Associations of multiple unhealthy lifestyle behaviors with overweight/obesity and abdominal obesity among Brazilian adolescents: A country-wide survey

Promoting Learning About Nutrition and Healthy Eating Behaviors in Chinese Children Through an Alternate Reality Game: A Pilot Study

Background: Childhood obesity is a growing public-health concern in China and globally, a trend influenced by multiple factors, including poor eating behaviors and insufficient physical activity. While interactive health games have shown promise in improving children's nutrition education and healthy eating behaviors, few have been tailored for the Chinese context. This study aimed to develop and evaluate Happy Farm, Happy Meal (HFHM), an alternate reality game (ARG) integrated into Chinese elementary students' daily routines to enhance their nutrition knowledge and improve their eating behaviors. Methods: This pilot study employed a quasi-experimental design with two third-grade classes, which were randomly assigned to the HFHM intervention group (n = 40) or a no-game control group (n = 39). The game design was informed by a pre-intervention survey and interviews with caregivers and teachers, which identified key dietary challenges such as picky eating, slow eating, and food waste. Over a two-week period, the HFHM group engaged in food- and nutrition-focused tasks that were incorporated into their lunchtime routines. Pre- and post-intervention data were collected on nutrition knowledge, food waste, picky eating, and meal duration, with daily progress tracking in the HFHM group. Results: Compared to the control group, the HFHM group showed a significant increase in nutrition knowledge (p < 0.05), reduced food waste (p < 0.01), decreased picky eating (p < 0.01), and improved meal duration (p < 0.05). However, the small sample size and short intervention period limit generalizability. Conclusions: These findings suggest HFHM is a promising tool for improving nutrition education and dietary behaviors in Chinese children. Future research should validate these findings in a larger sample and assess long-term impacts.

Clusters of diet, physical activity, screen-time and sleep among adolescents and associations with 3-year change in indicators of adiposity

BACKGROUND

Clusters of health behaviours could impact changes in adiposity among adolescents over time. This study examines the clustering of screen time, physical activity, dietary behaviours and sleep, and the associations with 3-year changes in indicators of adiposity.

METHODS

Data from the UK's Millennium Cohort Study were utilised when participants were aged 14 and 17 years respectively. At age 14, demographics, screen time, dietary behaviours and sleep duration were measured via self-report, and physical activity using wrist worn accelerometers. Height, weight, and percent body fat were measured at age 14 and 17 years. Behavioural clusters were determined using k-means clustering analysis, and associations with change in indicators of adiposity between age 14 and 17 years were examined using multivariate regression models.

RESULTS

Three clusters were identified at age 14, a 'healthy cluster', a 'mixed cluster', and an 'unhealthy cluster' in the analytical sample of 3,065 participants (52.5% girls). The 'unhealthy' cluster was the most prevalent cluster among boys (53%), while the 'healthy cluster' was most prevalent among girls (55.9%). Adolescents in healthy clusters had a lower BMI z-score and percent body fat at age 14 compared to those in the unhealthy and mixed clusters, and maintained lower scores at age 17. Boys in the mixed and unhealthy clusters at 14 years had a lower change in BMI z-score between 14 and 17 compared to boys in the healthy cluster.

CONCLUSION

Adolescents in the healthy cluster had lower BMI z-scores and percent body fat at age 14 years than those in the unhealthy cluster, and they maintained this lower level at age 17. Given the upward trend in BMI during this period, this maintenance could be interpreted as a positive outcome. Further prospective research is needed to better understand these associations as well as research examining the stability of cluster membership over time.

Association of a healthy lifestyle index with anthropometric indices and obesity in Hong Kong Chinese women: Evidence from the MECH-HK cohort study

AIM

This cross-sectional study aimed to examine the associations of a healthy lifestyle index (HLI) with several anthropometric indices and obesity among Hong Kong Chinese women.

SUBJECTS/METHODS

A total of 3174 women (56.16 ± 8.43 years) were included. The HLI consisted of diet, physical activity, sedentary time, sleep duration, skipping breakfast, smoking, and alcohol. Each factor was scored as 0 (unhealthy) or 1 (healthy). The overall HLI was the sum of these points, ranging from 0 (the least healthy) to 7 (healthiest). Percent body fat (PBF), body fat mass (BFM), fat free mass (FFM), waist circumference (WC), waist-to-hip ratio (WHR), height, and weight were measured using the InBody 270 device.

RESULTS

The number of women with 0-2, 3, 4, 5, 6-7-point HLI groups were 551, 759, 954, 645, and 265, respectively. As HLI increased, most anthropometric indices declined while FFM increased. The adjusted βs (95 % confidence intervals (95 % CIs)) for PBF (%), BFM (kg), WC (cm), WHR, height (cm), weight (kg), BMI (kg/m^2), and FFM (kg) were -0.653 (-0.829, -0.476), -0.582 (-0.751, -0.414), -0.719 (-0.971, -0.467), -0.005 (-0.006, -0.004), -0.181 (-0.347, -0.015), -0.602 (-0.850, -0.355), -0.188 (-0.282, -0.095), and 0.339 (0.213, 0.465), respectively. Additionally, compared to the 0-2-point group, the odds ratios (95 % CIs) of the 6-7-point groups were 0.54 (0.38-0.75) for central obesity and 0.55 (0.37-0.82) for general obesity.

CONCLUSIONS

HLI was inversely associated with PBF, BFM, WC, WHR, height, weight, BMI, central obesity, and general obesity, but was positively associated with FFM.

Individual and Joint Association between Cardiovascular Disease Risk Factors and Inadequate Lifestyle Behaviors in a Sample from Brazil

BACKGROUND

Individual and Joint Association between Cardiovascular Disease Risk Factors and Inadequate Lifestyle Behaviors in a Sample from Brazil. CVD: cardiovascular diseases.

BACKGROUND

Cardiovascular diseases (CVD) are often influenced by modifiable factors, notably individuals' lifestyle choices, which play a crucial role in modulating cardiovascular risk.

OBJECTIVE

To investigate the individual and simultaneous association between inadequate lifestyle behaviors and risk factors for CVD in adults and older adults.

