Associations between physical fitness and adherence to the Mediterranean diet with health-related quality of life in adolescents: results from the LabMed Physical Activity Study

Study on the relationship and related factors between physical fitness and health behavior of preschool children in southwest China

OBJECTIVE

To investigate the physical fitness level and health behavior status of preschool children in China, explore the relationship between physical fitness and health behavior, and further reveal the main factors affecting health behavior, to provide a reference for improving the physical fitness level of preschool children and maintaining healthy behavior.

METHODS

A total of 755 preschool children (394 boys and 361 girls, aged 4.52 ± 1.11 years) were selected from Chongqing and Liupanshui in China by cluster random sampling method for questionnaire survey and physical monitoring, and SPSS21.0 software was used to process and analyze the data.

RESULTS

(1) Heart rate (p = 0.015), protein content (p < 0.001), and time spent on the balance beam (p < 0.001) were significantly lower in boys than in girls, while BMI (p = 0.012), muscle mass (p < 0.001), and distance of standing long jump (p < 0.001) were significantly higher in boys than in girls. Meanwhile, systolic blood pressure (p = 0.004) and diastolic blood pressure (p = 0.001) of rural children were significantly higher than those of urban children, while BMI (p < 0.001) and sitting forward flexion (p = 0.019) were significantly lower than those of urban children. (2) The light-intensity physical activity (LPA) and moderate to vigorous physical activity (MVPA) of boys were significantly higher than that of girls (p < 0.001), and the MVPA of urban children was significantly higher than that of rural children (p = 0.001), and the former participated in sports classes more frequently (p < 0.001). (3) There was a significant correlation between physical activity (PA) and physical fitness indicators of preschoolers. Participating in sports interest classes was only significantly correlated with systolic blood pressure (r = 0.08) and sitting forward flexion (r = 0.09). (4) The PA level of preschool children was related to gender, household registration, kindergarten nature, age, residence environment, parental support, and participation degree. Participation in sports interest classes was related to gender, the nature of the kindergarten, household registration, age, and parent participation. Daily screen time was related to household registration, the nature of the kindergarten, the environment of residence, and the value perception of parents.

CONCLUSIONS

There were different degrees of correlation between preschool children's physical fitness and health behaviors, and children's health behaviors were closely related to gender, environment, parents, and other factors. Therefore, how to increase the protective factors of children's health behaviors and controlling the risk factors may be crucial to promoting the development of good health behaviors and improving the physical fitness of preschool children.

Adherence to the Mediterranean Food Pattern and Carbon Footprint of Food Intake by Employees of a University Setting in Portugal

BACKGROUND

The Mediterranean diet is characterized by the predominance of the consumption of fruit, vegetables, cereals, nuts, and pulses; consumption of olive oil as the main source of fat; regular but moderate consumption of win; moderate consumption of fish, dairy products, eggs, and white meats; and low consumption of red meat as well as sugar and sugary products. In addition to the reported health benefits, the Mediterranean diet has also been widely recognized as a sustainable food pattern. The objective of this study was to understand the relationship between the degree of adherence to the Mediterranean diet of employees of the University of Porto and the relationship with the carbon footprint of their food consumption.

METHODS

An observational, analytical study was carried out, through the analysis of food consumption data collected in the form of a survey in the previous 24 h inserted in the eAT24 software, as well as the analysis of sociodemographic, lifestyle, and health data collected in the questionnaire. The carbon footprint was calculated from the previous 24 h surveys using data available on a website, obtained in carbon dioxide equivalent per kilogram of food. Sociodemographic, eating habit, and lifestyle questions were selected to understand the relationship between these and adherence to the Mediterranean diet and the carbon footprint of food consumption.

RESULTS

In total, 13.2% of the participants had a Mediterranean diet score equal to or greater than six, and the sample had an average food intake carbon footprint of 8146 ± 3081 CO2eq/Kg of food. A weak, statistically significant positive correlation (r = 0.142, p = 0.006) was observed between Mediterranean diet adherence and the carbon footprint of food intake.

