1
|
Carballo-Casla A, Stefler D, Ortolá R, Chen Y, Knuppel A, Kubinova R, Pajak A, Rodríguez-Artalejo F, Brunner EJ, Bobak M. The Southern European Atlantic diet and all-cause and cause-specific mortality: a European multicohort study. Eur J Prev Cardiol 2024; 31:358-367. [PMID: 38102063 PMCID: PMC10873144 DOI: 10.1093/eurjpc/zwad370] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/24/2023] [Accepted: 11/25/2023] [Indexed: 12/17/2023]
Abstract
AIMS The Southern European Atlantic diet (SEAD) is the traditional dietary pattern of northwestern Spain and northern Portugal, but it may resemble that of central, eastern, and western European countries. The SEAD has been found associated with lower risk of myocardial infarction and mortality in older adults, but it is uncertain whether this association also exists in other European populations and if it is similar as that found in its countries of origin. METHODS AND RESULTS We conducted a prospective analysis of four cohorts with 35 917 subjects aged 18-96 years: ENRICA (Spain), HAPIEE (Czechia and Poland), and Whitehall II (United Kingdom). The SEAD comprised fresh fish, cod, red meat and pork products, dairy, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and moderate wine consumption. Associations were adjusted for sociodemographic variables, energy intake, lifestyle, and morbidity. After a median follow-up of 13.6 years (range = 0-15), we recorded 4 973 all-cause, 1 581 cardiovascular, and 1 814 cancer deaths. Higher adherence to the SEAD was associated with lower mortality in the pooled sample. Fully adjusted hazard ratios and 95% confidence interval per 1-standard deviation increment in the SEAD were 0.92 (0.89, 0.95), 0.91 (0.86, 0.96), and 0.94 (0.89, 0.99) for all-cause, cardiovascular, and cancer mortality, respectively. The association of the SEAD with all-cause mortality was not significantly different between countries [Spain = 0.93 (0.88, 0.99), Czechia = 0.94 (0.89,0.99), Poland = 0.89 (0.85, 0.93), United Kingdom = 0.98 (0.89, 1.07); P for interaction = 0.16]. CONCLUSION The SEAD was associated with lower all-cause, cardiovascular, and cancer mortality in southern, central, eastern, and western European populations. Associations were of similar magnitude as those found for existing healthy dietary patterns.
Collapse
Affiliation(s)
- Adrián Carballo-Casla
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Calle del Arzobispo Morcillo 4, 28029 Madrid, Spain
- Center for Networked Biomedical Research in Epidemiology and Public Health (CIBERESP), Avenida de Monforte de Lemos 3-5, 28029 Madrid, Spain
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet & Stockholm University, Tomtebodavägen 18 A SE-171 77 Stockholm, Sweden
| | - Denes Stefler
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Rosario Ortolá
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Calle del Arzobispo Morcillo 4, 28029 Madrid, Spain
- Center for Networked Biomedical Research in Epidemiology and Public Health (CIBERESP), Avenida de Monforte de Lemos 3-5, 28029 Madrid, Spain
| | - Yuntao Chen
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | | | - Ruzena Kubinova
- Department of Environmental Health and Population Health Monitoring, National Institute of Public Health, Šrobárova 49/48, 100 00 Prague, Czech Republic
| | - Andrzej Pajak
- Department of Epidemiology and Population Studies, Faculty of Health Sciences, Institute of Public Health, Jagiellonian University Medical College, Ulica Skawińska 8, 31-066 Krakow, Poland
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Calle del Arzobispo Morcillo 4, 28029 Madrid, Spain
- Center for Networked Biomedical Research in Epidemiology and Public Health (CIBERESP), Avenida de Monforte de Lemos 3-5, 28029 Madrid, Spain
- Cardiovascular and Nutritional Epidemiology Group, CEI UAM+CSIC, IMDEA Research Institute on Food & Health Sciences, Carretera de Canto Blanco 8, 28049 Madrid, Spain
| | - Eric J Brunner
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
- RECETOX, Faculty of Science, Masaryk University, Kotlářská 267/2, 611 37 Brno, Czech Republic
| |
Collapse
|
2
|
Tadiotto MC, Corazza PRP, de Menezes-Junior FJ, Tozo TAA, de Moraes-Junior FB, Brand C, Purim KSM, Mota J, Leite N. Moderating role of 1-minute abdominal test in the relationship between cardiometabolic risk factors and adiponectin concentration in adolescents. BMC Pediatr 2024; 24:75. [PMID: 38263075 PMCID: PMC10804517 DOI: 10.1186/s12887-024-04554-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/11/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Adiponectin is an anti-inflammatory cytokine secreted by adipose tissue, has been associated with adiposity and cardiometabolic risk, and has controversial results with muscular fitness. The aim of this study was to analyze the interaction of 1-minute abdominal test in the relationship between adiposity, body composition, cardiometabolic risk and adiponectin concentration in adolescents. METHODS This is a cross-sectional study conducted with 62 adolescents of both sexes, aged 11 to 16 years, approved by the Ethics Committee of Research in Humans (CAEE: 62963916.0.0000.5223). Body mass, height, abdominal circumference (AC), waist circumference (WC), fat mass (FM), fat-free mass (FFM), high density lipoprotein (HDL-c), low density lipoprotein (LDL-c), triglycerides (TG), adiponectin, systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MBP), 1-minute abdominal test (ABD) were measured. Body mass index (BMI), z-score BMI (BMI-z), triponderal mass index (TMI), and waist-to-height ratio (WHtR) were calculated. The macro PROCESS for SPSS v.24.0 was used for moderation analyses, with linear regression models. RESULTS Inverse interactions were found for adiposity (BMI, BMI-z, TMI, AC, WC, WHtR), body composition (FM, FFM) and CMRF (SBP, DBP, MBP, TG) versus 1-minute abdominal test with adiponectin concentration, demonstrating that abdominal test is a moderator in these relationships. CONCLUSION We conclude that 1-minute abdominal test may play an important role in the relationship between obesity and cardiometabolic risk. We found that muscular fitness can confer a protective effect on adolescents with high levels of abdominal test.