METHOD

A cross-sectional study with 1079 users of the Health Academy Program in Brazil. Information related to inadequate diet, excessive alcohol consumption, smoking, and physical inactivity were individually and collectively investigated (0, 1, or ≥ 2 factors) in association with CVD risk factors (hypertension, hypercholesterolemia, diabetes mellitus, and obesity), considering the following two outcomes: presence of CVD risk factors and number of CVD risk factors present in the same individual (0, 1, 2, or ≥ 3 risk factors). Logistic and multinomial logistic regression analyses were used. The statistical significance adopted was 5%.

RESULTS

A higher number of inadequate lifestyle behavior was associated with greater odds of simultaneous presence of 1, 2, or ≥ 3 CVD risk factors. The simultaneous adoption of 1 and ≥ 2 inadequate lifestyle behaviors was associated with greater odds of hypercholesterolemia. Simultaneous adherence to ≥ 2 inadequate lifestyle behaviors was associated with lower odds of hypertension.

CONCLUSION

A greater number of inadequate lifestyle behaviors was associated with higher odds of simultaneous presence of multiple CVD risk factors.

Factors associated with sarcopenic obesity in Brazilian adults and older people: Systematic review and meta-analysis of observational studies

AIM

Sarcopenic obesity (SO) is characterized by the coexistence of the loss of muscle mass and function with excess adipose tissue. Its prevalence has increased concomitantly with population aging, becoming one of the most significant challenges for public health, threatening the quality of life and the physical and mental health of the elderly population.

METHODS

This study estimated the prevalence and factors associated with SO among adults and the elderly in Brazil's macro-regions, utilizing MEDLINE, Embase, Web of Science, and the Virtual Health Library databases. Primary outcomes included SO prevalence overall and by subgroups, with secondary outcomes identifying associated factors.

RESULTS

A systematic review of 33 studies with 10 266 participants up to July 2023 showed a 17% prevalence of SO (95% confidence interval: 13-21%), using a random effects meta-analysis. The Central-West region had the highest occurrence (27%). Dual-energy X-ray absorptiometry (26%) and bioimpedance (6%) were the top diagnostic methods. Protective factors were chronic kidney disease and healthy lifestyles; risk factors included socioeconomic status, functionality, lifestyle, biochemical parameters, and comorbidities such as osteoarthritis and apnea.

CONCLUSIONS

The prevalence of SO in Brazil is significant, emerging as a critical public health problem. It is essential to direct attention to changes in prevalence rates in the coming years, given the rising obesity trends and the absolute increase in the elderly population. Geriatr Gerontol Int 2024; 24: 661-674.

Unraveling the rationale and conducting a comprehensive assessment of KD025 (Belumosudil) as a candidate drug for inhibiting adipogenic differentiation-a systematic review

Rho-associated kinases (ROCKs) are crucial during the adipocyte differentiation process. KD025 (Belumosudil) is a newly developed inhibitor that selectively targets ROCK2. It has exhibited consistent efficacy in impeding adipogenesis across a spectrum of in vitro models of adipogenic differentiation. Given the novelty of this treatment, a comprehensive systematic review has not been conducted yet. This systematic review aims to fill this knowledge void by providing readers with an extensive examination of the rationale behind KD025 and its impacts on adipogenesis. Preclinical evidence was gathered owing to the absence of clinical trials. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the study's quality was assessed using the Joanna Briggs Institute (JBI) Checklist Critical Appraisal Tool for Systematic Reviews. In various in vitro models, such as 3T3-L1 cells, human orbital fibroblasts, and human adipose-derived stem cells, KD025 demonstrated potent anti-adipogenic actions. At a molecular level, KD025 had significant effects, including decreasing fibronectin (Fn) expression, inhibiting ROCK2 and CK2 activity, suppressing lipid droplet formation, and reducing the expression of proadipogenic genes peroxisome proliferator-activated receptor gamma (PPARγ) and CCAAT/enhancer-binding protein α (C/EBPα). Additionally, KD025 resulted in the suppression of fatty acid-binding protein 4 (FABP4 or AP2) expression, a decrease in sterol regulatory element binding protein 1c (SREBP-1c) and Glut-4 expression. Emphasis must be placed on the fact that while KD025 shows potential in preclinical studies and experimental models, extensive research is crucial to assess its efficacy, safety, and potential therapeutic applications thoroughly and directly in human subjects.

Prediagnosis ultra-processed food consumption and prognosis of patients with colorectal, lung, prostate, or breast cancer: a large prospective multicenter study

Background and aims

Whether ultra-processed food consumption is associated with cancer prognosis remains unknown. We aimed to test whether prediagnosis ultra-processed food consumption is positively associated with all-cause and cancer-specific mortality in patients with colorectal, lung, prostate, or breast cancer.

Methods

This study included 1,100 colorectal cancer patients, 1750 lung cancer patients, 4,336 prostate cancer patients, and 2,443 breast cancer patients. Ultra-processed foods were assessed using the NOVA classification before the diagnosis of the first cancer. Multivariable Cox regression was used to calculate hazard ratio (HR) and 95% confidence interval (CI) for all-cause and cancer-specific mortality.

Results

High ultra-processed food consumption before cancer diagnosis was significantly associated with an increased risk of all-cause mortality in lung (HRquartile 4 vs. 1: 1.18; 95% CI: 0.98, 1.40; Ptrend = 0.021) and prostate (HRquartile 4 vs. 1: 1.18; 95% CI: 1.00, 1.39; Ptrend = 0.017) cancer patients in a nonlinear dose-response manner (all Pnonlinearity < 0.05), whereas no significant results were found for other associations of interest. Subgroup analyses additionally revealed a significantly positive association with colorectal cancer-specific mortality among colorectal cancer patients in stages I and II but not among those in stages III and IV (Pinteraction = 0.006), and with prostate cancer-specific mortality among prostate cancer patients with body mass index <25 but not among those with body mass index ≥25 (Pinteraction = 0.001).

Conclusion

Our study suggests that reducing ultra-processed food consumption before cancer diagnosis may improve the overall survival of patients with lung or prostate cancer, and the cancer-specific survival of certain subgroups of patients with colorectal or prostate cancer.

