Body image disorders associated with lifestyle and body composition of female adolescents

Polycystic ovary syndrome and body image concerns during adolescence

PURPOSE

This study aimed to compare body image concerns in adolescents with and without PCOS.

DESIGN AND METHODS

This cross-sectional study included 1076 adolescents, including 344 with PCOS and 732 without PCOS. The participants were asked to complete a comprehensive questionnaire that included demographic and reproductive parameters and the body image concerns inventory (BICI) which comprised two factors (1-dissatisfaction and embarrassment about one's appearance and 2-social function due to appearance concerns). Linear regression analysis was conducted to evaluate the effect of hyperandrogenism and/or abnormal uterine bleeding (AUB) and/or obesity on BICI and its domains both before and after adjustment for potential confounders.

RESULTS

The result showed that adolescents with PCOS had a worse total BICI score and its domains (p < 0.05). In multivariable-adjusted regression models, adolescents with PCOS were more likely to have a high body image concern (β = 0.05, P < 0.001), while those with high household income were less likely to have body image concern (β = -0.08, P = 0.004). Considering hyperandrogenism status, those with high household income were also less likely to have high body image concern (β = -0.08, P = 0.004), and age of menarche (β = -0.01, P = 0.013) were also inversely associated with total BICI score. Likewise, considering obese status, only high household income (β = -0.08, P = 0.004) was inversely associated with total BICI score. Also, considering menstrual irregularity status, high household income (β = -0.08, P = 0.005), and age of menarche (β = -0.01, P = 0.01) were inversely associated with the total BICI score.

CONCLUSION

Adolescents with PCOS had higher body image concerns. Apart from the being PCOS label, abnormal uterine bleeding was also a predictor of body image concern.

PRACTICAL IMPLICATIONS

Clinicians should pay attention to the greater influence of the PCOS label on altered body image in adolescents.

Investigating the Effects of a Physical Education (PE) Kit Intervention on Female Adolescent Body Esteem

It is widely acknowledged that adolescent females are particularly at risk of low body esteem. Low body esteem is associated with poor mental health and other negative outcomes. Interventions to help raise body esteem could have a considerable impact, especially if the intervention is low cost, easy to implement, and scalable. We investigated the efficacy of an intervention where participants could choose their clothes to wear during a physical education lesson (PE). PE is a context associated with low body esteem, a finding that is particularly evident among females. We hypothesized that body esteem would improve with choice. To show that body esteem does not randomly change, we tested its stability when assessed in a test-retest design when completed in a classroom setting, hypothesizing that body esteem would be stable. Participants (n = 110; Age M = 14.9 years; SD = 0.68 years) completed a 14-item body esteem scale eight times: (a) wearing the school uniform in a classroom and (b) during a PE lesson on two occasions in each context within a week. This was repeated at the re-test, which was separated by a two-week gap. The intervention was implemented and students were given a choice of PE kit and could wear their own (non-designer) clothes. The findings indicate that the choice of PE kit intervention was associated with improved body esteem in a PE context but was stable in a classroom context, which we hypothesized to be stable. We argue that this low-cost and scalable intervention represents a useful starting point for helping to support females with low body esteem among a potentially vulnerable population.

The association between sport type and eating/body image concerns in high school students: a cross-sectional observational study

PURPOSE

Disordered eating and body image concerns are increasingly common among adolescents, possibly representing the underpinning of eating disorders (EDs). This cross-sectional observational study aimed at investigating the relationship between various patterns of sports involvement or inactivity, and the abovementioned psychopathological dimensions.

METHODS

All adolescents attending their 3rd-5th Italian grade in a single high school reported their sociodemographic and anthropometric data, their weekly sports involvement, and filled the Eating Disorders Examination Questionnaire 6.0 (EDE-Q), the Body Uneasiness Test, and the Muscle Dysmorphia Disorder Inventory (for boys). Comparisons were performed considering sex, weekly hours of activity, and different sports type (none, individual, or team sports).

RESULTS

Of 744 enrolled students, 522 (70.2%) completed the survey. Girls showed higher underweight rates, preference for inactivity or individual sports, and higher psychometric scores compared to boys. Among girls, no differences were found based on time spent exercising or sports type. Inactive boys displayed worse weight- and shape-based psychopathology, higher body uneasiness, and higher appearance intolerance compared to those who devoted more time to exercise. Among boys, individual and team sports were associated with lower EDE-Q scores compared to inactivity, whereas body uneasiness and appearance intolerance were lower only in team sports.