CONCLUSIONS

Most of the participants had a low adherence to the Mediterranean diet, as well as a high carbon footprint of food intake when compared to other countries. People with higher scores for Mediterranean diet adherence have, on average, a higher carbon footprint from food consumption intake.

Perceived Quality of Life Is Related to a Healthy Lifestyle and Related Outcomes in Spanish Children and Adolescents: The Physical Activity, Sedentarism, and Obesity in Spanish Study

BACKGROUND

Maintaining a healthy lifestyle is crucial for safeguarding the well-being and quality of life perception, appropriate growth, and development of children and adolescents, while also mitigating the risk of future adult-onset diseases.

OBJECTIVE

To assess associations between perceived quality of life and healthy lifestyle and related outcomes in Spanish children and adolescents.

METHODS

Cross-sectional analysis of 8-16-year-old children and adolescents (n = 3534) were included in the nationwide study of Physical Activity, Sedentarism, and Obesity in Spanish Youth (PASOS). Data were collected through (1) questionnaires on health-related quality of life (HRQoL), healthy lifestyle outcomes (dietary intake, physical fitness, sleep, and screen time), and (2) anthropometric measurements for weight status assessment. Data were analysed by logistic regression, using the health-related quality of life (HRQoL) as the grouping variable.

RESULTS

Participants with a lower HRQoL were those with a lower adherence to the MedDiet and lower achievement of the recommended daily intake of fruit and vegetables. They were also less likely to follow the recommendations for screen time and sleep (with the exception of the weekend) compared to participants with a higher HRQoL. Participants with a lower HRQoL showed a lower healthy weight status and poorer physical fitness than those with a higher HRQoL.

CONCLUSIONS

Healthy eating habits, healthy weight status (normal weight), appropriate sleep time, physical fitness, and limited screen time play a crucial role in the perceived quality of life in children and adolescents.

A cohort study of factors influencing the physical fitness of preschool children: a decision tree analysis

Objective

Based on the decision tree model, to explore the key influencing factors of children's physical fitness, rank the key influencing factors, and explain the complex interaction between the influencing factors.

Methods

A cohort study design was adopted. 1,276 children (ages 3-6) from 23 kindergartens in Nanchang, China, were chosen for the study to measure the children's physical fitness at baseline and a year later and to compare the physical fitness scores at the two stages. The study was conducted following the Chinese National Physical Fitness Testing Standard (Children Part); To identify the primary influencing factors of changes in physical fitness, a decision tree model was developed, and a questionnaire survey on birth information, feeding patterns, SB, PA, dietary nutrition, sleep, parental factors, and other relevant information was conducted.

Results

The levels of physical fitness indicators among preschool children showed a significant increase after 1 year. The accuracy of the CHAID model is 84.17%. It showed that 7 variables were strongly correlated with the physical changes of children's fitness, the order of importance of each variable was weekend PA, weekend MVPA, mother's BMI, mother's sports frequency, father's education, mother's education, and school day PA. Three factors are related to PA. Four factors are related to parental circumstances. In addition to the seven important variables mentioned, variables such as breakfast frequency on school day, puffed food, frequency of outing, school day MVPA, parental feeling of sports, father's occupation, and weekend breakfast frequency are all statistically significant leaf node variables.

Conclusion

PA, especially weekend PA, is the most critical factor in children's physical fitness improvement and the weekend MVPA should be increased to more than 30 min/d based on the improvement of weekend PA. In addition, parental factors and school day PA are also important in making decisions about changes in fitness for children. The mother's efforts to maintain a healthy BMI and engage in regular physical activity are crucial for enhancing the physical fitness of children. Additionally, other parental factors, such as the parents' educational levels and the father's occupation, can indirectly impact the level of physical fitness in children.

Adherence to the Mediterranean Diet in medical students

OBJECTIVE

The protective effect of the Mediterranean Diet (MeDi) is undisputed. However, adherence to MeDi has decreased in recent years, particularly in young people. The aim of this study was to evaluate adherence to MeDi in medical students and to assess the influence of knowledge acquisition as well as other factors on dietary compliance.