Collapse
Affiliation(s)
- Maiara Cristina Tadiotto
- Department of Physical Education, Federal University of Paraná, Street Col. Francisco H. dos Santos, 100, Jardim das Americas, Curitiba, Paraná, 81531-980, Brazil.
| | - Patricia Ribeiro Paes Corazza
- Department of Physical Education, Federal University of Paraná, Street Col. Francisco H. dos Santos, 100, Jardim das Americas, Curitiba, Paraná, 81531-980, Brazil
| | - Francisco José de Menezes-Junior
- Department of Physical Education, Federal University of Paraná, Street Col. Francisco H. dos Santos, 100, Jardim das Americas, Curitiba, Paraná, 81531-980, Brazil
| | - Tatiana Aparecida Affornali Tozo
- Department of Physical Education, Federal University of Paraná, Street Col. Francisco H. dos Santos, 100, Jardim das Americas, Curitiba, Paraná, 81531-980, Brazil
| | - Frederico Bento de Moraes-Junior
- Department of Physical Education, Federal University of Paraná, Street Col. Francisco H. dos Santos, 100, Jardim das Americas, Curitiba, Paraná, 81531-980, Brazil
| | - Caroline Brand
- Physical Education School, IRyS Group, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | | | - Jorge Mota
- Faculty of Sport, University of Porto, Porto, Portugal
| | - Neiva Leite
- Department of Physical Education, Federal University of Paraná, Street Col. Francisco H. dos Santos, 100, Jardim das Americas, Curitiba, Paraná, 81531-980, Brazil
- Faculty of Sport, University of Porto, Porto, Portugal
| |
Collapse
|
3
|
Carballo-Casla A, Stefler D, Ortolá R, Chen Y, Knuppel A, Ruiz M, Kozela M, Kubinova R, Pajak A, Rodríguez-Artalejo F, Brunner EJ, Bobak M. The Southern European Atlantic diet and depression risk: a European multicohort study. Mol Psychiatry 2023; 28:3475-3483. [PMID: 37353584 PMCID: PMC10618086 DOI: 10.1038/s41380-023-02125-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/11/2023] [Accepted: 06/08/2023] [Indexed: 06/25/2023]
Abstract
The Southern European Atlantic diet (SEAD) is the traditional dietary pattern of north-western Spain and northern Portugal, but it may resemble that of other European countries. The SEAD has been found associated with lower risk for myocardial infarction and mortality. Since dietary patterns may also influence mental health, we examined the association between the SEAD and depression risk in southern, central, eastern, and western European populations. We conducted a prospective analysis of five cohorts (13,297 participants aged 45-92 years, free of depression at baseline): Seniors-ENRICA-1 and Seniors-ENRICA-2 (Spain), HAPIEE (Czechia and Poland), and Whitehall-II (United Kingdom). The SEAD comprised cod, other fresh fish, red meat and pork products, dairy, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and moderate wine consumption. Depression at follow-up was defined according to presence of depressive symptoms (based on available scales), use of prescribed antidepressants, inpatient admissions, or self-reported diagnosis. Associations were adjusted for sociodemographic, lifestyle, and dietary variables. During a median follow-up of 3.9 years (interquartile range 3.4-4.9), there were 1437 new depression cases. Higher adherence to the SEAD was associated with lower depression risk in the pooled sample. Individual food groups showed a similar tendency, albeit non-significant. The fully adjusted odds ratio (95% confidence interval) per 1-standard deviation increment in the SEAD was 0.91 (0.86, 0.96). This association was rather consistent across countries [Spain = 0.86 (0.75, 0.99), Czechia = 0.86 (0.75, 0.99), Poland = 0.97 (0.89, 1.06), United Kingdom = 0.85 (0.75, 0.97); p for interaction = 0.24], and was of similar magnitude as that found for existing healthy dietary patterns. In conclusion, the SEAD was associated with lower depression risk across European populations. This may support the development of mood disorder guidelines for Southern European Atlantic regions based on their traditional diet, and for central, eastern, and western European populations based on the SEAD food groups that are culturally rooted in these places.
