Excess of weight, but not underweight, is associated with poor physical fitness in children and adolescents from Castilla-La Mancha, Spain

Path analysis for affecting the physical fitness of marine majors: A cross-sectional observational study from the perspective of health

The physical fitness of marine major students is critically linked to their academic performance and future career prospects. To investigate the influence of various environmental factors on the physical fitness of maritime majors and to identify potential strategies for improving physical fitness among this population. A cross-sectional observational study was conducted among maritime students. The study surveyed and field-tested 517 male marine majors across 1st to 3rd-grade students using a combination of questionnaire surveys and on-site testing methods. There were no significant differences in body mass index (BMI) and social support among these 1st to 3rd-grade students; however, there were differences in sports lifestyle and physical fitness index (PFI). Social support positively correlated with a sports lifestyle. There is no correlation between BMI and PFI. Social support influences the sports lifestyle of marine majors, which in turn affects BMI and PFI. Pleasure-type and fitness-type sports lifestyles serve as mediators between social support and PFI, while BMI is also a mediator between sports lifestyle and PFI. Social support affects the sports lifestyle of marine majors, which affects BMI and directly influences PFI.

Gender differences and climate zones in overweight and obesity prevalence in European elementary school children from 2000 to 2020: a systematic review and meta-analysis

Introduction

After 2000, there are more obese than underweight people in the world. We face a rapid increase in average global warming of 1.5°C, reported as a syndemic problem of three interconnected epidemics: obesity, global warming, and undernutrition. We aimed to analyze the impact and association between global warming and obesity in children and differences by gender across Europe after 2000.

Methods

We searched PubMed, MEDLINE, Google Scholar, ScienceDirect, and Embase databases. The considered population were children aged 6-14. Only cross-sectional studies that defined obesity by the IOTF cutoffs and the subjects' place of residence, used to determine precise climate zones, were included. We assessed the prevalence of obesity and overweight using a random-effects and the Mantel-Haenszel fixed-effect method when heterogeneity was greater/lower than 50%. We did a subgroup analysis for prevalence across gender, obesity, and overweight, two decades, regions, countries, and the Köppen-Geiger climate zones. Random effects of the meta-regression were used to study the global warming impact and differences in trends across European countries by gender for both conditions separately.

Results

We identified 114 studies that included 985,971 children from 39 European countries. A significant difference between genders was in favor of obese girls 4.78 (95% CI: 3.85-5.93) versus boys 5.76% (95% CI: 5.11-6.48, p = 0.03), respectively, but not for overweight children. Most of the obese girls were in South Europe 7.51% (95% CI: 6.61-8.51) versus East Europe 2.86% (95% CI: 23-3.12), versus boys in South Europe 8.66% (95% CI: 7.68-9.74) and North Europe 3.49% (95% CI: 2.90-4.19), respectively. The "cold" Köppen-Geiger climate zone, with lowest temperatures, has the largest trend rise between two decades of 2.8% and 1.53% for obese girls and boys, and 5.31% and 1.81% for overweight girls and boys, respectively, followed by the smallest number of obese girls 3.28% (95% CI: 2.17-4.92) and boys 3.58% (95% CI: 2.39-5.33), versus the zone with the highest temperatures "hot" for girls 7.02% (95% CI: 6.30-7.82) and for boys 8.23% (95% CI: 7.55-8.96), respectively. The meta-regression proved global warming has a significant impact on the distribution of obesity and overweight across climate zones, R2 = 0.52 and R2 = 0.22. No significant gender differences, or significant interaction, was noted.

Conclusion

Our meta-analysis provides a comprehensive overview of the association between and impact of global warming on obesity. This impact increases obesity among children in Europe throughout all climate zones, and emphasizes an urgent call for further preventive methods in schools, since obesity differences continue their trend of disappearing into the future.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021282127, identifier: CRD42021282127.

Assessment of the Relationship between Body Weight Status and Physical Literacy in 8 to 12 Year Old Pakistani School Children: The PAK-IPPL Cross-Sectional Study

(1) Background: Physical literacy (PL) is a multidimensional concept, since it fosters lifetime engagement in physical activities and reduces obesity; however, empirical evidence is lacking to support this association. This study first aimed to establish PL levels stratified by normal weight children and children with overweight and obesity. Furthermore, this study determined a correlation between PL domains and BMI by weight status among South Punjab school children. (2) Methods: This cross-sectional study involved 1360 (Boys: 675 and Girls: 685) children aged 8 to 12, and was conducted using CAPL-2. T-tests and chi-square were used to determine the difference between categorical variables, with MANOVA used to compare weight statuses. Spearman correlation was employed to determine the correlation between variables; p < 0.05 was considered significant. (3) Results: Normal weight children had significantly higher PL and domain scores, except for the knowledge domain. Most children with normal weights were at the achieving and excelling levels, while children with overweight and obesity were at the beginning and progressing levels. The correlation among PL domains in normal and overweight and obese children ranged from weak to strong (r = 0.001 to 0.737), and the knowledge domain was inversely correlated with the motivation domain (r = -0.023). PL and domain scores were inversely correlated to BMI, except for the knowledge domain. (4) Conclusions: Children with normal weight tend to have higher PL and domain scores, while those with overweight or obesity tend to have lower scores. There was a positive relationship between normal weight and higher PL and domain scores, and an inverse relationship was observed between BMI and higher PL scores.