Clustering of diet, physical activity and sedentary behaviour and related physical and mental health outcomes: a systematic review

BACKGROUND

Physical activity (PA), sedentary behaviour (SB) and diet play an important role in the physical and mental health of young people. Understanding how these behaviours cluster, and the impact of clusters on health is important for the development of public health interventions. This review examines the prevalence of clusters of PA, sedentary time, and dietary behaviours, and how clusters relate to physical and mental health indicators among children, adolescents and young adults.

METHODS

Electronic (PubMed, Web of Science and Scopus) and manual searches were conducted for articles that were (i) observational studies including children, adolescents and/or young adults aged 5-24 years, (ii) examined the 'patterning', 'clustering', or 'co-existence' of each of PA, dietary behaviour and SB, and (iii) published in English up to and including July 2022. In addition to information on clustering, data on physical and mental health outcomes were extracted where reported. Included studies were assessed using the Cochrane risk of bias for observational studies. A narrative synthesis was conducted due to high heterogeneity. This review was registered with PROSPERO (CRD42021230976).

RESULTS

Forty-nine cross-sectional studies and four prospective cohort studies from eighteen countries reporting data from 778,415 individual participants were included. A broad range of clusters (n = 172) were found (healthy, unhealthy, and mixed). Mixed clusters were common (n = 98), and clusters of high diet quality, low PA and high SB were more prevalent in girls, while mixed clusters of high PA, high SB and low diet quality were more prevalent in boys. Unhealthy clusters comprising low moderate to vigorous PA, low consumption of fruits and vegetables, and high screen time were prevalent, particularly in those from lower socioeconomic status families. Compared to those with healthy behavioural clusters, those with unhealthy and mixed clusters had a higher adiposity, higher risk of cardiovascular disease, poorer mental health scores, and lower cardiorespiratory fitness.

CONCLUSIONS

PA, SB and diet cluster in healthy, unhealthy and mixed patterns in young people that differ across sociodemographic characteristics. Unhealthy clusters are associated with poorer health outcomes. Intervention strategies targeting un-clustering multiple unhealthy behaviours should be developed and evaluated for their impact on health outcomes.

The association between multiple cardiovascular risk factors and overweight in Brazilian adolescents: an analysis based on the grade of membership

The aim of the current research is to analyze the coexistence of modifiable risk behaviors for cardiovascular disease (CVD) in 12-to-17-year-old adolescents living in Brazil and their influence on overweight. National, cross-sectional, school-based epidemiological study focused on estimating the prevalence of cardiovascular risk factors and metabolic syndrome in 12 to 17 year old adolescents enrolled in public and private schools in Brazilian counties accounting for more than 100 thousand inhabitants. The grade of membership method was used to identify the coexistence of risk factors among adolescents. The analytical sample comprised 71,552 adolescents. According to the two herein generated profiles, adolescents classified under Profile 2 have shown behaviors such as smoking, alcohol consumption and diet rich in Ultra-processed food intake ≥ 80% of the percentage of total caloric value. In addition, adolescents presenting CVD risk profile have shown increased likelihood of being overweight. The study has found coexistence of risk factors for CVD in Brazilian adolescents, with emphasis on tobacco smoking and alcoholic beverage intake. In addition, it heads towards the analysis of the association between CVD risk factors and health outcomes, such as overweight.

Neural correlates of changing food choices while bypassing values

Current theories suggest that altering choices requires value modification. To investigate this, normal-weight female participants' food choices and values were tested before and after an approach-avoidance training (AAT), while neural activity was recorded during the choice task using functional magnetic resonance imaging (fMRI). During AAT, participants consistently approached low- while avoiding high-calorie food cues. AAT facilitated low-calorie food choices, leaving food values unchanged. Instead, we observed a shift in indifference points, indicating the decreased contribution of food values in food choices. Training-induced choice shifts were associated with increased activity in the posterior cingulate cortex (PCC). In contrast, the medial PFC activity was not changed. Additionally, PCC grey matter density predicted individual differences in training-induced functional changes, suggesting anatomic predispositions to training impact. Our findings demonstrate neural mechanisms underlying choice modulation independent of valuation-related processes, with substantial theoretical significance for decision-making frameworks and translational implications for health-related decisions resilient to value shifts.

Plant-based diets and the risk of pancreatic cancer: a large prospective multicenter study

BACKGROUND

Plant-based diets have been recommended for improving health outcomes, including cancer. However, previous studies on plant-based diets and the risk of pancreatic cancer are scarce and fail to consider plant food quality.

OBJECTIVES

We sought to examine the potential associations of 3 plant-based diet indices (PDIs) with the risk of pancreatic cancer in a US population.

METHODS

A population-based cohort of 101,748 US adults was identified from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. The overall PDI, healthful PDI (hPDI), and unhealthful PDI (uPDI) were constructed to qualify adherence to overall, healthy, and less healthy plant-based diets, respectively, with higher scores indicating better adherence. Multivariable Cox regression was used to compute hazard ratios (HRs) for pancreatic cancer incidence. Subgroup analysis was conducted to identify the potential effect modifiers.

RESULTS

Over a mean follow-up of 8.86 years, 421 pancreatic cancer cases occurred. Participants in the highest compared with the lowest quartiles of overall PDI had a lower risk of pancreatic cancer [HR_{quartile 4 versus 1}: 0.74; 95% confidence interval (CI): 0.57, 0.96; P_trend = 0.023]. A stronger inverse association was observed for hPDI (HR_{quartile 4 versus 1}: 0.56; 95% CI: 0.42, 0.75; P_trend < 0.001). Conversely, uPDI was positively associated with the risk of pancreatic cancer (HR_{quartile 4 versus 1}: 1.38; 95% CI: 1.02, 1.85; P_trend = 0.012). Subgroup analyses revealed a stronger positive association for uPDI in participants with BMI <25 (HR_{quartile 4 versus 1}: 3.22; 95% CI: 1.56, 6.65) than in those with BMI ≥25 (HR_{quartile 4 versus 1}: 1.08; 95% CI: 0.78, 1.51) (P_interaction = 0.001).