Collapse
Affiliation(s)
- Adrián Carballo-Casla
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain. Center for Networked Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
- Department of Epidemiology and Public Health, University College London, London, UK.
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet & Stockholm University, Stockholm, Sweden.
| | - Denes Stefler
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Rosario Ortolá
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain. Center for Networked Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Yuntao Chen
- Department of Epidemiology and Public Health, University College London, London, UK
| | | | - Milagros Ruiz
- Department of Epidemiology and Public Health, University College London, London, UK
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Magdalena Kozela
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland
| | | | - Andrzej Pajak
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain. Center for Networked Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- IMDEA Research Institute on Food & Health Sciences. CEI UAM+CSIC, Madrid, Spain
| | - Eric J Brunner
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, London, UK
| |
Collapse
|
4
|
Lorenzo PM, Izquierdo AG, Rodriguez-Carnero G, Fernández-Pombo A, Iglesias A, Carreira MC, Tejera C, Bellido D, Martinez-Olmos MA, Leis R, Casanueva FF, Crujeiras AB. Epigenetic Effects of Healthy Foods and Lifestyle Habits from the Southern European Atlantic Diet Pattern: A Narrative Review. Adv Nutr 2022; 13:1725-1747. [PMID: 35421213 PMCID: PMC9526853 DOI: 10.1093/advances/nmac038] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/21/2022] [Indexed: 01/28/2023] Open
Abstract
Recent scientific evidence has shown the importance of diet and lifestyle habits for the proper functioning of the human body. A balanced and healthy diet, physical activity, and psychological well-being have a direct beneficial effect on health and can have a crucial role in the development and prognosis of certain diseases. The Southern European Atlantic diet, also named the Atlantic diet, is a unique dietary pattern that occurs in regions that present higher life expectancy, suggesting that this specific dietary pattern is associated with positive health effects. In fact, it is enriched with nutrients of high biological value, which, together with its cooking methods, physical activity promotion, reduction in carbon footprint, and promoting of family meals, promote these positive effects on health. The latest scientific advances in the field of nutri-epigenetics have revealed that epigenetic markers associated with food or nutrients and environmental factors modulate gene expression and, therefore, are involved with both health and disease. Thus, in this review, we evaluated the main aspects that define the Southern European Atlantic diet and the potential epigenetic changes associated with them based on recent studies regarding the main components of these dietary patterns. In conclusion, based on the information existing in the literature, we postulate that the Southern European Atlantic diet could promote healthy aging by means of epigenetic mechanisms. This review highlights the necessity of performing longitudinal studies to demonstrate this proposal.
Collapse
Affiliation(s)
- Paula M Lorenzo
- Epigenomics in Endocrinology and Nutrition Group, Epigenomics Unit, Instituto de Investigacion Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago de Compostela (CHUS/SERGAS), Santiago de Compostela, Spain,CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain
| | - Andrea G Izquierdo
- Epigenomics in Endocrinology and Nutrition Group, Epigenomics Unit, Instituto de Investigacion Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago de Compostela (CHUS/SERGAS), Santiago de Compostela, Spain,CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain
| | - Gemma Rodriguez-Carnero
- Epigenomics in Endocrinology and Nutrition Group, Epigenomics Unit, Instituto de Investigacion Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago de Compostela (CHUS/SERGAS), Santiago de Compostela, Spain,Endocrinology and Nutrition Division, Complejo Hospitalario Universitario de Santiago de Compostela (CHUS/SERGAS), Santiago de Compostela, Spain
| | - Antía Fernández-Pombo
- Endocrinology and Nutrition Division, Complejo Hospitalario Universitario de Santiago de Compostela (CHUS/SERGAS), Santiago de Compostela, Spain
| | - Alba Iglesias
- Epigenomics in Endocrinology and Nutrition Group, Epigenomics Unit, Instituto de Investigacion Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago de Compostela (CHUS/SERGAS), Santiago de Compostela, Spain
| | - Marcos C Carreira
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain,Molecular and Cellular Endocrinology Group. Instituto de Investigacion Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago de Compostela (CHUS) and Santiago de Compostela University (USC), Santiago de Compostela, Spain
| | - Cristina Tejera
- Epigenomics in Endocrinology and Nutrition Group, Epigenomics Unit, Instituto de Investigacion Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago de Compostela (CHUS/SERGAS), Santiago de Compostela, Spain,Endocrinology and Nutrition Unit, Complejo Hospitalario Universitario de Ferrol (CHUF/SERGAS), Ferrol, Spain