Relationship between body mass index and physical fitness of children and adolescents in Xinjiang, China: a cross-sectional study

Background

Xinjiang is an economically underdeveloped area in China, but the obesity rate of children and adolescents is increasing year by year. Physical fitness and body mass index (BMI) are very important factors for healthy development, whereas few studies focus on the relationship between them in this region. This study aimed to explore the relationship between physical fitness and BMI of children and adolescents aged 7 to 18 in Xinjiang.

Method

A total of 17,356 children and adolescents aged 7–18 years were involved. BMI was divided into five levels by percentiles, from very low to very high. Physical fitness was evaluated by five indicators: grip strength, standing long jump, sit-and-reach, 50 m dash, and endurance running. Single-factor analysis of variance was used to compare the Z-scores of the five physical fitness indicators among different BMI levels for the four age groups by gender. A nonlinear quadratic regression model was used to evaluate the relationship between BMI and each indicator in the four age groups.

Result

There is a significant correlation between the five health-related indicators (grip strength, standing long jump, sit and reach, 50 m dash, endurance run) at two age groups (13-15 yrs., 16-18 yrs) of children and adolescents in Xinjiang, China. The range of the Pearson coefficient is 0.048 ~ 0.744. For the other two age groups (7-9 yrs., 10-12 yrs.,) significant correlations are found only in some indicators, and the Pearson coefficient ranges from 0.002 to 0.589. The relationship between BMI and physical fitness presents an U-shaped or inverted U-shaped curve in most age groups(R² ranges from − 0.001 to 0.182. Children and adolescents with normal BMI score higher on physical fitness tests, and boys (R² ranges from − 0.001 to 0.182) are more pronounced than girls (R² ranges from 0.001 to 0.031).

Conclusion

Children and adolescents with a BMI above or below the normal ranges have lower physical fitness than those with normal BMI. BMI and physical fitness have an U-shaped or inverted U-shaped curve relationship, and the impact is more evident in boys than girls. Targeted actions such as improving the quality of physical education classes, advocating students to keep a balanced diet and physical exercise should be taken designedly.

Underweight children are agile but lack power

Given the knowledge gap in literature on the impact of undernutrition on muscular power and agility in school-aged children, the aim of this study was to compare physical fitness in such underweight- and normal weight children. In this cross-sectional study, 853 children were included (459 boys; mean age: 9.2 (1.8) years). The children were grouped according to their BMI-for-age-and-sex: normal weight (− 1 ≤ z-score < 2) and underweight (z-score < − 1). Within the underweight group, three thinness subgroups were composed: grade 1 (− 2 ≤ z-score < − 1), grade 2 (− 3 ≤ z-score < − 2) and grade 3 (z-score < − 3). Their agility, muscular endurance and power were assessed with the Performance and Fitness test battery (PERF-FIT). Regardless the country they lived in, the underweight children showed better agility (p = 0.012) and muscular endurance (p = 0.004) than those with normal weight. They presented with lower muscular power than the normal weight group, shown by significantly shorter overhead throwing distances (p = 0.017) and less standing long jump peak power (p < 0.001). The standing long jump peak power decreased further with increasing thinness grade (p = 0.027).

Conclusion: Underweight children are more agile, but have lower muscular power compared to their normal weight peers. Its relationship with motor competence and physical activity, necessitates attention for tackling muscular strength deficiencies in these children, enabling them to meet the basic requirements for a healthy lifestyle later in life.

Has the Prevalence of Childhood Obesity in Spain Plateaued? A Systematic Review and Meta-Analysis

The prevalence of excess body weight (overweight plus obesity) in children has risen during the last decades in many countries, but it is unclear whether it has reached a plateau in Spanish children. We performed an updated systematic review and meta-analysis for the prevalence of excess body weight in children from Spain, comparing the trends between 1999 and 2010 and 2011 and 2021. Data were reported in a prior meta-analysis, plus an updated search using the Web of Science, MEDLINE (via PubMed) and EMBASE databases for data from January 2018 until December 2021. Thirteen representative studies were identified (34,813 children aged 2 to 13 years), with sample sizes averaging 2678 (range: 396-16,665). The prevalence of excess body weight in Spanish children aged 2 to 6 years increased from 23.3% (95% CI, 18.5% to 25.5%) during the period 1999-2010 to 39.9% (95% CI, 35.4% to 44.7%) during 2011-2021. In children aged 7 to 13 years, the prevalence of excess body weight increased from 32.3% (95% CI, 29.1-35.6%) during the period 1999-2010 to 35.3% (95% CI, 32.9-37.7%) during 2011-2021. The prevalence of childhood overweight and obesity in Spain has substantially increased in the last decade. New food policies to address the childhood obesity epidemic are urgently required to reverse current trends.