DESIGN

A cross-sectional study was conducted on medical students. The data were obtained through anonymous surveys that collected demographic characteristics, medical history, alcohol and tobacco consumption, physical activity and adherence to MeDi – using 14-point Mediterranean Diet Adherence Score (MEDAS) –. Adherence to MeDi and related factors were evaluated by univariate and multivariable analysis.

PARTICIPANTS

Medical students from the first to the sixth year of the 2018–2019 academic year.

SETTING

The study was conducted at the university of Las Palmas de Gran Canaria.

RESULTS

Of 589 respondents (73 % women) mean aged 22 years (range 18–39), 58·9 % showed good adherence to MeDi. Adherence was significantly associated with age (P = 0·017) but not with sex or the presence of comorbidities. Independently, adherence to MeDi was higher in last academic courses (OR = 2·1; 95 % CI = 1·3, 3·2; P = 0·001), in those who consumed alcohol more frequently (OR = 1·5; 95 % CI = 1·0, 2·1; P = 0·039) and in those who practiced more exercise (OR = 1·5; 95 % CI = 1·2, 1·9; P < 0·001).

CONCLUSIONS

Half of all medical students did not have a good adherence to MeDi. Adherence was higher at older age in higher academic years and related to greater physical activity. It would be convenient to quantify dietary knowledge as well as implement nutritional educational programmes, favouring a healthy lifestyle.

The mediating effect of food choice upon associations between adolescent health-related quality of life and physical activity, social media use and abstinence from alcohol

BACKGROUND

Understanding how health-related quality of life (HRQoL) is related to lifestyle factors during adolescence is crucial to effective health promotion. The aim of this analysis was to identify associations between HRQoL and lifestyle and to determine the degree to which they are mediated by food choices in adolescents.

METHODS

The Wellbeing in Schools (NI) survey (N = 1609; 13-14 years) assessed HRQoL using the Kidscreen52. Food choice was assessed by Food Frequency Questionnaire (FFQ) and physical activity was assessed using the Physical Activity Questionnaire for Adolescents (PAQ-A). Social media and alcohol abstinence were self-reported.

RESULTS

Path analysis indicated that fruit and vegetable intake was associated with higher HRQoL on dimensions of moods and emotions, parent relations and home life, financial resources, and social support and peers. Bread and diary intake was related to higher physical wellbeing. Protein was associated with higher psychological wellbeing, moods and emotions, self-perception, parent relations and home life, financial resources, and lower social support and peers. Junk food was related to lower moods and emotions. Males had higher psychological wellbeing, moods and emotions, parental relations and home life. Females had higher self-perception, autonomy, and social support and peers. Greater physical activity explained higher HRQoL on all dimensions. Less social media was associated with higher psychological wellbeing, moods and emotions, self-perception, parent relations and home life, and school environment. Alcohol abstinence was associated with higher physical wellbeing, psychological wellbeing, moods and emotions, self-perception, parent relations and home life, and school environment dimensions.

CONCLUSION

Intervention to promote HRQoL in adolescents should consider food choices whilst encouraging physical activity, discouraging social media and deterring alcohol, and targeting boys and girls separately.

Associations between Dietary Patterns and Physical Activity with Physical Fitness among Adolescents in Shandong Province, China: A Cross-Sectional Study