CONCLUSIONS

In this US population, adherence to a healthy plant-based diet confers a lower risk of pancreatic cancer, whereas adherence to a less healthy plant-based diet confers a higher risk. These findings highlight the importance of considering plant food quality in preventing pancreatic cancer.

Patterns of unhealthy behaviours during adolescence and subsequent anxiety and depression in adulthood: a prospective register linkage study of the HUNT survey and health registries

BACKGROUND

There is increasing need for prospective investigations in the preventing role of health-related behaviours on mental health problems. The aim of this study is to identify patterns of health-related behaviours in adolescence, and the association between the behavioural patterns and the subsequent diagnoses and/or drug treatment for anxiety and/or depression in adulthood.

METHODS

This prospective study consisted of 13-19-year-old participants in the Trøndelag Health Study (Young-HUNT3) in 2006-2008 (n = 2061, 1205 females and 856 males) in Norway, who also participated in HUNT4 (2017-2019). Survey data on health-related behaviours in adolescence, including low level of physical activity, low consumption of wholegrain bread, fish, fruit, vegetables and high consumption of sugar-sweetened beverages and insomnia were linked on an individual level to prospective information on drug use and diagnosis in national health registries. The different patterns of health-related behaviours were identified through latent class analysis. Subsequent anxiety or depression was defined as at least one recording in either of three registries covering recorded diagnosis in primary and specialist healthcare, or dispensed prescription drugs during 2008-2019. Additionally, self-reported psychological distress measured in young adulthood was applied as a supplemental outcome measure.

RESULTS

Four patterns of health-related behaviours were identified: high risk behaviours (class 1), moderate to high risk behaviours (class 2), low to moderate risk behaviours (class 3) and low risk behaviours (class 4). Adolescents in class 3 showed higher odds of subsequent diagnoses for anxiety and/or depression in primary and specialist healthcare compared to class 4 participants. In addition, both class 1 and class 4 participants had higher odds for self-reported psychological distress than those class 4 (OR = 1.56 and OR = 1.86, respectively).

CONCLUSIONS

Our findings suggest that health-related behaviours are clustered among Norwegian adolescents. The patterns of unhealthy behaviours during adolescence only partly increased the risk of anxiety and depression in adulthood. Promoting healthy behaviours during adolescence may potentially reduce the burden of mental illness in adulthood, but further research is needed to clarify the nature of the relationships.

IMPACTS OF COVID-19 ON COLLEGE STUDENTS’ SPORTS

ABSTRACT Introduction: Students have realized the importance of physical education after the epidemic of COVID-19 and have increased the demand of seeking a healthy lifestyle even during home isolation. In contrast, the current physical education system in colleges and universities does not meet the real demands of its students, demonstrating a barrier between teaching and learning. Objective: Study students’ lifestyle and sports habits during the epidemic of COVID-19. Methods: An online questionnaire was conducted to investigate and analyze students’ home exercise environment, lifestyle and exercise practices, and exercise psychology during COVID-19. A total of 1274 valid questionnaires were obtained. The data from the questionnaires were entered, sorted, and analyzed, and relevant figures were drawn and discussed. Results: It was noted that students mostly preferred outdoor exercise equipment and hands-free activities outside the home. This picture reversed during the COVID-19 epidemic when students preferred indoor equipment. In terms of exercise programs, an effective exercise program is needed to allow people to exercise effectively during home isolation. Conclusion: Physical education teachers in colleges and universities should select the right means of physical fitness to combine sports and sports life that can be practiced at home, according to the actual situation of students and their psychological demands. Students should be given a better sports experience during the quarantine process, stimulating them to stay positive and with good physical quality, aiming at strengthening immunity and reducing the risk of infection by COVID-19. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Association between screen time and obesity in US adolescents: A cross-sectional analysis using National Survey of Children's Health 2016-2017

OBJECTIVE

This study examines the association between time spent watching TV, playing video games, using a computer or handheld device (screen time), and BMI among U.S. adolescents, and potential effect modification of these associations by sex, sleep duration, and physical activity.

METHODS

A secondary analysis of 10-17-year-old participants in the 2016-2017 National Survey of Children's Health was conducted. Multivariable logistic regression was used to examine the association between parent-reported screen time and BMI categories and effect modification by sex, sleep duration and physical activity.

RESULTS

The analysis included 29,480 adolescents (49.4% female). Those with ≥1 hour (vs <1 hour) of TV/video games per day were more likely to be overweight/obese (adjusted Odds Ratio (aOR) 1-3 hours = 1.4; 95% Confidence Interval (CI)1.19, 1.65; aOR ≥4 hours = 2.19; 95% CI 1.73, 2.77). This association was stronger in adolescents who did not meet the guidelines for physical activity (aOR ≥ 4 hours = 3.04; 95% CI: 2.1, 4.4) compared with those who did (aOR ≥ 4 hours = 1.64; 95% CI: 0.72, 3.72). Using computers/handheld devices was associated with a smaller increase in odds of overweight/obesity (aOR ≥4 hours = 1.53; 95% CI:1.19, 1.97).

CONCLUSION

Watching TV or playing video games for ≥1 hour per day is associated with obesity in adolescents who did not meet the guidelines for physical activity. Using computers or handheld devices seems to have a weaker association with BMI compared with TV/video games.

Sundararajan E, Asadi S, Nilashi M, Ab Aziz MJ, Saravanan MS, Abdelhaq M, Alsaqour R. A Hybrid MCDM Approach Based on Fuzzy-Logic and DEMATEL to Evaluate Adult Obesity

Obesity and its complications is one of the main issues in today's world and is increasing rapidly. A wide range of non-contagious diseases, for instance, diabetes type 2, cardiovascular, high blood pressure and stroke, numerous types of cancer, and mental health issues are formed following obesity. According to the WHO, Malaysia is the sixth Asian country with an adult population suffering from obesity. Therefore, identifying risk factors associated with obesity among Malaysian adults is necessary. For this purpose, this study strives to investigate and assess the risk factors related to obesity and overweight in this country. A quantitative approach was employed by surveying 26 healthcare professionals by questionnaire. Collected data were analyzed with the DEMATEL and Fuzzy Rule-Based methods. We found that lack of physical activity, insufficient sleep, unhealthy diet, genetics, and perceived stress were the most significant risk factors for obesity.