Validity and Reliability of the International FItness Scale (IFIS) in preschool children

OBJECTIVES

Examine the validity and reliability of parent-reported International FItness Scale (IFIS) in preschool-age children.

METHOD

A cross-sectional study of 3051 Spanish preschoolers (3-5 years). Fitness was measured by PREFIT fitness test battery and reported by parents using an adapted version of the IFIS. Waist circumference was evaluated, and the waist-to-height ratio (WHtR) was calculated. Seventy-six parents of randomly selected schoolchildren completed the IFIS twice (two weeks apart) for a reliability assessment.

RESULTS

ANCOVA, adjusted for sex, age and WHtR, showed that preschoolers who were scored by their parents as having average-to-very good fitness had better levels of measured physical fitness than those preschoolers who were classified as having "very poor/poor" fitness levels (18.1laps to 22.1laps vs 15.6laps for cardiorespiratory fitness; 6.6 kg to 7.5 kg vs 5.3 kg for muscular fitness-handgrip-; 71.7 cm to 76.4 cm vs 62.0 cm for muscular fitness-standing long jump-; 17.2s to 16.2s vs 18.2s for speed/agility; and 11.2s to 15.6s vs 8.7s for balance; p < 0.001). The weighted kappa for concordance between parent-reported fitness levels and objective assessment was poor (κ ≤0.18 for all fitness measures). Overall, the mean values of the abdominal adiposity indicators were significantly lower in high-level fitness categories reported by parents than in low-level fitness categories (p < 0.05). The test-retest reliability of IFIS items ranged from 0.46 to 0.62.

CONCLUSIONS

The reliability of the parent-reported IFIS are acceptable, but the concordance between parents reported and objectively measures fitness levels is poor, suggesting that parents' responses may not be able to correctly classify preschoolers according to their fitness level.

Speed of Movement, Fatness, and the Change in Cardiometabolic Risk Factors in Children

We aimed to examine speed of movement and its interactive association with fatness to changes in cardiometabolic risk factors over one year in children. The analysis included 8345 children aged 6-13 years. Cardiometabolic risk score was computed by summing Z-scores of waist circumference, the average of systolic and diastolic blood pressure, fasting glucose, high-density lipoprotein cholesterol (multiplied by -1), and triglycerides. Both high baseline and improvement in speed of movement were associated with favourable changes in percent body fat, lipids, and cardiometabolic risk score. Percentages of the association between baseline speed of movement and changes in cardiometabolic risk score, triglycerides, and high-density lipoprotein cholesterol explained by baseline BMI were 24.6% (19.6-29.1%), 26.2% (19.7-31.1%), and 12.5% (9.6-15.4%), respectively. The corresponding number for percent body fat was 47.0% (40.4-54.1%), 43.3% (36.7-51.7%), and 29.8% (25.0-34.6%), respectively. Speed of movement mediated the association between fatness and cardiometabolic risk factors. Improved speed of movement was associated with a lower increase in blood pressure in obese children only. Speed of movement is a strong predictor of changes in cardiometabolic risk factors. Fatness and speed of movement are interactively associated with cardiometabolic risk factors. Speed of movement may attenuate the positive association between fatness and blood pressure.

Obesity and thinness prevalence trends in Spanish schoolchildren: are they two convergent epidemics?

BACKGROUND

The objective of this study was to analyse the secular trends in body composition variables and weight status among Spanish schoolchildren from 1992 to 2017, and to examine the persistence in the same weight status category from 2013 to 2017 of the birth cohort in 2007-08.

METHODS

The data for the prevalence/trend analysis were taken from cross-sectional analyses conducted in 1992 (n = 308), 1996 (n = 307), 1998 (n = 275), 2004 (n = 1119), 2010 (n = 912), 2013 (n = 352) and 2017 (n = 275) using similar procedure methods among schoolchildren (aged 4-6 y and 8-11 years) from 22 public schools in the province of Cuenca, Spain. The data for the longitudinal analysis were obtained from cross-sectional analyses of measurements gathered in 2013 and 2017 in the same cohort of children (n = 275) born in 2007 and 2008. Weight, height, body fat percentage (by electronic bioimpedance) and waist circumference were measured by trained personnel. Weight status was defined according to the BMI cut-offs proposed by the International obesity task force (IOTF) criteria.

RESULTS

In schoolchildren, the overall prevalence of thinness increased from 5.9% in 1992 to 14.5% in 2017, P < 0.001. Whereas, the overall prevalence of obesity/overweight remained relatively steady between the same time period (from 25.2% to 26.9%), P = 0.599. In relation to the longitudinal analyses, we observed that 70.9% of schoolchildren in 2017 remained in the same weight status category as in 2013.

CONCLUSIONS

The child obesity epidemic in Spain has remained relatively stable over the last two decades. However, the prevalence of thinness shows a worrying upward trend.

Prevalence and trends of underweight in European children and adolescents: a systematic review and meta-analysis

PURPOSE

This study aimed at providing prevalence trend estimates of underweight among children and adolescents in Europe from 2000 to 2017.