CONCLUSIONS

The study confirms the presence of remarkable sex differences in eating and body concerns of adolescents. Among boys, sports involvement is tied to lower ED psychopathology, and preference for team sports may be associated with reduced concerns. Wider longitudinal studies on will clarify the direction and specificity of these findings.

LEVEL OF EVIDENCE

Level V-Cross-sectional observational study.

[Influence of exercise in the body image of preadolescents and adolescents: importance of the index of corporal mass as a factor of confusion]

INTRODUCTION

adolescents are the group most vulnerable to distortions in the perception of their image. This often leads to body dissatisfaction that can negatively affect their self-esteem. The practice of physical activity (PA) could help solve this problem.

OBJECTIVES

to analyze the influence that the amount of PA performed has on the self-perception of body image in the pre and adolescent population while taking into account confounding factors that could affect this relationship.

METHODS

a cross-sectional study of 822 participants aged 9 to 16 years was conducted. The prevalence of PA, their body mass index (BMI), and their objective and perceived physical condition (PC) were determined. The Stunkard pictogram was used to determine the degree of body dissatisfaction.

RESULTS

a generalized satisfaction with own body image was found regardless of age and sex. Low-magnitude significant associations were found between perceived body image and the amount of PA, perceived PC, and objective PC. PA did not influence body satisfaction when adjusted for BMI, which was the variable that presented the highest correlations with self-perception (r = 0.713) and self-satisfaction (r = 0.576).

CONCLUSIONS

a generalized satisfaction with one's own body image was identified in the pre and adolescent population under study. The amount of PA was not shown to be a variable with great influence on self-perception and body satisfaction, contrary to BMI.

Individual and Combined Association between Unhealthy Lifestyle Behaviors and Body Weight Dissatisfaction in a Sample of Adolescents from Southern Brazil

The individual and combined association between unhealthy lifestyle behaviors and body weight dissatisfaction in adolescents was investigated. This cross-sectional research used data from 676 students (348 female), aged between 14 and 19 years old (mean of 14.6 years old) from southern Brazil. Unhealthy lifestyle behaviors and body weight dissatisfaction were assessed through a questionnaire. Unhealthy lifestyle behaviors included smoking, excessive alcohol consumption, sedentary lifestyle, and poor diet, and were analyzed as individual factors and as combinations of behaviors. For males, smoking (OR: 2.6; 95% CI: 1.6-4.0) and the combination of smoking/excessive consumption of alcoholic beverages (OR: 2.5; 95% CI: 1.1-5.8) were directly associated with the desire to reduce body weight, whereas the combination of smoking/inadequate diet (OR: 1.3; 95% CI: 1.0-1.6) was associated with the desire to increase body weight. For females, the combinations of inadequate diet/physical inactivity (OR: 1.6; 95% CI: 1.0-2.5) and of smoking/excessive consumption of alcoholic beverages (OR: 1.9; 95% CI: 1.4-2.8) were directly associated with the desire to reduce body weight. The presence of simultaneous unhealthy lifestyle behaviors is associated with bodyweight dissatisfaction in adolescents.

Associations between eating behaviours and cardiometabolic risk among adolescents in the Health Outcomes and Measures of the Environment study

BACKGROUND

Eating behaviours are associated with childhood obesity, but their associations with cardiometabolic risk are less clear.

OBJECTIVES

We evaluated cross-sectional associations between eating behaviours and cardiometabolic risk among 185 adolescents (age 12.4 ± 0.7 years; 53% female; body mass index (BMI)-z 0.72 ± 1.37) from Cincinnati, Ohio (HOME Study; enrolled 2003-2006).

METHODS

Caregivers assessed adolescents' eating behaviours with the Child Eating Behaviour Questionnaire. We computed adolescents' cardiometabolic risk scores based on HOMA-IR, triglycerides to high-density lipoprotein cholesterol ratio, adiponectin to leptin ratio, systolic blood pressure, and cross-sectional area of fat inside the abdominal cavity. Using multivariable linear regression models, we estimated associations of eating behaviour subscales with cardiometabolic risk scores or individual risk components.

RESULTS

Emotional overeating (ß = 1.34, 95% CI: 0.67, 2.01), food responsiveness (ß = 0.99, 95% CI: 0.41, 1.57), and emotional undereating (ß = 0.64, 95% CI: 0.08, 1.21) were associated with higher cardiometabolic risk scores. Satiety responsiveness (ß = -0.79, 95% CI: -1.59, 0.00) was associated with lower cardiometabolic risk scores. Adjusting for adolescent BMI-z at age 12 attenuated these associations, suggesting that adiposity may mediate these associations.