Individual SFA intake and risk of overweight/obesity: findings from a population-based nationwide cohort study

The relationship between SFA consumption and the risk of overweight/obesity remains unclear. Epidemiological evidence is lacking among Chinese population. This study aimed to investigate the association between individual dietary SFA intake and the risk of overweight/obesity in Chinese adults. Data from 8465 adults with BMI < 24 kg/m² at entry in the China Health and Nutrition Survey (1989-2011) were analysed. Three-day 24-h dietary records were used to collect dietary data. Cox proportional hazards regression models were constructed to estimate hazard ratios (HR) and 95 % CI for the risk of developing overweight or obesity. A total of 3171 incident cases of overweight/obesity were identified (1649 for women and 1522 for men) during a median of 11 years of follow-up. Compared with the lowest category, the intake of total SFA (TSFA) showed no significant association with the risk of overweight/obesity. However, an increased risk of overweight/obesity was observed with a higher intake of medium chain SFA (MCSFA) (P_trend = 0·004), especially decanoic acid (10:0) (HR was 1·25 (95 % CI 1·10, 1·42) comparing the highest category with the reference group; P_trend < 0·001), whereas an inverse relationship was observed for hexanoic acid (6:0) consumption; compared with non-consumers, 6:0 intake was associated with 32 % lower risk of overweight/obesity (HR: 0·68 (95 % CI 0·56, 0·84); P_trend < 0·001). Overall, the intake of subtypes of MCSFA but not TSFA was associated with the risk of overweight/obesity. Increasing hexanoic acid (6:0) and limiting decanoic acid (10:0) consumption may be protective for overweight/obesity among Chinese population.

Association of Physical Activity with Anthropometrics Variables and Health-Related Risks in Healthy Male Smokers

Anthropometric variables (AV) are shown to be essential in assessing health status and to serve as markers for evaluating health-related risks in different populations. Studying the impact of physical activity (PA) on AV and its relationship with smoking is a non-trivial task from a public health perspective. In this study, a total of 107 healthy male smokers (37 ± 9.42 years) were recruited from different states in Malaysia. Standard procedures of measurement of several anthropometric indexes were carried out, and the International Physical Activity Questionnaire (IPPQ) was used to ascertain the PA levels of the participants. A principal component analysis was employed to examine the AV associated with physical activity, k-means clustering was used to group the participants with respect to the PA levels, and discriminant analysis models were utilized to determine the differential variables between the groups. A logistic regression (LR) model was further employed to ascertain the efficacy of the discriminant models in classifying the two smoking groups. Six AV out of twelve were associated with smoking behaviour. Two groups were obtained from the k-means analysis, based on the IPPQ and termed partially physically active smokers (PPAS) or physically nonactive smokers (PNAS). The PNAS were found to be at high risk of contracting cardiovascular problems, as compared with the PPAS. The PPAS cluster was characterized by a desirable AV, as well as a lower level of nicotine compared with the PNAS cluster. The LR model revealed that certain AV are vital for maintaining good health, and a partially active lifestyle could be effective in mitigating the effect of tobacco on health in healthy male smokers.

HelperFriend, a Serious Game for Promoting Healthy Lifestyle Behaviors in Children: Design and Pilot Study

BACKGROUND

The use of health games is a promising strategy for educating and promoting healthy lifestyle behaviors among children.

OBJECTIVE

We aimed to describe the design and development of a serious game, called HelperFriend, and evaluate its feasibility, acceptability, and preliminary effects in children in a pilot study. HelperFriend is a vicarious experiential video game designed to promote 3 lifestyle behaviors among young children: physical activity, healthy eating, and socioemotional wellness.

METHODS

Participants aged 8 to 11 years were recruited from an elementary school and randomized to receive a healthy lifestyle behavior educational talk (control) or play six 30-minute sessions with HelperFriend (intervention). Assessments were conducted at baseline (T0) and after the intervention (ie, 4 weeks) (T1). The primary outcome was gain in knowledge. The secondary outcomes were intention to conduct healthy behaviors, dietary intake, and player satisfaction.

RESULTS

Knowledge scores of intervention group participants increased from T0 to T1 for physical activity (t14=2.01, P=.03), healthy eating (t14=3.14, P=.003), and socioemotional wellness (t14=2.75, P=.008). In addition, from T0 to T1, the intervention group improved their intention to perform physical activity (t14=2.82, P=.006), healthy eating (t14=3.44, P=.002), and socioemotional wellness (t14=2.65, P=.009); and there was a reduction in their intake of 13 unhealthy foods. HelperFriend was well received by intervention group.

CONCLUSIONS

HelperFriend appears to be feasible and acceptable for young children. In addition, this game seems to be a viable tool to help improve the knowledge, the intention to conduct healthy behaviors, and the dietary intake of children; however, a well-powered randomized controlled trial is needed to prove the efficacy of HelperFriend.

Factors Associated with a Health-promoting Lifestyle among Adults and Older Adults in the Era of COVID-19: An Integrative Review

AIM: To identify the factors associated with a health-promoting lifestyle (HPL) among adults or older adults during the COVID-19 pandemic. METHODS: On the basis of the PRISMA guidelines, primary articles published in English within the period from December 2019 to December 2021 were searched for on five databases: PubMed, Cochrane Library, Scopus, Web of Science, and CINAHL Plus with Full Text. RESULTS: The current review identified nine relevant studies with a total of 4,509 adults and older adults. We found that sociodemographic were associated with HPL among both adults and older adults in the COVID-19 era. The findings also asserted that a nurse-led lifestyle intervention is an effective program for improving the self-efficacy and HPL of older adults with chronic illnesses. CONCLUSION: According to this review’s findings, individuals and healthcare professionals should consider the sociodemographic and social factors associated with HPL among adults and older adults, it is important to improve and standardize the guidelines for home-based services so that they can be used properly to help them deal with the COVID-19 pandemic and similar health crises.