METHODS

MEDLINE, Web of Science, Scopus and CINAHL were searched from their inception up to March 2020. Moreover, searches were conducted on health institutions' websites to identify studies not published in scientific journals. Underweight was defined according to the body mass index (BMI) cut-offs proposed by the International Obesity Task Force (IOTF) and the World Health Organization (WHO) definition criteria. The Mantel-Haenszel method was used to compute the pooled prevalence estimates whenever there was no evidence of heterogeneity; otherwise, the DerSimonian and Laird random-effects method was used. Subgroup analyses by sex, age range (2-13 and 14-18 years old), study year (2000-2006 and 2007-2017), country and European region were conducted.

RESULTS

A total of 49 studies with data from 323,420 children and adolescents aged 2 to 18 years, from 26 countries were included. From 2000 to 2017, according to the IOTF criteria, the prevalence of underweight showed an increasing trend in Eastern, Northern and Southern Europe, where the underweight prevalence ranged from 9.1 to 12.0%, from 4.1 to 6.8%, and from 5.8 to 6.7%, respectively. In Western Europe, the prevalence of underweight tended to decrease, from 14.0 to 11.8%. No significant differences were found by sex or age range.

CONCLUSION

The prevalence of underweight is considerable (overall, around 8-9%), particularly in Eastern Europe, and follows a slight upward trend during the past decade.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42017056924.

The reciprocal relationship between body mass index categories and physical fitness: A 4-year prospective cohort study of 20 000 Chinese children

INTRODUCTION

Body mass index (BMI) categories and physical fitness are associated but the reciprocal relationship between BMI categories and physical fitness has not been investigated. This study aims to investigate the longitudinal reciprocal relationship between BMI categories and physical fitness.

METHODS

This is a population-based 4-year cohort study in 48 elementary schools. Children aged 6 to 9 years at recruitment were included. BMI categories and physical fitness including handgrip strength, core muscle endurance, flexibility, and cardiorespiratory fitness were measured using standard equipment and protocol.

RESULTS

Among 26 392 eligible participants, 19 504 (73.9%) were successfully followed for 3 years. Baseline obesity prevalence was 5.9%. After 3 years, those who were unfit at baseline had an increased risk of obesity (risk ratio [RR] 1.41, 95% CI 1.16-1.71, P < .001) and those who were fit at baseline had a decreased risk of obesity (RR 0.69, 95% CI 0.60-0.80, P < .001) compared with moderately fit children. Furthermore, improvement of fitness predicted decreased risk of obesity. Similarly, normal body weight also predicted better physical fitness. The path analysis confirmed a strong reciprocal relationship between physical fitness and obesity.

CONCLUSIONS

Better physical fitness was prospectively associated with normal weight and vice versa. Physically fit children were more likely to maintain a healthy weight and those with a healthy weight were more likely to be physically fit, which is important for healthy development.

Association between Weight Status and Physical Fitness in Chinese Mainland Children and Adolescents: A Cross-Sectional Study

Background: The increasing prevalence of obesity among children and adolescents is a major public health challenge worldwide. This study examined the relationship between physical fitness and BMI spanning the range from underweight to obese among Chinese mainland children and adolescents. Methods: Participants were 22,681 children and adolescents (11,300 boys and 11,381 girls) aged 10–18 years from the Chinese mainland. Weight status was classified as underweight, normal weight, overweight, and obese using WHO 2007 standards. Physical fitness parameters such as cardiorespiratory fitness (VO_2max), lower body explosive strength (standing broad jump), upper body explosive strength (handgrip strength), abdominal muscular endurance (sit-ups in 30 s), flexibility (sit-and-reach), and agility (repeat bestride (20 s)) were assessed. Results: There was a significant association between weight status categories and physical fitness in all age groups and sex (p_linear < 0.001, p_quadratic < 0.001). Underweight adolescents performed better in lower limb strength, flexibility, agility, and cardiorespiratory fitness than their obese peers, but worse in upper limb strength. Underweight boys aged 10–11 and 12–13 years and girls aged 10–11 years showed significantly (p < 0.05) high odds of meeting a low physical fitness index. Obese adolescents have high odds of meeting a low physical fitness index with age. Conclusion: The present study showed a nonlinear relationship between weight status and physical fitness. Children and adolescents who were classified as underweight or obese had poorer physical fitness than their normal-weight peers.

Prevalence of severe/morbid obesity and other weight status and anthropometric reference standards in Spanish preschool children: The PREFIT project

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.