CONCLUSION

Hedonistic eating behaviours were associated with higher cardiometabolic risk in these adolescents.

Body Weight Dissatisfaction and Health Risk Behaviors in Adolescents

Body weight dissatisfaction has been described as a marker for various health diseases, given its direct association with social, physical, and emotional suffering. We investigated the association between body weight dissatisfaction and health risk behaviors in adolescents. This was a cross-sectional study conducted with 668 adolescents aged 14-19 years in the city of São José, southern Brazil. Body weight satisfaction/dissatisfaction was assessed using a questionnaire validated for the investigated population. Health risk behaviors included smoking, alcohol, illicit drugs, medication, non-prescription anabolic steroids, not using seatbelt, unsafe sexual behavior and not knowing how to deal with day-to-day stress. Among males, 66.1% were dissatisfied with their body weight (32.1% due to thinness and 34.0% due to overweight). Among females, 80.0% were dissatisfied with their body weight (24.5% due to thinness and 55.5% due to overweight). There were no significant differences regarding health risk behaviors according to body weight satisfaction/dissatisfaction and sex. Compared to males who were satisfied with their body weight, those who were dissatisfied due to being overweight were more likely to be using tobacco (OR: 2.9; 95% CI: 2.1-4.2), alcohol (OR: 1.7; 95% CI: 1.5-1.9) and anabolic steroids (OR: 2.7; 95% CI: 1.2-5.7). Compared to females who were satisfied with their body weight, those who were dissatisfied due to thinness were more likely to be consuming alcoholic beverages (OR: 1.6; 95% CI: 1.2-2.0) and less likely to be consuming illicit drugs (OR: 0.5; 95% CI: 0.3-0.8). Interventions aimed at health education regarding the non-adoption of risk behaviors such as alcohol and tobacco use, as well as the non-use of anabolic steroids, and favoring the maintenance of general health, may be important for adolescents with body dissatisfaction. These data suggest that health risk behaviors such as adolescent male use of tobacco, alcohol, and anabolic steroids and the use of alcohol and drugs by female adolescents can be related to body weight dissatisfaction.

Association between physical activity and online sexual objectification experience: The mediating role of body-image depression

Objective

With the popularization and development of online media technology, more and more women are paying attention to their body image and physical behavior. The purpose of this study was to investigate the effect of online sexual objectification experience on the physical activity of female college students and verify the mediating role of body-image depression between them.

Methods

A cross-sectional convenient sample of 882 female college students from four universities in Hubei Province completed an online survey, and the Online Sexual Objectification Experience Scale (OSOES), the Body-Image Depression Questionnaire, and the Physical Activity Rating Scale (PARS) were used to collect the data. The mediating effect of the association between online sexual objectification experience and physical activity, was examined using the process procedure in SPSS and the bootstrap method.

Results

Online sexual objectification experience was significantly positively correlated with physical activity (r = 0.420, p < 0.01). Body-image depression was significantly negatively correlated with online sexual objectification experience and physical activity (r = -0.484, p < 0.01; r = -0.569, p < 0.01). Online sexual objectification experience can affect physical activity directly (β = 6.49, p < 0.001, effect value 44.97%) and also indirectly through body-image depression (β = 7.95, p < 0.001, effect value 55.03%); there were significant differences between major and education-level categories in body-image depression and physical activity.

Conclusion

Both online sexual objectification experience and body-image depression can promote physical activity among female college students, and body-image depression has a mediating effect between online sexual objectification experience and physical activity.

A study on differences about the influencing factors of depressive symptoms between medical staff and residents during 2022 city-wide temporary static management period to fighting against COVID-19 pandemic in Shanghai

Objectives

Our study aimed to identify the latent class of depressive symptoms in the Shanghai population during the city-wide temporary static management period and compare differences in the factors influencing depressive symptoms between medical staff and residents.

Methods

An online cross-sectional survey was conducted with 840 participants using questionnaires, including Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Pittsburgh Sleep Quality Index (PSQI), and self-compiled questionnaire (demographic characteristics and internet usage time). Latent class analysis (LCA) was performed based on participants' depressive symptoms. The latent class subgroups were compared using the chi-square test and t-test. Logistic regression was used in our study to analyze the factors influencing depressive symptoms within the medical staff group and residents group and then compare their differences.