| | - Diego Bellido
- Epigenomics in Endocrinology and Nutrition Group, Epigenomics Unit, Instituto de Investigacion Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago de Compostela (CHUS/SERGAS), Santiago de Compostela, Spain,Endocrinology and Nutrition Unit, Complejo Hospitalario Universitario de Ferrol (CHUF/SERGAS), Ferrol, Spain
| | - Miguel A Martinez-Olmos
- Epigenomics in Endocrinology and Nutrition Group, Epigenomics Unit, Instituto de Investigacion Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago de Compostela (CHUS/SERGAS), Santiago de Compostela, Spain,CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain,Endocrinology and Nutrition Division, Complejo Hospitalario Universitario de Santiago de Compostela (CHUS/SERGAS), Santiago de Compostela, Spain
| | - Rosaura Leis
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain,Department of Pediatrics, Complejo Hospitalario Universitario de Santiago de Compostela (CHUS); Instituto de Investigacion Sanitaria de Santiago de Compostela (IDIS) and Santiago de Compostela University (USC), Santiago de Compostela, Spain,Fundacion Dieta Atlántica, Santiago de Compostela, Spain
| | - Felipe F Casanueva
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain,Molecular and Cellular Endocrinology Group. Instituto de Investigacion Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago de Compostela (CHUS) and Santiago de Compostela University (USC), Santiago de Compostela, Spain,Fundacion Dieta Atlántica, Santiago de Compostela, Spain
| | | |
Collapse
|
5
|
García-Gómez B, Rivas-Casais A, Lorences-Touzón R, Piedrafita-Páez N, Muñoz-Ferreiro N, Vázquez-Odériz L, Romero-Rodríguez Á. Adherence to and knowledge about the Atlantic Diet pattern in the senior population of the Galician region (NW-Spain). J Funct Foods 2022. [DOI: 10.1016/j.jff.2022.105015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
6
|
de Lima TR, Martins PC, Moreno YMF, Chaput JP, Tremblay MS, Sui X, Silva DAS. Muscular Fitness and Cardiometabolic Variables in Children and Adolescents: A Systematic Review. Sports Med 2022; 52:1555-1575. [PMID: 35020179 DOI: 10.1007/s40279-021-01631-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND The importance of muscular fitness (MF) in the performance of activities of daily living is unequivocal. Additionally, emerging evidence has shown MF can reduce cardiometabolic risk in children and adolescents. OBJECTIVES The purpose of this study was to examine and summarize the evidence regarding the relationship between MF phenotypes (i.e., maximum muscular strength/power, muscular endurance, and maximum muscular strength/power/endurance) and cardiometabolic variables (obesity, blood pressure, lipids, glucose homeostasis, inflammatory markers, and clustered cardiometabolic variables) in children and adolescents. DESIGN This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was registered with PROSPERO, number CRD42020179273. DATA SOURCES A systematic review was performed on five databases (PubMed, EMBASE, SciELO, Scopus, and Web of Knowledge) from database inception to May 2020, with complementary searches in reference lists. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Eligibility criteria included (1) a study sample of youth aged ≤ 19 years, (2) an assessment of MF with individual or clustered cardiometabolic variables derived from adjusted models (regardless of test/measurement adopted or direction of reported association), and (3) a report of the association between both, using observational studies. Only original articles published in peer-reviewed journals in English, Portuguese, and Spanish languages were considered. The quality of the included studies was assessed by using the National Heart, Lung, and Blood Institute checklist. The percentage of results reporting a statistically significant inverse association between each MF phenotype and cardiometabolic variables was calculated. RESULTS Of the 23,686 articles initially identified, 96 were included (77 cross-sectional and 19 longitudinal), with data from children and adolescents from 35 countries. The score for the quality of evidence ranged from 0.33 to 0.92 (1.00 maximum). MF assessed by maximum muscular strength/power was inversely associated with lower obesity (64/113 total results (56.6%)) and reduction in clustered cardiometabolic risk (28/48 total results (58.3%)). When assessed by muscular endurance, an inverse association with obesity (30/44 total results (68.1%)) and cardiometabolic risk (5/8 total results (62.5%)) was identified. Most of the results for the relationship between MF phenotypes with blood pressure, lipids, glucose homeostasis, and inflammatory markers indicated a paucity of evidence for these interrelationships (percentage of results below 50.0%). CONCLUSION MF assessed by maximum muscular strength/power or muscular endurance is potentially associated with lower obesity and lower risk related to clustered cardiometabolic variables in children and adolescents. There is limited support for an inverse association between MF with blood pressure, lipids, glucose homeostasis biomarkers, and inflammatory markers in children and adolescents.