Association between Adherence to the Mediterranean Diet and Physical Fitness with Body Composition Parameters in 1717 European Adolescents: The AdolesHealth Study

Obesity, low levels of physical fitness, and unhealthy eating patterns are responsible for part of the health problems of adolescents today. The current study aimed at examining the association between the adherence to the Mediterranean diet (MD), through each answer to the items of the Adherence to the MD Questionnaire (KIDMED), and physical fitness with body composition parameters (body mass index (BMI), percentage of body fat, and waist circumference) in 1717 European adolescents (N = 900 boys, N = 817 girls). Data of body composition, physical fitness results, and the answers to KIDMED were analyzed by the Student’s t-test. Additionally, the effect size (ES) was calculated and a Chi-square test analyzed the proportion of participants with and without over waist circumference, overfat, and overweight in each KIDMED question. The relative risk of suffering over waist circumference, overfat and overweight in relation to the responses was calculated by Odd-Ratio. Adherence to the MD did not influence the condition of over waist circumference, overfat and overweight, although certain dietary habits were identified as risk factors for their development. Over waist circumference, overfat, and overweight boys and girls presented higher levels of body mass, waist circumference, body fat percentage, and BMI (p < 0.001; ES = 1.73–3.38), as well as lower levels of all the parameters of the physical fitness analyzed (p < 0.001; ES = 0.45–1.08), except the handgrip test. A direct relationship between fitness and over waist circumference, overfat, and overweight was found.

Prevalence and Trends of Overweight and Obesity in European Children From 1999 to 2016: A Systematic Review and Meta-analysis

IMPORTANCE

Studies of trends in excess weight among European children throughout the last few decades have rendered mixed results. Additionally, some studies were outdated, were based on self-reported weight and height, or included only a few European countries.

OBJECTIVE

To assess prevalence trends in measured overweight and obesity among children across Europe from 1999 to 2016 using a systematic methodology.

DATA SOURCES

MEDLINE, Embase, CINAHL, and Web of Science were searched from their inception until May 2018. Moreover, searches were conducted on health institutions' websites to identify studies not published in scientific journals.

STUDY SELECTION

The inclusion criteria were: (1) studies reporting the population-based prevalence of excess weight (overweight plus obesity) or obesity according to body mass index cutoffs proposed by the International Obesity Task Force; (2) cross-sectional or follow-up studies; and (3) studies including populations aged 2 to 13 years.

DATA EXTRACTION AND SYNTHESIS

Literature review and data extraction followed established guidelines. The Mantel-Haenszel method was used to compute the pooled prevalence estimates and their 95% CI whenever there was no evidence of heterogeneity (I2 < 50%); otherwise, the DerSimonian and Laird random-effects method was used. Subgroup analyses by study year, country, or European region (Atlantic, Iberian, Central, and Mediterranean) were conducted. Prevalence estimates were calculated as an aggregate mean, weighted by the sample size and the number of individuals in each study.

RESULTS

A total of 103 studies (477 620 children aged 2 to 13 years) with data from 28 countries were included. The combined prevalence of overweight and obesity in the Iberian region tended to decrease from 30.3% (95% CI, 28.3%-32.3%) to 25.6% (95% CI, 19.7%-31.4%) but tended to increase in the Mediterranean region from 22.9% (95% CI, 17.9%-27.9%) to 25.0% (95% CI, 14.5%-35.5%). No substantial changes were observed in Atlantic Europe or Central Europe, where the overweight and obesity prevalence changed from 18.3% (95% CI, 14.0%-23.9%) to 19.3% (95% CI, 17.7%-20.9%) and from 15.8% (95% CI, 13.4%-18.5%) to 15.3% (95% CI, 11.6%-20.3%), respectively.

CONCLUSIONS AND RELEVANCE

The prevalence of childhood overweight and obesity is very high, but trends have stabilized in most European countries. There are substantial between-country differences in the current levels and trends of overweight and obesity. The rising prevalence in some Mediterranean countries is worrisome.

TRIAL REGISTRATION

PROSPERO identifier: CRD42017056924.

Variations in Central Adiposity, Cardiovascular Fitness, and Objectively Measured Physical Activity According to Weight Status in Children (9-11 Years)

The purpose of this study was twofold: first, to compare the central adiposity (CA), cardiovascular fitness (CF), and physical activity (PA) in children with different weight status, and second, to determine the associations between moderate to vigorous physical activity (MVPA) and measures of adiposity [CA and body mass index (BMI)] and CF. A sample of 244 children (boys = 120 and girls = 124), 9.7-10.8 years of age (10.3 ± 0.3 years), was measured for stature, body mass, waist circumferences, and 20-m multi-stage fitness test. PA was recorded with ankle mounted accelerometer. BMI groups were used to classify children as underweight (UW), normal weight (NW), and overweight (OW). The prevalence of being OW was 21.7 and 25% in boys and girls, respectively. Only 5.3% of the participants were found to accumulate recommended amount (≥60 min/day) of MVPA. Boys were significantly outperformed girls in terms of CF. Moreover, they were significantly more engaged in moderate and vigorous physical activities than girls. Regardless of gender, results indicated that OW children had significantly higher values in all anthropometric parameters and lower level of CF than their UW and NW counterparts. In girls, OW children were found to accrue less time engaging in MVPA than the children in UW and NW groups. In boys, OW children were found to accrue less time engaging in vigorous activities than UW and NW children. Results also showed that there were no significant differences between UW and NW girls and boys in respect to CF. Besides, UW girls were found to accrue more time engaging in MVPA than NW girls. MVPA was found to be significantly and negatively correlated with BMI and waist circumference and significantly and positively correlated with CF in both boys and girls. These discrepancies and associations highlight the considerable influences of MVPA on weight status and CF in children.