Results

Two distinct subgroups were identified based on the LCA: the group with low-depressive symptoms and the group with high-depressive symptoms. There were significant differences between the two groups (P < 0.05) on age, education level, marital status, internet usage time, identity characteristics (medical staff or residents), family income level, living style, overall quality of sleep, and anxiety levels. Furthermore, logistic regression analysis results showed that compared with the residents group, the participants in the group of medical staff with "increasing internet usage time" and the "daytime dysfunction" would have nearly two times the possibility of getting serious depressive symptoms.

Conclusions

There are differences in the factors influencing depression symptoms between medical staff and residents during the 2022 city-wide temporary static management period to fighting against the COVID-19 pandemic in Shanghai. We should pay special attention to those with increasing internet usage time and daytime dysfunction in medical staff working in a special environment such as the COVID-19 pandemic.

Association between body image dissatisfaction and body anthropometric indices among Chinese children and adolescents at different developmental stages

Objective

Children at different developmental stages show different physical development and psychological cognitive characteristics and may pay different attention to body parts. The purpose of this study was to analyze the associations between body image dissatisfaction (BID) and body anthropometric indices (BAIs) among Chinese children and adolescents at different developmental stages.

Methods

A total of 609 Chinese primary and secondary school students aged 8-15 years (329 boys and 280 girls) were selected using stratified cluster sampling. The students' body height, sitting height (SH), weight, chest circumference (CC), hip circumference (HC), waist circumference (WC), scapular skinfold thickness (SST), triceps skinfold thickness (TST), and abdominal skinfold thickness (AST) were measured. Boys' testicular volumes and first spermatorrhea and girls' breast measures and menarche were assessed using the Tanner stage standard. A body shape questionnaire (BSQ) was used to survey the subject's BID.

Results

In boys with testicular volume < 4 ml, the hip-to-height ratio (HHR) was positively correlated with BSQ score (β = 8.17, P < 0.01). In boys with testicular volume ≥4 ml and nonfirst spermatorrhea, the HHR and SST were positively correlated with BSQ score (β = 2.51, P = 0.04; β = 4.98, P < 0.01). In boys with first spermatorrhea, weight was positively correlated with BSQ score (β = 10.30, P < 0.01). In girls with breast development < Tanner stage II, waist-to-height ratio (WHtR) was positively correlated with BSQ score (β = 5.12, P < 0.01); In girls with breast development ≥ Tanner stage II and nonmenarche, chest-to-sitting height ratio (CSHR) was positively correlated with BSQ score (β = 10.82, P < 0.01), and waist-to-hip ratio (WHR) was negatively correlated with BSQ score (β = -3.61, P = 0.04). In girls with menarche, WHtR and sitting height-to-height ratio (SHHR) were positively correlated with BSQ score (β = 6.09, P < 0.01; β = 2.05, P = 0.02).

Conclusion

The associations between body image dissatisfaction and anthropometric indices among Chinese children and adolescents at different developmental stages are different.

Physical Activity and Body Image Perception in Adolescents: A Systematic Review

Adolescence represents a vulnerable phase of life for psychological health. The practice of physical activity (PA) appears to have a positive influence on adolescents, increasing self-esteem and producing a more positive body image. A systematic review of published articles over the past 10 years until June 2022 was conducted according to the PRISMA statement employing the electronic databases MEDLINE and Web of Science (639 records) to summarize the literature on the relationship between body image dissatisfaction (BID) and assessed by figural scales and practice of structured and unstructured PA in adolescents (10-18 years), taking into account BMI and/or weight status. All articles were independently reviewed using inclusion/exclusion criteria, retrieved data, and assessed quality with the adapted Newcastle-Ottawa Scale for observational studies. The main finding of interest that emerged from most of the 28 included studies is the negative association between BID and PA during adolescence: as PA increases, BID decreases. However, this updated systematic review also identified some flaws in the existing literature, highlighting the need for high-quality adolescent research using validated figural scales and objective PA assessments. In conclusion, the reviewed studies showed that PA involvement can be efficacious in protecting from body image perception concerns and enhancing body satisfaction. Future interventions should promote structured and unstructured PA during adolescence to improve self-esteem and body image.

Weight misperception and substance use: Brazilian Study of Cardiovascular Risks in Adolescents (ERICA)

BACKGROUND

Adolescence is a crucial period for body image formation. Weight misperception is the discrepancy between individuals' body weight perception and their actual nutritional status. Both weight concerns and substance use are common among adolescents, and there is evidence of an associations between these two variables. Thus, the aim of this study was to assess the association between weight misperception and substance use (smoking and alcohol) in a national sample of normal weight Brazilian adolescents.