High waist-to-height ratio and associated factors in adolescents from a city in Southern Brazil: a cross-sectional study

Objective:

To verify the prevalence of abdominal obesity with the waist-to-height ratio (WHtR) and associated factors in adolescents from a city in Southern Brazil.

Methods:

A total of 960 adolescents (494 boys) aged 15–18 years old participated in this study. The dependent variable was WHtR; independent variables were self-reported age, economic level, sexual maturation, physical activity level, screen time, and body fat. Data were analyzed using descriptive statistics and logistic regression.

Results:

It was observed that 36.7% of the adolescents presented high WHtR (50.2% in girls and 23.9% in boys). Regardless of sex, adolescents with high body fat were more likely of having high WHtR (boys: Odds Ratio [OR] 29.79; 95% confidence interval [95%CI] 16.87–52.62; girls: OR 19.43; 95%CI 10.51–35.94). In girls, high WHtR was associated with age (OR 1.83; 95%CI 1.17–2.87), and in boys, with economic level (OR 2.34; 95%CI 1.01–5.45).

Conclusions:

One in each three adolescents has abdominal obesity. Among adolescents with high body fat, girls aged 15–16 and boys with high-income are the groups most exposed to abdominal obesity.

Poor Health Related Quality of Life and Unhealthy Lifestyle Habits in Weight-Loss Treatment-Seeking Youth

Obesity is associated with unhealthy lifestyle behaviors and poor Health Related Quality of Life (HRQOL). The cumulative effect of lifestyle behaviors on HRQOL has been demonstrated in chronically ill adolescents, but not in adolescents with obesity. The present study aimed to assess the association between HRQOL and adherence to the Mediterranean Diet (MD) and/or low levels of physical activity (PA) in a large sample of outpatient adolescents with overweight or obesity seeking weight loss treatment. Four-hundred-twenty participants were enrolled from 10 Italian outpatient clinics. The demographics and anthropometric features, KIDMED scores, and exercise levels of the participants were collected, together with parental features. The HRQOL was assessed by the Pediatric Quality of Life Inventory (PedsQL™), Adolescents Version 4.0. PedsQL total score and functioning subscales were lower in adolescents who reported one or two unhealthy habits. Compared with the high/intermediate groups, the risk of low HRQOL was twice as high for each unit increase in BMI SDS, while the percentage was reduced by 12.2% for every unit increase in the KIDMED score and by 32.3% for each hour increase of exercise. The clustering of these two unhealthy behaviors conferred a 120% higher risk of low HRQOL. Similarly, adolescents displaying better diet quality and/or a physically more active lifestyle have better physical and psychological functioning. Further studies are needed to disclose whether these characteristics may be predictive of better adherence to weight loss treatment.

Use of latent class analysis as a method of assessing the physical activity level, sedentary behavior and nutritional habit in the adolescents' lifestyle: A scoping review

BACKGROUND

Currently, adolescents' lifestyle is commonly characterized by physical inactivity, sedentary behavior, and inappropriate eating habits in general. A person-oriented approach as Latent Class Analysis (LCA) can offer more insight than a variable-centered approach when investigating lifestyle practices, habits, and behaviors of adolescent population.

OBJECTIVE

The aim of the present study was to assess which variables are mostly used to represent the physical activity level, sedentary behavior SB) and nutritional habit in the adolescents' lifestyle in studies that used the LCA.

DESIGN

Scoping review.

METHODS

The study was a performed in accordance with the proposed criteria for systematic reviews and meta-analyses-Preferred Reporting Items for Systematic Reviews and Meta-Analyses and registered in PROSPERO (CRD42018108444). The original articles were searched in MEDLINE/PubMed, Scopus, ScienceDirect, Web of Science, PsycINFO, and SPORTdiscus. The Quality Assessment Tool analyzed the risk of bias of the included studies.

RESULTS

30 original articles were selected. The physical activity level (28 studies), SB and nutritional habits (18 studies) were the most common variable used to evaluate the adolescent's lifestyle by LCA model. Specifically, physical inactivity and high SB were the manifest variables with higher frequency in the negative latent classes (LCs) in adolescent girls. On the other hand, physical exercises and sports were activities more commonly labeled as positive LCs.

CONCLUSIONS

The LCA models of the most of selected studies showed that physical inactivity, high SB were the most common in the LCs with negative characteristics of the adolescents' lifestyle. Better understanding the results of analyzes of clusters of multivariate behaviors such as the LCA can help to create more effective strategies that can make the lifestyle of adolescents healthier.

Fitness Level Differences between Students in Kosovo and Montenegro

Geographical, cultural, and socio-economic factors create a different lifestyle. Accordingly, the aim of this research was to identify the differences in anthropometric and fitness characteristics among adolescents living in Montenegro and Kosovo in order to optimize the physical fitness as a consequence of the proactive behavior. Anthropometric characteristics and fitness level measures were assessed by Eurofit testing battery among 600 Kosovar and 600 Montenegrin students, equally distributed by gender. Differences between countries, gender, and age group (13, 14 and 15 years) were assessed with multivariate and univariate analysis of variance. The results showed that Montenegrin students are taller, heavier, and achieve better results in the sit-ups and 20-m endurance shuttle-run tests. Kosovar students achieve better results in the standing broad jump and 10 × 5 m shuttle-run tests. Males achieve significantly better results in all tests, excluding the sit-and-reach test. Statistically significant differences among age groups were found for all variables, regardless gender and country (except for the flamingo and sit-and reach tests). This study is of importance to physical education teachers and curriculum authors to optimize students’ proactive behavior based on the identified anthropometric and physical fitness differences between the two countries, age groups, and genders.