Collapse
Affiliation(s)
- Tiago Rodrigues de Lima
- Research Center in Kinanthropometry and Human Performance, Sports Center, Federal University of Santa Catarina, University Campus, Trindade, Florianópolis, Santa Catarina, 88010-970, Brazil.
| | - Priscila Custódio Martins
- Research Center in Kinanthropometry and Human Performance, Sports Center, Federal University of Santa Catarina, University Campus, Trindade, Florianópolis, Santa Catarina, 88010-970, Brazil
| | - Yara Maria Franco Moreno
- Department of Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Jean-Philippe Chaput
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Mark Stephen Tremblay
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Xuemei Sui
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Diego Augusto Santos Silva
- Research Center in Kinanthropometry and Human Performance, Sports Center, Federal University of Santa Catarina, University Campus, Trindade, Florianópolis, Santa Catarina, 88010-970, Brazil
| |
Collapse
|
7
|
Carballo-Casla A, Ortolá R, García-Esquinas E, Oliveira A, Sotos-Prieto M, Lopes C, Lopez-Garcia E, Rodríguez-Artalejo F. The Southern European Atlantic Diet and all-cause mortality in older adults. BMC Med 2021; 19:36. [PMID: 33557823 PMCID: PMC7871632 DOI: 10.1186/s12916-021-01911-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/13/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The Southern European Atlantic Diet (SEAD) is the traditional diet of Northern Portugal and North-Western Spain. Higher adherence to the SEAD has been associated with lower levels of some cardiovascular risk factors and reduced risk for myocardial infarction, but whether this translates into lower all-cause mortality is uncertain. We hence examined the association between adherence to the SEAD and all-cause mortality in older adults. METHODS Data were taken from the Seniors-ENRICA-1 cohort, which included 3165 individuals representative of the non-institutionalized population aged ≥ 60 years in Spain. Food consumption was assessed with a validated diet history, and adherence to the SEAD was measured with an index comprising 9 food components: fresh fish, cod, red meat and pork products, dairy products, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and wine. Vital status was ascertained with the National Death Index of Spain. Statistical analyses were performed with Cox regression models and adjusted for the main confounders. RESULTS During a median follow-up of 10.9 years, 646 deaths occurred. Higher adherence to the SEAD was associated with lower all-cause mortality (fully adjusted hazard ratio [95% confidence interval] per 1-SD increment in the SEAD score 0.86 [0.79, 0.94]; p-trend < 0.001). Most food components of the SEAD showed some tendency to lower all-cause mortality, especially moderate wine consumption (hazard ratio [95% confidence interval] 0.71 [0.59, 0.86]). The results were robust in several sensitivity analyses. The protective association between SEAD and all-cause death was of similar magnitude to that found for the Mediterranean Diet Adherence Screener (hazard ratio [95% confidence interval] per 1-SD increment 0.89 [0.80, 0.98]) and the Alternate Healthy Eating Index (0.83 [0.76, 0.92]). CONCLUSIONS Adherence to the SEAD is associated with a lower risk of all-cause death among older adults in Spain.
Collapse
Affiliation(s)
- Adrián Carballo-Casla
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz, Calle del Arzobispo Morcillo 4, 28029, Madrid, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Avenida de Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - Rosario Ortolá
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz, Calle del Arzobispo Morcillo 4, 28029, Madrid, Spain. .,CIBER of Epidemiology and Public Health (CIBERESP), Avenida de Monforte de Lemos 3-5, 28029, Madrid, Spain.
| | - Esther García-Esquinas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz, Calle del Arzobispo Morcillo 4, 28029, Madrid, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Avenida de Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - Andreia Oliveira
- EPIUnit-Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.,Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mercedes Sotos-Prieto
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz, Calle del Arzobispo Morcillo 4, 28029, Madrid, Spain.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA
| | - Carla Lopes
- EPIUnit-Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.,Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz, Calle del Arzobispo Morcillo 4, 28029, Madrid, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Avenida de Monforte de Lemos 3-5, 28029, Madrid, Spain.,IMDEA Food Institute, CEI UAM+CSIC, Carretera de Canto Blanco 8, 28049, Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz, Calle del Arzobispo Morcillo 4, 28029, Madrid, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Avenida de Monforte de Lemos 3-5, 28029, Madrid, Spain.,IMDEA Food Institute, CEI UAM+CSIC, Carretera de Canto Blanco 8, 28049, Madrid, Spain
| |
Collapse
|
8
|
The longitudinal relationship between dietary intake, physical activity and muscle strength among adolescents. Br J Nutr 2020; 124:1207-1218. [PMID: 32624008 DOI: 10.1017/s0007114520002202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The longitudinal relationship between muscle strength, dietary intake and physical activity among adolescents is not well understood. We investigated the trend and longitudinal effects of dietary intakes and physical activity scores on muscle strength in adolescents. This prospective cohort study consisted of 436 adolescents (134 males; 302 females) aged 13 years at baseline (2012) who were followed up at the ages of 15 (2014) and 17 (2016) years, respectively. We measured muscle strength using a calibrated hand dynamometer, estimated dietary intake with a 7-d dietary history and physical activity scores with a validated physical activity questionnaire for older children. A generalised estimating equation was used to examine the effect of dietary intakes and physical activity on muscle strength changes. The analysis was performed separately by sex. The muscle strength for males and females had increased within the 5-year period. The dietary intakes (energy and macronutrients) also increased initially but plateaued after the age of 15 years for both sexes. Females recorded a significant declining trend in physical activity scores compared with males as they grew older. A significant positive longitudinal relationship was found between protein (β = 0·035; P = 0·016), carbohydrate intake (β = 0·002; P = 0·013) and muscle strength among males. However, no longitudinal relationship was found between dietary intake, physical activity and muscle strength among females. Higher protein and carbohydrate intake among males was associated with higher muscle strength but was not observed in females. Nutrition and physical activity focusing on strength building are required in early adolescence and need to be tailored to males and females accordingly.