METHODS

Data were obtained from the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional, multicenter, national, school-based survey, carried out in 124 municipalities with more than 100,000 inhabitants from Brazil. The sample included adolescents aged 12-17 years, classified as normal weight by nutritional status evaluation. The following measures were collected: weight underestimation and overestimation (exposure); having tried cigarette smoking, current smoking, current alcohol consumption, binge drinking and current smoking and alcohol consumption(outcomes); macro-region, sex, type of school, and excessive screen time (confounders). The frequency of variables was calculated with 95% confidence intervals (CI). Poisson regression models were used to estimate prevalence ratios (PR).

RESULTS

In total, data from 53,447 adolescents were analyzed. Weight misperception was present in a third of the adolescents, with similar prevalence of weight underestimation and overestimation. In adolescents aged 12-14 years, weight underestimation and overestimation were associated with having tried cigarette smoking (PR: 1.18 and 1.43, respectively), current alcohol consumption (PR: 1.33 for both weight misperception categories), and binge drinking (PR: 1.96 and 2.01, respectively). Weight underestimation was associated with both having tried cigarette smoking and current alcohol consumption in boys (PR: 1.14 and 1.16, respectively) and girls (PR: 1.32 and 1.15, respectively). In girls, weight overestimation was associated with all substance use variables (PR between 1.19 and 1.41).

CONCLUSIONS

Our results showed an association between weight misperception and having tried cigarette smoking, alcohol consumption, and binge drinking in younger adolescents. In addition, weight overestimation was associated with all substance use indicators in girls. Based on our findings, interventions aimed to improve weight perception in normal weight adolescents may contribute to the reduction of substance use in this population.

Analysis of Adolescent Physical Activity Levels and Their Relationship with Body Image and Nutritional Habits

The main objective of this research article was to make a cluster analysis in Compulsory Secondary Education students with regard to their physical activity levels, their relationship with nutritional habits and body perception. In this study, a total of 1089 students participated, to whom a battery of tests was given in order to assess three aspects: levels of physical activity, food consumption habits and perception of body image. The main results indicated that the adolescent sample presented high levels of physical activity in comparison with other studies. In addition, a profile analysis was carried out, showing that there were no differences in physical activity, in nutritional habits or in body-image index. Taking into account gender, women who practice light physical activity had better nutritional habits. On the other hand, boys dominated in the group of moderate-to-high physical activity, while the girls were mainly included in the profile of low physical activity. Finally, body-image index was greater in men than women. It was concluded that is necessary to promote the importance of adequate nutritional habits in addition to physical activity, and it is necessary to promote body image, particularly among adolescent girls, given their low values of physical activity and worse body-image perception in relation to boys.

Individual, parental and built environmental features as influencing factors of active travel to school in northeast China: findings from a cross-sectional study

OBJECTIVES

Active travel to school (ATS)-associated factors had been studied in some developed countries but rarely in China. We studied the associated factors of ATS at individual, parental and built environment domains in northeast China.

DESIGN AND PARTICIPANTS

A cross-sectional survey was conducted among 4-6 grade students in 2017. Sociodemographic features and information of parents were collected using questionnaires, and SuperMap (a geographical information system software) was used to catch built environment features. Logistic regression models were used to examine the relationship between multilevel factors and ATS.

RESULTS

Our study sample comprised 3670 primary school students aged from 8 to 15 (boys=51.0%, ATS=48.8%). Perceived to be fat (OR 1.25, 95% CI 1.00 to 1.55, p<0.05), feeling easy to walk for a short distance (OR 1.63, 95% CI 1.21 to 2.20, p<0.05), mother unemployed (OR 1.52, 95% CI 1.13 to 2.06, p<0.05), higher land use mix (OR 1.23, 95% CI 1.11 to 1.37, p<0.001) and higher density of public transport stations (OR 1.22, 95% CI 1.09 to 1.37, p<0.05) were positively associated with increased possibility of ATS, while higher household annual income (OR 0.60, 95% CI 0.44 to 0.83, p<0.05) and possession of private vehicles (OR 0.56, 95% CI 0.45 to 0.69, p<0.001) were negatively associated with possibility of ATS.

CONCLUSIONS

The significant factors associated with ATS were at every examined level, which implies multilevel interventions are needed to encourage ATS. Further interventions could focus on the children's willingness to lead students to opt for healthy behaviours, and children from wealthier families should be encouraged to choose ATS. Also, the government should improve built environment walkability so as to encourage ATS.