Background: The trend of physical fitness (PF) and physical activity (PA) among Chinese adolescents is not optimistic, and unhealthy dietary behaviors are common. PA and dietary patterns (DPs) have been linked to PF in adolescents, but the associations between DPs and PF with PF in Chinese adolescents are rarely discussed. Methods: A total of 8796 adolescents aged 11–18 were enrolled from Shandong Province, China. The CNSPFS battery was applied to assess PF. PA levels and diet quality were determined using the Physical Activity Questionnaire for Adolescents and the modified Chinese Diet Quality Questionnaire, respectively. This study used factor analysis to identify DPs and linear regression models to investigate the association between PF and related factors. Results: The average PF score of the participants was 75.67. Adolescents who were girls, lived in rural areas and were active in PA performed better on the PF test (p < 0.05). Boys whose fathers were university educated or above had a higher probability of achieving higher PF scores (OR 4.36, 95% CI 1.32–14.36); however, if their mothers were university educated or above, they had a lower probability of achieving higher PF scores (OR 0.22, 95% CI 0.063–0.76). Unhealthy dietary pattern was negatively correlated with cardiorespiratory fitness in boys (OR 0.56, 95% CI 0.31–0.98). The association between unhealthy dietary pattern and girls’ BMI became significant after adjustment for PA (p < 0.05). Conclusions: Girls performed better in PF than boys. Highly educated fathers could contribute to improve the PF performance in boys. There were four DPs among adolescents in Shandong Province, and different DPs may have different effects on PF in boys and girls.

Mediterranean diet, physical activity, and family characteristics associated with cognitive performance in Italian primary school children: analysis of the I-MOVE project

Working memory (WM) is a multicomponent system that supports cognitive functioning. It has been linked to a wide variety of outcomes including academic success and general well-being. The present study examined the relations between adherence to the Mediterranean diet (MD) and WM among Italian children, adjusting for important parent characteristics and children's lifestyle habits. Data for this study was obtained from 106 children attending primary school in Imola (Italy) who were part of the I-MOVE study emphasizing school-based physical activity. Children's adherence to the MD was calculated using the KIDMED index (KI) based on the ZOOM-8 questionnaire. Physical activity (PA) levels were assessed using an actigraph accelerometer and WM using the backward digit span test. Univariate regression was used to select significant child-level and family measures associated with WM, which were then tested in a single multivariate regression model. Older age is positively associated with higher WM (β = 0.36; 95% CI 0.25, 0.47). Dietary adherence (KI) (β = 0.07; 95% CI 0.01, 0.14) and engagement in organized PA outside school hours (β = 0.58; 95% CI 0.09, 1.10) are positively related to WM. Among the family measures, father's education was positively associated with WM for high school education and for university vs. middle school or lower, respectively.

CONCLUSION

Adherence to the MD was associated with better WM capacity in primary school children. These findings can be used to guide policymakers in designing health promotion programs and instituting policies emphasizing healthy nutrition to improve physical health and boost cognitive functioning.

WHAT IS KNOWN

• The development of working memory involves the entire childhood with a rapid spurt between 2 and 8 years of age. • Working memory plays a critical role in children's learning and academic performance and underlies higher-order cognitive abilities.

WHAT IS NEW

• Adherence to the Mediterranean Diet was associated with higher working memory capacity in primary school children. • Health promotion interventions based on PA and sound nutrition involving children benefit not only physical and mental health, but also cognitive health.

Individual and combined impact of physical fitness on health-related quality of life during adolescence: DADOS Study

The purpose of the present study was to investigate the individual and combined impact of physical fitness components at baseline on health-related quality of life (HRQoL) at 24-month follow-up in adolescents. This longitudinal research included 199 adolescents (13.9±0.3 years at baseline) from the DADOS study. Cardiorespiratory fitness was assessed using the 20-m shuttle run test. Muscular strength was assessed using the standing broad jump test. Motor competence was assessed using the 4 × 10-m shuttle run test. A physical fitness z-score was calculated as the mean of the z-scores values of each fitness test. A fitness index ranging from 0 to 3 was created according to the number of physical fitness components in which participants achieved high levels according to normative values. HRQoL was evaluated by the KIDSCREEN-10 questionnaire. Linear regression analyses showed that cardiorespiratory fitness, muscular strength, and the physical fitness z-score at baseline were individually associated with HRQoL at follow-up (β ranging from 0.123 to 0.183; all p < 0.05). Moreover, logistic regression analysis revealed that adolescents with a fitness index ≥1 at baseline were more likely to achieve high HRQoL at 24-month follow-up, compared with their peers with an index of 0 (OR ranging from 3.554 to 9.087; all p < 0.05). Our results revealed an individual and cumulative positive impact of physical fitness at baseline on HRQoL at 24-month follow-up. These findings underline the key role of promoting the enhancement of overall physical fitness components in order to improve adolescents' health and well-being.Highlights Adolescents with high levels of cardiorespiratory fitness, muscular strength and motor competence will benefit from a greater physical and mental well-being over the time.The more physical fitness components with optimal levels, the greater likelihood of reaching better HRQoL over the time.Public health authorities should focus on the promotion of multiple physical fitness components to increase adolescent's likelihood of achieving greater HRQoL over the time.

