-activity rhythms with obesity, cardiorespiratory fitness and metabolic risk in adolescents from nine European countries.
Methods: 1044 adolescents (12.5-17.5 y) were studied. Circadian health was evaluated by actigraphy with accelerometers (Actigraph GT1M). Characteristics of the daytime activity such as fragmentation (intradaily variability), estimated acrophase, and 10 h mean daytime activity index were obtained. Body composition was assessed using Bioelectrical-Impedance-Analysis, skinfold thickness, air-displacement-plethysmography and Dual-energy-X-ray-Absorptiometry. Cardiorespiratory fitness (VO2max) and metabolic risk were studied.
Results: Highly fragmented activity rhythms were associated with obesity and central adiposity (P < 0.05). Obese adolescents had-3 times higher odds of having a high fragmentation of daytime activity compared to normal weight adolescents OR (95% CI) = 2.8 (1.170, 6.443). A highly fragmented rhythm was also related to lower cardiorespiratory fitness and higher metabolic risk (P < 0.05) so those adolescents classified as low fitness showed a significantly higher fragmentation of daytime activity than those included in the high fitness group (P < 0.0001). Other characteristics of the rhythms such as smaller 10 h daytime mean activity index and delayed estimated acrophase were also related to obesity and metabolic risk (P < 0.05).
Conclusions: Our results indicate that the daily organization of the rest-activity cycle is more fragmented in obese and less fit adolescents and correlates with higher metabolic risk. This fact reinforces our hypothesis that disturbances in daily rhythms can be considered as sensitive markers of poorer adolescent's health.

Background: Childhood obesity has become a major health problem in children under the age of 5 years. Providing reference standards would help paediatricians to detect and/or prevent health problems related to both low and high levels of body mass and to central adiposity later in life. Therefore, the aim of this study was to examine the prevalence of different weight status categories and to provide sex- and age-specific anthropometry reference standards for Spanish preschool children.
Methods: A total of 3178 preschool children (4.59±0.87 years old) participated in this study. Prevalence of different degrees of obesity (mild, severe, and morbid) and other weight status categories were determined.
Results: Reference standards were obtained. Prevalence of overweight and obese preschool children in the Spanish population ranged from 21.4 to 34.8%. Specifically, the obesity prevalence was 3.5, 1.2, and 1.3% of these subjects were categorized as mild, severe, and morbid obese. Sex- and age-specific reference standards for anthropometric parameters are provided for every 0.25 years (i.e. every trimester of life).
Conclusion: Our results show a high prevalence of overweight/obese preschoolers. The provided sex- and age-specific anthropometric reference standards could help paediatricians to track and monitor anthropometric changes at this early stage in order to prevent overweight/obesity.

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.

Objectives: Reference values are necessary for classifying children, for health screening, and for early prevention as many non-communicable diseases aggravate during growth and development. While physical fitness reference standards are available in children aged 6 and older, such information is lacking in preschool children. Therefore, the purposes of this study were (1) to provide sex-and age-specific physical fitness reference standards for Spanish preschool children; and (2) to study sex differences across this age period and to characterise fitness performance throughout the preschool period.
Design: Cross-sectional. Methods: A total of 3179 preschool children (1678 boys) aged 2.8–6.4 years old from Spain were included in the present study. Physical fitness was measured using the PREFIT battery.
Results: Age- and sex-specific percentiles for the physical fitness components are provided. Boys performed better than girls in the cardiorespiratory fitness, muscular strength, and speed-agility tests over the whole preschool period studied and for the different percentiles. In contrast, girls performed slightly better than boys in the balance test. Older children had better performance in all fitness tests than their younger counterparts. Conclusions: Our study provides age- and sex-specific physical fitness reference standards in preschool children allowing interpretation of fitness assessment. Sexual dimorphism in fitness tests exists already at preschool age, and these differences become larger with age. These findings will help health, sport, and school professionals to identify preschool children with a high/very low fitness level, to examine changes in fitness over time, and to analyse those changes obtained due to intervention effects.

This study aimed to analyse the association between socioeconomic status (SES) and fatness and fitness in preschoolers. 2, 638 preschoolers (3–5 years old; 47.2% girls) participated. SES was estimated from the parental educational and occupational levels, and the marital status. Fatness was assessed by body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR). Physical fitness components were assessed using the PREFIT battery. Preschoolers whose parents had higher educational levels had lower fatness (P &lt; 0.05). BMI significantly differed across occupational levels of each parent (P &lt; 0.05) and WHtR across paternal levels (P = 0.004). Musculoskeletal fitness was different across any SES factor (P &lt; 0.05), except handgrip across paternal occupational levels (P = 0.05). Preschoolers with high paternal occupation had higher speed/agility (P = 0.005), and those with high or low maternal education had higher VO2max (P = 0.046). Odds of being obese and having low musculoskeletal fitness was lower as SES was higher (P &lt; 0.05). Those with married parents had higher cardiorespiratory fitness than single-parent ones (P = 0.010). School-based interventions should be aware of that children with low SES are at a higher risk of obesity and low fitness already in the first years of life.