Hypertension, lifestyle, and nutritional status of participants in the Study of Cardiovascular Risks in Adolescents in the Federal District

ABSTRACT Objective To estimate the prevalence of hypertension in participants of the Study of Cardiovascular Risks in Adolescents in Federal District, Brazil, and to investigate the factors related to lifestyle and nutritional status. Methods Lifestyle, economic, and demographic variables were obtained using a self-administered questionnaire. Anthropometric data and blood pressure measurements were collected according to a standardized protocol. Descriptive statistics was used to know the distribution of the investigated parameters in relation to the outcome. The association between hypertension and the variables of interest was investigated by hierarchical multivariate analysis using Poisson regression, considering p<0.05. Results We evaluated 2,646 adolescents with a mean age of 14.9 years. The prevalence of hypertension was 8.0% (95%CI 6.8-9.3). Studying in schools in the rural region (PR=2.1; 95%CI 1.4-3.3), having obesity (PR=4.0; 95%CI 2.5-6.3), male sex (PR=2.2; 95%CI 1.6-3.0) and age over 15 years (PR=1.4; 95% CI 1.0-1.9) were factors associated with a higher prevalence of hypertension. School feeding consumption was a protective factor (PR=0.7; 95%CI 0.6-0.9). Conclusions The prevalence of arterial hypertension was 8% and was associated with male sex, age at least 15 years, attendance in rural schools, and obesity. The consumption of school feeding was a protective factor.

PHYSICAL ACTIVITY, EATING HABITS AND SLEEP DURING SOCIAL ISOLATION: FROM YOUNG ADULT TO ELDERLY

ABSTRACT Introduction Social isolation is one of the strategies used to prevent the contagion and transmission of the coronavirus (COVID-19), but it impacts on the daily routines and lifestyle of the population. Objective Therefore, the aim of this study was to analyze the physical activity, sleep and eating habits of adults and the elderly during the COVID-19 pandemic. Method A cross-sectional study with a sample comprising 135 participants, divided by age group. First, the whole group was divided into age groups with a 10-year cut-off. They were then characterized by sex, type of home, eating habits, sleep, and physical activity. For the second analysis, the participants were organized into three groups: young adults (18-40 years), middle-aged adults (41-60 years) and elderly (>60 years). An online questionnaire was sent to all the participants, with 26 questions focusing on eating habits, sleep, protective behaviors against COVID-19, and physical activity. Results The participants were mainly women (85.9%), external community (71.1%), students’ families (17.1%), teachers and staff (11.8%). Of the total participants, 40% were dedicated to home care activities and 21.1% had started working from home. The remainder (38.9%) were engaged in activities such as studying or caring for dependents. The younger age group (18-40 years old) reported spending more time in sedentary activities during the day, and 34.2% did not perform physical activity and ate lower quality food during social isolation (p<0.01). All groups, with the exception of the 30-40 age group (p <0.01) highlighted the importance of having the presence of a teacher responsible for guiding physical activities during isolation. Conclusion We conclude that, social isolation has more negative impact on the habits of the younger group. Cross-sectional study.

Prevalence of overweight and obesity in Brazilian children and adolescents: a systematic review

abstract It is important to know about overweight and obesity situation of Brazilian children and adolescents. The present study aims to update scientific production, through a systematic review, on the prevalence and factors associated with overweight and obesity in Brazilian children and adolescents. Nine databases were verified, and 1,316 references were examined from 2018 to 2019. The electronic search was conducted by three independent researchers. All review steps followed a strategy based on PRISMA. 40 studies were included in this systematic review. Most studies use the World Health Organization classification criteria. The prevalence of overweight in Brazilian children and adolescents varies from 8.8% to 22.2% (boys: 6.2% to 21%; girls: 6.9% to 27.6%). The prevalence of obesity varied from 3.8% to 24% (boys: 2.4% to 28.9%; girls: 1.6% to 19.4%). It was observed that the socioeconomic factors (sex, skin color, economic level, region, mother's educational level, living in a rented house and without access to the internet), hereditary/genetic (family history of dyslipidemia and overweight and rs9939609 genotype) and behavioral (physical activity, screen time, eating habits, perceived body weight, health vulnerability, presence of a result close to home, alcoholic beverages, cigarette consumption) were associated with the outcome. It is concluded that the prevalence of overweight and obesity among Brazilian children and adolescents are worrisome and most of the factors associated with the outcomes are subject to change from the adoption of a healthy lifestyle.

Gender differences in the longitudinal association between multilevel latent classes of chronic disease risk behaviours and body mass index in adolescents

INTRODUCTION

Few studies have assessed the relationship between chronic disease risk behaviours and body mass index (BMI) in a longitudinal, sex/gender-specific context. This study used gender-specific analyses to assess the extent to which chronic disease risk behaviour latent classes are associated with BMI and weight status at follow-up.

METHODS

Longitudinal data from 4510 students in Grades 9 to 12, tracked from 2013- 2015, who participated in the COMPASS study were used to assess gender differences in the lagged association between previously determined latent classes (of physical activity and substance use) with BMI using multilevel mixed-effects models. Our multilevel regression models assessed the association between two latent classes, active experimenters and inactive non-using youth, with BMI when stratified by gender.

RESULTS

Male inactive non-substance-using youth were associated with a 0.29 higher continuous BMI (95% CI: 0.057, 0.53) and odds of overweight/obesity increased by 72% (OR = 1.72, 95% CI: 1.2, 2.4) for binary BMI at follow-up relative to active youth who experiment with substance use. No significant associations were detected in females.

CONCLUSION

Over time, physical activity has a protective role on BMI in male youth. Both substance use and physical inactivity should be addressed in obesity prevention efforts. Gender stratification in analyses is also important since females and males have different contributing factors to increases in BMI.

Developing and Validating an Instrument to Evaluate Theory-Based Behavioral Antecedents of Consuming a High-Fiber Diet

Obesity is a major public health concern, with low consumption of fiber-rich foods (e.g., fruits and vegetables) commonly cited as a causal factor. The purpose of this study was to evaluate the validity of a survey measuring the constructs of the Reasoned Action Approach under the context of consuming a high-fiber diet. After an initial draft of the survey was developed, it was evaluated by a panel of six experts to establish face and content validity. Next, data were collected from an adult sample (n = 878), and psychometric data revealed indices of reliability (Cronbach’s alpha) and validity (confirmatory factor analysis). The average age of adults was 51.5 years (±12.8), and a majority were Caucasian (81%), and women (93%). With regards to construct validity, the model structure had adequate fit (e.g., Comparative Fit Index = 0.960). In addition all items loaded significantly on its corresponding scale. For internal consistency reliability, all Cronbach’s alpha scores were > 0.70. Overall the survey appears to be a promising tool for researchers and practitioners. Understanding the theoretical determinants of fiber consumption will help tie theory together with practice.