Collapse
|
9
|
Tejera-Pérez C, Sánchez-Bao A, Bellido-Guerrero D, Casanueva FF. The Southern European Atlantic diet. Minerva Endocrinol (Torino) 2020; 46:145-160. [PMID: 33213124 DOI: 10.23736/s2724-6507.20.03381-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The Southern Europe Atlantic Diet (SEAD) is the traditional diet consumed in the Northwestern region of the Iberian Peninsula: Galicia (Spain) and North of Portugal. These regions have geographical, climatic and cultural characteristics that had led them to develop their own dietary pattern. This dietary pattern integrated into its environment is based on fresh, local and seasonal products intake. In this diet there is a high intake of fish, seafood, cereals, potatoes, legumes, fruits, dairy products and vegetables. Meat, preferably lean meat, is consume moderately as well as eggs and wine. SEAD is more than a diet, it is a lifestyle where exercise, simples cooking techniques, respect for the traditions and pleasure of eating accompanied are constants. Although this pattern has been known for centuries, it did not begin to be define as such until the signing of "Baione Declaration" in 2006. Some bioactive compounds of SEAD had showed health benefits and protect against acute myocardial infarction. Data supports that SEAD is a sustainable diet. In the presented review, results of studies on the SEAD are presented and discussed. Also, a recent proposal of SEAD Index is reported. Therefore, SEAD should be considered as an excellent dietary pattern and lifestyle.
Collapse
Affiliation(s)
- Cristina Tejera-Pérez
- Unit of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Ferrol, A Coruña, Spain - .,Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain -
| | - Ana Sánchez-Bao
- Unit of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Ferrol, A Coruña, Spain
| | - Diego Bellido-Guerrero
- Unit of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Ferrol, A Coruña, Spain.,Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | - Felipe F Casanueva
- Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain.,Unit of Endocrinology and Nutrition, Department of Medicine, Complejo Hospitalario Universitario de Santiago, University of Santiago de Compostela (USC), Santiago de Compostela, Spain.,CIBEROBN de Fisiopatología de Obesidad y Nutrición, Santiago de Compostela, Spain
| |
Collapse
|
10
|
Leidy HJ, Gwin JA. Growing up strong: The importance of physical, mental, and emotional strength during childhood and adolescence with focus on dietary factors. Appl Physiol Nutr Metab 2020; 45:1071-1080. [PMID: 32650648 DOI: 10.1139/apnm-2020-0058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Childhood and adolescence are critical time periods for growth and development. Given the current physical and psychological health concerns affecting United States youth, an emerging area of interest exists supporting the importance of physical and psychological aspects of strength for health, resilience, and well-being through these life stages. This synopsis highlights the key concepts that were presented within the 2018 Strength Summit conference, entitled The Role of Strength in Optimal Health and Well-being. During the conference, strength was broadly defined as the ability to successfully respond to a challenge. Although much of the current research focuses on strength from a muscle function and performance perspective, mental and emotional strength are also important components of overall health and well-being, especially in children and adolescents. This paper provides a brief overview of the clinical and/or research-based strength outcomes, summarizes the relationship between strength and health, and discusses evidence-based dietary factors that promote strength in children and adolescents. Novelty Building physical, mental, and emotional strength during childhood and adolescence lays the foundation for health and well-being. Emerging evidence indicate positive associations between diet quality and strength in children and adolescents. Promising areas include the promotion of family-based meals, with focus on breakfast, for improved strength in United States youth.