Background: We compared differences in physical activity (PA) between pre/mid-pubertal and post-pubertal participants according to gender.
Methods: The study included a total of 1842 healthy participants aged 12.5–17.4 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. Participants wore a uniaxial accelerometer (ActiGraph GT1M, Pensacola, FL, USA) attached to their lower back for seven consecutive days to measure PA. Pubertal status was assessed by physical examination and the population was classified as pre/mid-pubertal (Tanner stages 1–3) or post-pubertal (Tanner stages 4–5). PA was compared between these groups according to gender during the whole week, on school-free days and on school days, before and after school, and during lessons and recesses.
Results: When comparing the pre/mid-pubertal group with the post-pubertal group, girls’ total PA did not differ between groups. However, a slight difference was observed in boys, among whom PA on school-free days showed a difference of 17.6% between the pre/mid-pubertal group and the post-pubertal group (679 kcounts vs 564 kcounts, respectively; P = 0.0007) and 20% (162 kcount vs 135 kcounts; P = 0.006) for school recess. There was no difference among girls.
Conclusions: A reduced level of PA in the post-pubertal groups was only observed in boys during non-organized times such as on school-free days and during school recesses, with a moderate impact on total PA.

Obesity and metabolic syndrome (MetS) are worldwide major health challenges. The Mediterranean diet (MD) is associated with a better cardiometabolic profile, but these beneficial effects may be influenced by genetic variations, modulating the predisposition to obesity or MetS. The aim was to assess whether interaction effects occur between an obesity genetic risk score (obesity-GRS) and the MD on adiposity and MetS in European adolescents. Multiple linear regression models were used to assess the interaction effects of an obesity-GRS and the MD on adiposity and MetS and its components. Interaction effects between the MD on adiposity and MetS were observed in both sex groups (p < 0.05). However, those interaction effects were only expressed in a certain number of adolescents, when a limited number of risk alleles were present. Regarding adiposity, a total of 51.1% males and 98.7% females had lower body mass index (BMI) as a result of higher MD adherence. Concerning MetS, only 9.9% of males with higher MD adherence had lower MetS scores. However, the same effect was observed in 95.2% of females. In conclusion, obesity-related genotypes could modulate the relationship between MD adherence and adiposity and MetS in European adolescents; the interaction effect was higher in females than in males.

Childhood obesity is a worldwide epidemic. Mediterranean diet (MD) is inversely associated with childhood obesity, but the interaction with other environmental factors, such screen time, might influence the health benefits of a high MD adherence in adolescents. The aim of the present study was to assess whether an association between MD and screen time exists in European adolescents. Moreover, we also explored whether sedentary time has a modulatory effect on the association between MD and adiposity. Adherence to the MD (24 h recalls), screen time (questionnaire), pubertal development, body mass index (BMI), fat mass index (FMI) and waist circumference (WC) were evaluated in 2053 adolescents (54.7% females), aged 12.5–17.5 years. In females, MD adherence was associated with lower BMI and FMI only when they were exposed to less than 338 min/day of screen time (81.8% of females); MD adherence was also associated with lower WC only when females were exposed to less than 143 min/day of screen time (31.5% of females). No significant MD-screen time interaction was observed in males. In conclusion, screen-time-based sedentary behaviours had a modulatory effect in the association between MD adherence and adiposity in European female adolescents.

Obesity is the result of interactions between genes and environmental factors. Since monogenic etiology is only known in some obesity-related genes, a genetic risk score (GRS) could be useful to determine the genetic predisposition to obesity. Therefore, the aim of our study was to build a GRS able to predict genetic predisposition to overweight and obesity in European adolescents. A total of 1069 adolescents (51.3% female), aged 11–19 years participating in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) cross-sectional study were genotyped. The sample was divided in non-overweight (non-OW) and overweight/obesity (OW/OB). From 611 single nucleotide polymorphisms (SNP) available, a first screening of 104 SNPs univariately associated with obesity (p < 0.20) was established selecting 21 significant SNPs (p < 0.05) in the multivariate model. Unweighted GRS (uGRS) was calculated by summing the number of risk alleles and weighted GRS (wGRS) by multiplying the risk alleles to each estimated coefficient. The area under curve (AUC) was calculated in uGRS (0.723) and wGRS (0.734) using tenfold internal cross-validation. Both uGRS and wGRS were significantly associated with body mass index (BMI) (p < .001). Both GRSs could potentially be considered as useful genetic tools to evaluate individual’s predisposition to overweight/obesity in European adolescents