"Determining a Health-promoting Lifestyle among Afghan Immigrants Women in Iran"

BACKGROUND

Health-promoting lifestyle is an effective strategy for maintaining and controlling health, especially in immigrant women as a vulnerable group. Regarding this, the present study was conducted to determine the health promoting lifestyle and its associated factors in Afghan migrant women in Iran.

METHOD

This was a population based cross-sectional study in which 255 Afghan women of reproductive age. The study population was selected using the continuous sampling method from all Afghan women who referred to health centers of southwest of Tehran in 2018. The data were collected through the socio-demographic and Health Promoting Lifestyle Profile-II (HPLP-II) questionnaire.

RESULTS

The total HPLP-II mean score of women was (124.05 ± 17.28). The lowest score was related to physical activity dimension (14.70 ± 3.78) and the highest score was related to spiritual growth (24.56 ± 5.06). Although some factors such as age, duration of education, income level, ability to speak Persian, education level of husband, and number of children significantly related factors to participant's lifestyle (P <.05), but multiple regression model showed that income level and ability to speak Persian are final statistically related factors to Afghan women health promoting lifestyle in Iran.

CONCLUSION

Familiarization of the individual with the Persian language and the promotion of employment status should be considered due to the low socio-economic level and the fact that most women participating in the study are housewives.

Animal Protein Intake Is Associated with General Adiposity in Adolescents: The Teen Food and Development Study

Protein plays a crucial role in the growth and development of adolescents. However, being a secondary energy source, protein's role in obesity has been sidelined. We examined whether intake of protein (total, animal, plant), branched-chain (BCAAs), and sulfur-containing (SCAAs) amino acids are associated with general body and central obesity and body composition in a cross-sectional study among healthy adolescents. Students aged 12-18 years old (n = 601) in schools near two major Adventist universities in California and Michigan provided dietary data via a validated web-based food frequency questionnaire (FFQ) and anthropometric data during school visits. Intakes of total, animal, and plant proteins, and BCAAs and SCAAs were derived from FFQ data. We defined general body obesity with body-mass-index-for-age (BMIz) z-scores and central obesity with waist-to-height ratios (WHtR). After full adjustment for covariates, multiple regression analyses showed significant positive associations between intakes of total protein (β = 0.101, 95% CI: 0.041, 0.161), animal protein (β = 0.118, 95% CI: 0.057, 0.178), BCAAs (β = 0.056, 95% CI: 0.025, 0.087), and SCAAs (β = 0.025, 95% CI: 0.012, 0.038) with general body adiposity. Animal protein (β = 0.017, 95% CI: 0.001, 0.033) and SCAAs (β = 0.004, 95% CI: 0.000, 0.008) were also associated with central obesity. Total and animal protein and BCAA and SCAA were also significantly associated with fat mass. Our findings suggest that high protein intake may pose a possible detriment to adolescent health. Longitudinal and safety evaluation studies are recommended.

Risk Factors and Prevalence of Abdominal Obesity among Upper-Secondary Students

Inadequate eating habits, as well as a low level of physical activity, influence adipose tissue deposition. The aim of the study was to assess the prevalence of central obesity in upper-secondary students and to determine the factors related to its occurrence. The survey included 309 participants, aged 16 to 18 years from Krakow (Poland). Anthropometric measurements were taken during the periodic assessment of students’ health status. An anonymous questionnaire was used to assess the nutritional and non-nutritional risk factors of participants. According to different methods of measurement, abdominal obesity (AO) was observed in 15.5% (WC—waist circumference), 10.7% (WHtR—waist to height ratio) or 21.7% (WHR—waist to hip ratio) participants. Abdominal obesity (WC) was significantly associated with family history of excess body weight and higher economic status of the family. The risk of AO (WC) was significantly lower among adolescents who declared higher physical activity. Boys who eat first breakfasts have lower AO risk according to WHtR interpretation. Abdominal obesity in gender group was related to the self-esteem of one’s own appearance according to WHtR and WC. Abdominal obesity was associated with the family environment and modifiable lifestyle factors and was dependent on gender.

Behavioral, socio-environmental, educational and demographic correlates of excess body weight in Italian adolescents and young adults

BACKGROUND AND AIMS

Excess body weight (EBW) is the most prevalent nutritional disorder among adolescents worldwide. Identifying determinants of EBW may help find new intervention strategies. Behavioral, socio-economic, educational and demographic correlates of EBW were examined in a population of Italian adolescents, separately for males and females.

METHODS AND RESULTS

As many as 1039 male and 2052 female students (aged 16-19 ys) attending the last three years of different types of high-school of the Emilia-Romagna region in Italy were offered participation, with 552 males and 841 females being finally evaluated. The prevalence of EBW was 21.0% in males and 14.1% in females. Step-wise multivariate logistic regression analyses were performed showing that EBW was negatively related to energy intake in males (odds ratio for 100 kcal/day (OR) = 0.94, 95% confidence interval (CI): 0.89 to 0.98; P = 0.008), and to father's educational attainment (OR = 0.70, 95% CI: 0.52 to 0.95; P = 0.020), but positively related to parental obesity (OR = 2.80, 95% CI: 1.65 to 4.76; P < 0.001). In females, EBW was positively related to parental obesity (OR = 1.94, 95% CI: 1.15 to 3.29; P = 0.013), but negatively to mother's educational attainment (OR = 0.66, 95% CI: 0.45 to 0.97; P = 0.034) and type of attended school (OR = 0.66, 95% CI: 0.49 to 0.89; P = 0.007). Mother's occupation was also an independent determinant of EBW status in females (OR = 0.39, 95% CI: 0.18 to 0.85; P = 0.018 for being unemployed vs blue-collar).

CONCLUSION

Parental obesity is associated with EBW in male and female adolescents. Importantly, we found sex differences in socio-economic and educational factors impacting on EBW, supporting possible distinct area of investigation.