The Mediating Role of the Muscle Quality Index in the Relation of Screen Time and Abdominal Obesity with Health-Related Quality of Life in Chilean Schoolchildren

Screen time (ST) and abdominal obesity have a negative effect on health-related quality of life (HRQoL). However, there is little information regarding the mediating role of the muscle quality index (MQI) in these relationships. The aim of the present study was to investigate the association between HRQoL, physical status (i.e., anthropometrics and fitness), lifestyle (i.e., ST and physical activity), and the MQI, and then to determine the potential mediating role of the MQI in the relation of ST and abdominal obesity with HRQoL in Chilean schoolchildren. The cross-sectional study included 750 schoolchildren (girls, n = 332 and boys, n = 418) aged between 10 and 14 years (11.73 ± 1.08 y). MQI, lifestyle, fitness parameters, waist-to-height ratio (WtHR) and HRQoL were measured. HRQoL presented a significant correlation with WtHR (r: -0.19), VO2_max (r: 0.20), physical activity after school (r: 0.26), ST (r: -0.26) and MQI (r: 0.15). According to MQI, the high-MQI group reported higher HRQoL than the low-MQI group (low MQI: 36.10 ± 3.63 vs. high MQI: 37.43 ± 4.00, p < 0.001). In the mediation model, ST and abdominal obesity were negatively linked to HRQoL; the indirect effect confirmed that MQI is a partial mediator in the relation between ST and HRQoL (indirect effect = -0.04; SE = 0.02; 95% CI: -0.09, -0.01) and in the relation between abdominal obesity and HRQoL (indirect effect = -1.81; SE = 0.83; 95% CI: -3.41, -0.40). In conclusion, MQI is related to better HRQoL in schoolchildren, and the negative relation of ST and abdominal obesity with HRQoL is mediated by MQI.

Adherence to the Mediterranean Diet and Health-Related Quality of Life during the COVID-19 Lockdown: A Cross-Sectional Study including Preschoolers, Children, and Adolescents from Brazil and Spain

Scientific literature has suggested positive associations between the Mediterranean diet (MD) and the health-related quality of life (HRQoL) in young populations. However, to our knowledge, this relationship is unexplored during a situation of social isolation (i.e., lockdown). The objective of the current study is to examine the relationship between the MD and HRQoL during the COVID-19 lockdown among preschoolers, children, and adolescents from Brazil and Spain. This cross-sectional study includes a sample of 1099 three- to seventeen-year-old participants (47.6% girls) who were recruited via social networks. The HRQoL was assessed with the EQ-5D-Y. The Quality Index for Children and Teenagers (KIDMED) questionnaire was applied to evaluate the relationship between the MD and HRQoL. The highest prevalence of reported problems was found for worried, sad, or unhappy participants (39.8%). Furthermore, the lowest proportion of HRQoL problems was observed for "mobility" (2.5%). The proportion of high adherence to the MD was 44.3%. Participants with greater MD adherence reported higher HRQoL mean scores when compared with those who did not adhere to the MD (83.7 ± 0.6 vs. 85.6 ± 0.7, respectively; p < 0.05). Adherence to the MD and especially daily fruit intake were related to higher HRQoL during the COVID-19 lockdown among Brazilian and Spanish young people aged three to seventeen years.