Body Dissatisfaction and Its Association with Health-Related Factors in Rural and Urban Mexican Adolescents from the State of Jalisco

Background: To better understand Mexican adolescent’s body self-perception, this study aimed to analyze their body dissatisfaction (BD) levels according to sex and place of residence. We also aimed to explore differences in body composition (BC), physical fitness (PF), and physical activity (PA) between satisfied and dissatisfied adolescents and to find the associations between BD and these parameters. Methods: Cross-sectional, observational study carried out in Jalisco (Mexico) in which 451 adolescents (43.68% males, 43.90% rural) aged 13–17 years were evaluated. BD and self-perceived PF and PA were assessed with validated questionnaires, while objectively measured PF (strength, explosive strength, speed-agility, and cardiovascular fitness) was assessed using field tests. To evaluate BC, anthropometric measures and bioelectric impedance analysis were carried out. Regression analysis was used to ascertain the associations between health-related factors and body dissatisfaction. Results: Girls obtained higher scores on the BD questionnaire than boys (11.12 ± 3.13 vs. 10.33 ± 2.73; p < 0.05), whereas no geographical differences between rural and urban adolescents were found. BD was positively associated with higher fat mass (β = 0.15; p < 0.001), and negatively associated with muscle mass and PF (β = −0.24 and β = −0.23; p < 0.001). However, PA was not associated with any of the measured parameters. Conclusions: selected parameters of BC, PF, and sex have an impact on the Mexican adolescent’s body satisfaction levels and should be considered when designing future health policies.

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.

The Mediating Effect of Life Satisfaction on Relation between Perceived Physical Attractiveness and Health-Promoting Lifestyle in Korean Adults

Physical attraction, perceived in terms of satisfaction with body image and interpersonal relationships, can be an essential factor in an individual's emotional and social well-being. However, empirical studies that link physical attraction to health are limited. This study explores the mediating effect of life satisfaction on the relation between perceived physical attractiveness and lifestyle of health, making an effort to reach an optimal state in physical, emotional, social, spiritual, and intellectual domains in Korean adults. Four hundred fifty-nine adults in a community setting participated in this cross-sectional study. The results showed positive associations among physical attractiveness, life satisfaction, and health-promoting lifestyle after adjusting for age, gender, marital status, education, and job status. Life satisfaction partially mediated the relationship between perceived physical attractiveness and a higher lifestyle of health (z = 2.80, p = 0.005). For health promotion and disease prevention, positive psychology can be a suitable strategy. Physical attractiveness and life satisfaction can be important keys to maintain health-promoting lifestyle behavior.

Molecular Epidemiology of Enteroaggregative Escherichia coli (EAEC) Isolates of Hospitalized Children from Bolivia Reveal High Heterogeneity and Multidrug-Resistance

Enteroaggregative Escherichia coli (EAEC) is an emerging pathogen frequently associated with acute diarrhea in children and travelers to endemic regions. EAEC was found the most prevalent bacterial diarrheal pathogen from hospitalized Bolivian children less than five years of age with acute diarrhea from 2007 to 2010. Here, we further characterized the epidemiology of EAEC infection, virulence genes, and antimicrobial susceptibility of EAEC isolated from 414 diarrheal and 74 non-diarrheal cases. EAEC isolates were collected and subjected to a PCR-based virulence gene screening of seven virulence genes and a phenotypic resistance test to nine different antimicrobials. Our results showed that atypical EAEC (a-EAEC, AggR-negative) was significantly associated with diarrhea (OR, 1.62, 95% CI, 1.25 to 2.09, p < 0.001) in contrast to typical EAEC (t-EAEC, AggR-positive). EAEC infection was most prevalent among children between 7–12 months of age. The number of cases exhibited a biannual cycle with a major peak during the transition from warm to cold (April–June). Both typical and a-EAEC infections were graded as equally severe; however, t-EAEC harbored more virulence genes. aap, irp2 and pic were the most prevalent genes. Surprisingly, we detected 60% and 52.6% of multidrug resistance (MDR) EAEC among diarrheal and non-diarrheal cases. Resistance to ampicillin, sulfonamides, and tetracyclines was most common, being the corresponding antibiotics, the ones that are frequently used in Bolivia. Our work is the first study that provides comprehensive information on the high heterogenicity of virulence genes in t-EAEC and a- EAEC and the large prevalence of MDR EAEC in Bolivia.