Health-related physical fitness and weight status in 13- to 15-year-old Latino adolescents. A pooled analysis

OBJECTIVE

The aim of this study was to investigate the relation between health-related physical fitness and weight status in 13- to 15-year-old Latino adolescents.

METHOD

The final sample consisted of 73,561 adolescents aged 13-15 years (35,175 girls) from Chile (n=48,771) and Colombia (n=24,790). Cardiorespiratory and musculoskeletal fitness were measured using 20-m shuttle run (relative peak oxygen uptake - VO_2peak) and standing broad jump test (lower body explosive strength), respectively. The International Obesity Task Force definition was used to define weight status (i.e., underweight, normal weight, overweight, and obese).

RESULTS

The present study found an inverted J-shape relationship between body mass index, cardiorespiratory fitness, and musculoskeletal fitness in both genders and all age groups (p<0.01). Results also suggest that underweight adolescents, and not just overweight and obese adolescents, have lower odds of having a healthy cardiorespiratory fitness (based on new international criterion-referenced standards) profile when compared with their normal weight peers, except in girls aged 14 (p=0.268) and 15 years (p=0.280).

CONCLUSIONS

The present results indicate low cardiorespiratory fitness and musculoskeletal fitness levels in underweight, overweight, and obese adolescents when compared with their normal weight peers. The findings appear to suggest that exercise programs should to decrease fat mass in overweight/obese adolescents and increase muscle mass in underweight adolescents.

The Relationships Between Weight Status and Physical Fitness Among Chinese Children and Youth

PURPOSE

This study examined the prevalence of different weight status and the relationships between weight status and physical fitness among Chinese children and youth.

METHODS

Participants were 107,206 Grade 4 children and 70,213 Grade 8 youth from the China National Assessment of Educational Quality - Physical Education & Health in 2015 (CNAEQ-PEH 2015). Using World Health Organization (WHO) and US Centers for Disease Control and Prevention (CDC) criteria, weight status was divided into four groups (underweight, normal weight, overweight, and obese) according to Body Mass Index (BMI). The differences of physical fitness performances (15-m progressive aerobic cardiovascular endurance run [PACER], standing long jump, and 50-m sprint) among four weight status groups were compared. Data were analyzed using descriptive statistics, MANCOVA, and Cohen's d.

RESULTS

The prevalence of weight status varied by criteria (e.g., for Grade 4 boys, the prevalence of underweight by WHO and CDC were 5.9% and 10.5%; overweight were 14.5% and 11.4%, respectively). Compared with the normal weight group, the selected physical fitness performances in the overweight and obese groups were worse (p < .001) with small to large effect sizes.

CONCLUSION

The prevalence of underweight and overweight/obese was relatively high among Chinese children and youth. The prevalence of underweight, overweight, and obesity varied slightly depending on the criteria used for evaluating BMI. The overweight/obese participants tended to perform poorer in selected physical fitness tests. The performance disparities between the normal weight group and overweight/obese groups were larger in Grade 4 than in Grade 8 and among boys than among girls.

The Relationship Between Strength Measurements and Anthropometric Indicators (BMI and Skinfold Thickness) in Ellisras Rural Adolescents Aged 9–15 Years: Ellisras Longitudinal Study

Purpose. Handgrip strength and arm hang have been recognized as predictors of muscle strength and presented as biomarkers for important health outcomes and overall fitness of an individual. The aim of the study was to investigate the relationship between arm hang and handgrip strength with BMI and skinfold thickness.

Method. The total of 769 children (391 boys and 378 girls) aged 9-15 years underwent a series of anthropometric and strength measurements with the use of standard procedures. Linear regression was applied to assess the relationship of arm hang and handgrip strengths with body mass index and skinfold thickness.

Results. The prevalence of undernutrition and low strength measurements was high (1.7-85%) while the prevalence of overweight and obesity was low (1.5-4.2%) in the Ellisras children aged 9-15 years. Boys showed a significantly higher (p < 0.05) mean arm hang (9.6-13.1 kg) than girls (4.0-5.1 kg) aged 11-15 years. There was a significant (p < 0.05) association between low strength and underweight among Ellisras rural children when unadjusted (OR = 0.650; 95% CI = 0.487-0.867) and adjusted (OR = 0.650; 95% CI = 0.489-0.868) for age and gender.

Conclusions. The prevalence of undernutrition and poor strength was high. An association was observed between arm hang and anthropometric indicators while handgrip showed no significant association with anthropometric indicators. Further studies are needed to investigate the association between strength and undernutrition over time.

International variability in 20 m shuttle run performance in children and youth: who are the fittest from a 50-country comparison? A systematic literature review with pooling of aggregate results

OBJECTIVES

To describe and compare 20 m shuttle run test (20mSRT) performance among children and youth across 50 countries; to explore broad socioeconomic indicators that correlate with 20mSRT performance in children and youth across countries and to evaluate the utility of the 20mSRT as an international population health indicator for children and youth.