Collapse
Affiliation(s)
- Heather J Leidy
- Department of Nutritional Sciences & Dept. of Pediatrics, University of Texas at Austin, Austin, TX 78723, USA
| | - Jess A Gwin
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760, USA.,Oak Ridge Institute for Science and Education, Belcamp, MD, USA
| |
Collapse
|
11
|
Agostinis-Sobrinho C, Rosário R, Santos R, Norkiene S, Mota J, Rauckienė-Michaelsson A, González-Ruíz K, Izquierdo M, Garcia-Hermoso A, Ramírez-Vélez R. Higher Cardiorespiratory Fitness Levels May Attenuate the Detrimental Association between Weight Status, Metabolic Phenotype and C-Reactive Protein in Adolescents-A Multi-Cohort Study. Nutrients 2020; 12:E1461. [PMID: 32443557 PMCID: PMC7284377 DOI: 10.3390/nu12051461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 12/31/2022] Open
Abstract
Results from several studies show that only obese, unfit subjects, but not obese, fit subjects, are at higher mortality risk than are normal-weight fit subjects. The aim of the study was two-fold: (1) to examine the differences in C-reactive protein levels across different metabolic phenotypes (healthy and unhealthy) of weight status and (2) ascertain whether high levels of cardiorespiratory fitness (CRF) attenuate the association of C-reactive protein and metabolic phenotypes of weight status. This was a pooled study, which included data from three cross-sectional projects (1706 youth (921 girls) aged 12-18 years). We used a Shuttle run test to assess CRF. Adolescents were classified into six metabolic phenotypes (healthy and unhealthy) of weight status (non-overweight, overweight and obese), based on age- and sex-specific cutoff points for triglycerides, systolic blood pressure, HDL-cholesterol, glucose and body mass index. High-sensitivity assays were used to obtain the C-reactive protein as inflammatory biomarker. After adjustment for potential confounders (age, sex, pubertal stage and country), the analysis of covariance (ANCOVA) shows that C-reactive protein is directly associated with metabolic phenotypes of weight status. Subjects with obesity, regardless of their metabolic profile, had higher levels of C-reactive protein Z-score. In addition, (after adjustments for potential confounders) a two-way ANCOVA showed that high levels of CRF attenuated the associations of C-reactive protein levels in metabolic healthy non-overweight and in adolescents with obesity. In conclusion, higher CRF levels may attenuate the detrimental association between obesity and C-reactive protein independently of metabolic phenotype. Findings from this study are important for prevention, clinical practice on issues associated with adiposity and metabolic disorders.
Collapse
Affiliation(s)
- Cesar Agostinis-Sobrinho
- Faculty of Health and Sciences, Klaipeda University, 92294 Klaipeda, Lithuania; (C.A.-S.); (S.N.); (A.R.-M.)
| | - Rafaela Rosário
- School of Nursing, University of Minho, 4710 Braga, Portugal;
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
| | - Rute Santos
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, 4200-450 Porto, Portugal; (R.S.); (J.M.)
| | - Sigute Norkiene
- Faculty of Health and Sciences, Klaipeda University, 92294 Klaipeda, Lithuania; (C.A.-S.); (S.N.); (A.R.-M.)
| | - Jorge Mota
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, 4200-450 Porto, Portugal; (R.S.); (J.M.)
| | - Alona Rauckienė-Michaelsson
- Faculty of Health and Sciences, Klaipeda University, 92294 Klaipeda, Lithuania; (C.A.-S.); (S.N.); (A.R.-M.)
| | - Katherine González-Ruíz
- Grupo de Ejercicio Físico y Deportes, Vicerrectoría de Investigaciones, Universidad Manuela Beltrán, Bogotá 110231, Colombia;
| | - Mikel Izquierdo
- Department of Health Sciences, Public University of Navarra, Navarrabiomed-IdiSNA, Complejo Hospitalario de Navarra (CHN), 31008 Pamplona, Spain; (M.I.); (A.G.-H.)
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Antonio Garcia-Hermoso
- Department of Health Sciences, Public University of Navarra, Navarrabiomed-IdiSNA, Complejo Hospitalario de Navarra (CHN), 31008 Pamplona, Spain; (M.I.); (A.G.-H.)
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, USACH, Santiago 7500618, Chile
| | - Robinson Ramírez-Vélez
- Department of Health Sciences, Public University of Navarra, Navarrabiomed-IdiSNA, Complejo Hospitalario de Navarra (CHN), 31008 Pamplona, Spain; (M.I.); (A.G.-H.)
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| |
Collapse
|
12
|
Changes in muscular fitness and its association with blood pressure in adolescents. Eur J Pediatr 2018; 177:1101-1109. [PMID: 29740692 DOI: 10.1007/s00431-018-3164-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/20/2018] [Accepted: 04/25/2018] [Indexed: 01/02/2023]
Abstract
The aims of this study were to examine the longitudinal association between muscular fitness (MF) and blood pressure (BP) 2 years later, and to determine whether changes in MF over a 2-year period were associated with BP at follow-up, in adolescents. The sample comprised 734 youths (349 girls) aged from 12 to 18 years. MF was assessed with the standing long jump and handgrip tests. Socioeconomic status, pubertal stage, waist circumference, resting BP, and cardiorespiratory fitness were measured according to standard procedures. Regression analyses showed a significant inverse association between MF at baseline and systolic BP (β = - 0.072; p = 0.032) and rate pressure product (β = - 0.124; p < 0.001) at follow-up, after adjustments for age, sex, height, pubertal stage, and socioeconomic status. However, when analyses were further adjusted for waist circumference and cardiorespiratory fitness, these associations did not remain significant. Adolescents with persistently high and increasing MF exhibited the lowest levels of diastolic BP (F(3, 721) = 3.814, p = 0.018) and systolic BP (F(3, 721) = 3.908, p = 0.014) when compared to those with persistent low MF after adjustment for age, sex, height, socioeconomic status, cardiorespiratory fitness, and waist circumference.Conclusion: This study suggests that persistent greater and increasing MF in youth are associated with lower levels of BP across the adolescence. What is Known: • Currently, there is a growing interest on the health benefits of muscular fitness. • Cross-sectional studies have identified an association between muscular fitness and blood pressure in adolescents. What is New: • Changes in muscular fitness during adolescence were associated with systolic and diastolic BP over a 2-year period. • Adolescents with persistently low muscular fitness exhibited the highest levels of diastolic and systolic BP.