METHODS

A systematic review was undertaken to identify papers that explicitly reported descriptive 20mSRT (with 1-min stages) data on apparently healthy 9-17 year-olds. Descriptive data were standardised to running speed (km/h) at the last completed stage. Country-specific 20mSRT performance indices were calculated as population-weighted mean z-scores relative to all children of the same age and sex from all countries. Countries were categorised into developed and developing groups based on the Human Development Index, and a correlational analysis was performed to describe the association between country-specific performance indices and broad socioeconomic indicators using Spearman's rank correlation coefficient.

RESULTS

Performance indices were calculated for 50 countries using collated data on 1 142 026 children and youth aged 9-17 years. The best performing countries were from Africa and Central-Northern Europe. Countries from South America were consistently among the worst performing countries. Country-specific income inequality (Gini index) was a strong negative correlate of the performance index across all 50 countries.

CONCLUSIONS

The pattern of variability in the performance index broadly supports the theory of a physical activity transition and income inequality as the strongest structural determinant of health in children and youth. This simple and cost-effective assessment would be a powerful tool for international population health surveillance.

International normative 20 m shuttle run values from 1 142 026 children and youth representing 50 countries

OBJECTIVE

To develop sex-specific and age-specific international norms for the 20 m shuttle run test (20mSRT) in children and youth (aged 9-17 years), and to estimate the prevalence meeting the FITNESSGRAM criterion-referenced standards for healthy cardiorespiratory endurance (CRE).

METHODS

A systematic review was undertaken to identify papers explicitly reporting descriptive 20mSRT (with 1 min stages) data on children and youth since 1981. Data were included on apparently healthy (free from known disease/injury) 9-17 years old. Following standardisation to a common metric and for protocol differences, pseudo data were generated using Monte Carlo simulation, with population-weighted sex-specific and age-specific normative centiles generated using the Lambda Mu and Sigma (LMS) method. Sex-related and age-related differences were expressed as per cent and standardised differences in means. The prevalence with healthy CRE was estimated using the sex-specific and age-specific FITNESSGRAM criterion-referenced standards for [Formula: see text].

RESULTS

Norms were displayed as tabulated centiles and as smoothed centile curves for the 20mSRT using 4 common metrics (speed at the last completed stage, completed stages/minutes, laps and relative [Formula: see text]). The final data set included 1 142 026 children and youth from 50 countries, extracted from 177 studies. Boys consistently outperformed girls at each age group (mean difference±95% CI: 0.86±0.28 km/h or 0.79±0.20 standardised units), with the magnitude of age-related increase larger for boys than for girls. A higher proportion of boys (mean±95% CI: 67±14%) had healthy CRE than girls (mean±95% CI: 54±17%), with the prevalence of healthy CRE decreasing systematically with age.

CONCLUSIONS

This study provides the most comprehensive and up-to-date set of international sex-specific and age-specific 20mSRT norms for children and youth, which have utility for health and fitness screening, profiling, monitoring and surveillance.

Fat Mass Centile Charts for Brazilian Children and Adolescents and the Identification of the Roles of Socioeconomic Status and Physical Fitness on Fat Mass Development

This paper presents fat mass centile charts for Brazilian youth and investigates the roles of socioeconomic status and physical fitness (PF) on fat mass (FM) development. Two northeast Brazilian samples were used: a cross-sectional sample of 3659 (1921 girls) aged 8 to 16 years and a mixed-longitudinal series of cohorts (8-10, 10-12, 12-14, 14-16 years) with 250 boys and 250 girls. A measure of somatic maturity was used as a marker of biological maturation; PF comprised agility, explosive and static strength, and aerobic capacity. Socioeconomic status was based on school attended; public or private. Slaughter's anthropometric equations were used to estimate FM. Percentile charts was constructed using the LMS method. HLM (Hierarchical Linear Model) 7 software modeled FM changes, identifying inter-individual differences and their covariates. Girls and boys had different FM percentile values at each age; FM increased nonlinearly in both girls and boys. Higher PF levels reduced FM changes across time in both sexes. Sex-specific non-linear FM references were provided representing important tools for nutritionists, pediatriciann and educators. Physical fitness levels were found to act as a protective factor in FM increases. As such, we emphasize PF importance as a putative health marker and highlight the need for its systematic development across the school years.

Anthropometric Status and Nutritional Intake in Children (6-9 Years) in Valencia (Spain): The ANIVA Study

The aim of our study was to assess nutritional intake and anthropometric statuses in schoolchildren to subsequently determine nutritional adequacy with Spanish Dietary Reference Intake (DRIs). The ANIVA study, a descriptive cross-sectional study, was conducted in 710 schoolchildren (6–9 years) in 2013–2014 in Valencia (Spain). Children’s dietary intake was measured using 3-day food records, completed by parents. Anthropometric measures (weight and height) were measured according to international standards, and BMI-for-age was calculated and converted into z-scores by WHO-Anthro for age and sex. Nutrient adequacy was assessed using DRI based on estimated average requirement (EAR) or adequate intake (AI). Pearson’s chi-square and Student’s t-test were employed. Of our study group (47.61% boys, 52.39% girls), 53.1% were normoweight and the weight of 46.9% was inadequate; of these, 38.6% had excess body weight (19.6% overweight and 19.0% obesity). We found intakes were lower for biotin, fiber, fluoride, vitamin D (p < 0.016), zinc, iodine, vitamin E, folic acid, calcium and iron (p < 0.017), and higher for lipids, proteins and cholesterol. Our results identify better nutritional adequacy to Spanish recommendations in overweight children. Our findings suggest that nutritional intervention and educational strategies are needed to promote healthy eating in these children and nutritional adequacies.

Physical activity intervention (Movi-Kids) on improving academic achievement and adiposity in preschoolers with or without attention deficit hyperactivity disorder: study protocol for a randomized controlled trial

BACKGROUND

The prevention of obesity and improvement of academic achievement in children are concerns of industrialized societies. Obesity has been associated with psychological disorders, including attention deficit hyperactivity disorder, whose prevalence has been estimated at 6.8 % in Spanish children and adolescents. It is known that physical activity is positively related to academic achievement and negatively related to the risk of obesity in children. However, studies to test the effectiveness of physical activity interventions in improving academic achievement in preschool children are scarce and have some weaknesses that threaten their validity. Moreover, very few studies have examined their effectiveness in improving symptoms of attention deficit hyperactivity disorder. This paper outlines a two-year multidimensional preschool intervention (Movi-Kids) aimed at preventing obesity and improving academic achievement in children with or without attention deficit hyperactivity disorder.

METHODS/DESIGN

Twenty-one schools from Ciudad Real and Cuenca, Spain, were randomized to intervention and control groups. In the first academic year, children in the third grade of preschool and the first grade of primary school in the intervention group received the Movi-Kids intervention. In the second academic year, schools were crossed over to the other group. The intervention included children, parents and teachers, and the school environment, and consisted of: (i) three hour-long sessions of recreational non-competitive physical activity after school, weekly, (ii) educational materials for parents and teachers addressing sedentary lifestyle risks and (iii) playground modifications to promote physical activity during breaks. Primary outcome measures of this study were academic achievement (intelligence, cognition, memory, attention and perception), assessed by the Battery of General and Differential Aptitudes, and adiposity measures (body mass index, waist circumference, triceps skinfold thickness and body fat percentage). Secondary outcome measures were: attention deficit hyperactivity disorder risk, motor skills, health-related quality of life and sleep quality. These variables will all be measured in both groups at baseline and at the end of the first and second academic years.

DISCUSSION

It seems reasonable that an intervention to promote physical activity based on playground games will be useful for simultaneously improving academic achievement and controlling obesity.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01971827 .

Modeling the dynamics of BMI changes during adolescence. The Oporto Growth, Health and Performance Study

OBJECTIVES

The aims of this study were twofold: (i) to model changes in body mass index (BMI) of 10-18-year-old adolescents, and (ii) to investigate the effects of total physical activity (TPA), physical fitness (PF), sleep duration and fruit/vegetable consumption in BMI trajectories across time.

METHODS

Data were obtained from the Oporto Growth, Health and Performance Study and comprised 6894 adolescents (3418 girls) divided into four age cohorts (10, 12, 14 and 16 years) measured annually for 3 years. BMI was computed using the standard formula (kg m(-2)); TPA was estimated with the Baecke questionnaire; PF measures included 1-mile run/walk, 50 yard dash (50YD), standing long jump (SLJ), handgrip strength (HGr) and agility shuttle run. Longitudinal changes in BMI were analyzed using the multilevel modeling approach.

RESULTS

The average BMI at age of peak of height velocity was 20.7±0.07 kg m(-2) for girls (P<0.001) and 20.58±0.06 kg m(-2) for boys (P<0.001). The annual increment in BMI was 1.36±0.04 kg m(-2), P<0.001 and 1.23±0.03 kg m(-2), P<0.001 for girls and boys, respectively. PF were related to BMI trajectories in both sexes (Girls: β1mile=0.12±0.02, P<0.001; βSLJ=-0.01±0.00, P<0.001; β50YD=0.28±0.05, P<0.001; βHGr=-8.91±0.54, P<0.001; Boys: β1mile=0.18±0.02, P<0.001; βSLJ=-0.01±0.00, P<0.001; β50YD=0.26±0.04, P<0.001; and βHGr=-8.15±0.45, P<0.001). TPA only showed significant, but positive, association with girls' BMI trajectories (β=0.10±0.03, P=0.001). After adjusting for the covariates, sleep duration and fruit/vegetable intake did not show any significant association with BMI trajectories either sex.

CONCLUSIONS

BMI increased linearly with age in both gender. PF levels are negatively associated with BMI across time in both boys and girls. Therefore, promotion of PF in the adolescent years seems to be effective in the early prevention of obesity.