Collapse
|
13
|
Agostinis-Sobrinho C, Santos R, Rosário R, Moreira C, Lopes L, Mota J, Martinkenas A, García-Hermoso A, Correa-Bautista JE, Ramírez-Vélez R. Optimal Adherence to a Mediterranean Diet May Not Overcome the Deleterious Effects of Low Physical Fitness on Cardiovascular Disease Risk in Adolescents: A Cross-Sectional Pooled Analysis. Nutrients 2018; 10:nu10070815. [PMID: 29941782 PMCID: PMC6073276 DOI: 10.3390/nu10070815] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/21/2018] [Accepted: 06/22/2018] [Indexed: 12/19/2022] Open
Abstract
To examine the combined association of cardiorespiratory fitness (CRF), muscular fitness (MF), and adherence to a Mediterranean diet (MeDiet) on cardiovascular risk in adolescents, a pooled study, including cross-sectional data from two projects [2477 adolescents (1320 girls) aged 12–18 years], was completed. A shuttle run test was used to assess CRF. MF was assessed by the standing-long jump and handgrip tests. Adherence to a MeDiet was assessed by the Kidmed questionnaire. A cardiovascular risk score was computed from the following components: Age and sex, waist circumference, triglycerides, systolic blood pressure, high-density lipoprotein cholesterol (HDL), and glucose. Analysis of covariance showed that participants classified as having optimal (High) adherence to a MeDiet/HighMF/HighCRF, as well those classified as low adherence to a MeDiet/HighMF/HighCRF, had, on average, the lowest cardiovascular risk score (F = 15.6; p < 0.001). In addition, the high adherence to a MeDiet/LowMF/LowCRF group had the highest odds of having a high cardiovascular risk (OR = 7.1; 95% CI: 3.4–15.1; p < 0.001), followed by the low adherence to a MeDiet/LowMF/LowCRF group (OR = 3.7; 95% CI: 2.2–6.3; p < 0.001), high adherence to a MeDiet/HighMF/LowCRF group (OR = 3.1; 95% CI: 1.4–7.0; p = 0.006), and low adherence to a MeDiet/LowMF/HighCRF group (OR = 2.5; 95% CI: 1.5–4.4; p = 0.002) when compared to those with high adherence to a MeDiet/HighMF/HighCRF, after adjustments for potential confounders. In conclusion, our findings showed that, regardless of the MeDiet status, adolescents with low MF and low CRF cumulatively, presented the highest cardiovascular disease risk. Therefore, these findings suggest that the combination of these two fitness components may be beneficial to adolescents’ cardiometabolic profile, independent of MeDiet behaviour.
Collapse
Affiliation(s)
- César Agostinis-Sobrinho
- School of Physical Education, Physiotherapy and Dance, Federal University of the South of Brazil, Porto Alegre 91501-970, Brazil.
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, 4200450 Porto, Portugal.
- Faculty of Health Sciences, Klaipeda University, LT-91274 Klaipeda, Lithuania.
| | - Rute Santos
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, 4200450 Porto, Portugal.
- Early Start Research Institute, Faculty of Social Sciences, School of Education, University of Wollongong, Wollongong, NSW 2522, Australia.
| | - Rafaela Rosário
- School of Nursing, Research Centre in Child Studies, University of Minho, 4710 Braga, Portugal.
| | - Carla Moreira
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, 4200450 Porto, Portugal.
| | - Luís Lopes
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, 4200450 Porto, Portugal.
| | - Jorge Mota
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, 4200450 Porto, Portugal.
| | - Arvydas Martinkenas
- Faculty of Health Sciences, Klaipeda University, LT-91274 Klaipeda, Lithuania.
| | - Antonio García-Hermoso
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, USACH, Santiago 7500618, Chile.
| | - Jorge Enrique Correa-Bautista
- Centro de Estudios Para la Medición de la Actividad Física CEMA, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá 111221, Colombia.
| | - Robinson Ramírez-Vélez
- Centro de Estudios Para la Medición de la Actividad Física CEMA, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá 111221, Colombia.
| |
Collapse
|