Prospective Association between Adherence to the Mediterranean Diet and Health-Related Quality of Life in Spanish Children

Health-Related Quality of Life (HRQoL) is gaining attention in children and adolescents because it is an important outcome of their health status and well-being. Therefore, it is important to identify determinants for HRQoL. Currently, there is scarce and mainly cross-sectional evidence on the relationship between adherence to the Mediterranean diet and HRQoL in children and adolescents. Therefore, the objective of the present study was to assess the prospective association between adherence to the Mediterranean diet and HRQoL in Spanish children. The study was carried out in 1371 children aged 8 to 10 from different Catalan elementary schools with a medium follow-up of 15 months. The KidMed and KIDSCREEN-10 questionnaires were used to assess the relationship between diet and HRQoL, respectively. The KidMed score at baseline was positively associated with HRQoL (β = 0.320; 95% CI 0.101−0.540) after adjusting for confounders. Additionally, the logistic regression analysis showed positive associations between baseline consumption of fruit, vegetables, pulses, and high adherence to the Mediterranean diet and HRQoL at follow-up (p < 0.05 for all) while the consumption of fast-food, pasta or rice, baked good or pastries, and sweets were negatively correlated (p < 0.05 for all) with HRQoL at follow-up. In conclusion, adherence of the Mediterranean diet was predictive for HRQoL in Spanish children, but further prospective studies are needed to confirm this result.

Association between Dietary Patterns and Physical Fitness among Chinese Children and Adolescents in Shaanxi Province

Background: This study aims to investigate the associations between dietary patterns (breakfast, egg, dairy products, and sugared beverage intake frequencies) and physical fitness among Chinese children and adolescents in Shaanxi Province. METHODS: Data were extracted from the Chinese National Survey on Students’ Constitution and Health (CNSSCH). The study ultimately included 7305 participants (48.4% male, 51.6% female) aged 6–22 in Shaanxi Province, China. Multiple linear regression was used to examine the association of the frequency of breakfast, egg, dairy product, and sugared beverage intakes with physical fitness. RESULTS: The frequency of breakfast, egg, and dairy product intakes were all independently and positively associated with the level of physical fitness. The frequency of sugared beverage intake was negatively associated with the level of physical fitness. CONCLUSION: Healthier dietary patterns (i.e., higher breakfast, egg, and dairy product intakes and lower sugared beverage intake) were associated with greater physical fitness. Specifically, maintaining a healthy dietary pattern of breakfast, egg, and dairy product intakes can positively affect the strength and endurance performance of children and adolescents. Increased dairy product intake plays a crucial part in boosting the physical fitness total scores of children and adolescents.

Differences in body composition and physical fitness parameters among prepubertal and pubertal children engaged in extracurricular sports: the active health study

Background

This study aimed to analyze the associations of maturity status, chronological age and sex with physical fitness and body composition among active children.

Methods

A total of 1682 children (72% boys; age = 11.22 ± 2.64 years; height = 147.57 ± 15.87 cm; weight = 44.55 ± 15.29 kg) from rural areas participating in extracurricular sports were divided into four groups according to their sex and maturity status (prepubertal and pubertal according to stages described by Tanner). Body composition (body mass index, muscle mass and fat mass) and physical fitness (20-m shuttle-run test, handgrip strength and vertical jump) were assessed using standardized procedures. A two-way ANOVA and product–moment correlations were performed.

Results

Prepubertal boys had more fat mass (%) than pubertal boys [P<0.001; effect size (ES): 0.45], while prepubertal girls had more muscle mass (%) than pubertal girls (P<0.001; ES: 0.47). The pubertal group displayed higher fitness outcomes (absolute values) regardless of sex (P<0.05). However, the prepubertal group had higher percentile values in the 20-m shuttle-run test and vertical jumps than the pubertal group regardless of sex (P < 0.001; ES: 0.29–0.48). All the measures of physical fitness were positively associated with chronological age and muscle mass (%).

Conclusions

Although absolute values of body composition and physical fitness appear to increase among pubertal children participating in extracurricular sports, the percentiles indicate that puberty is accompanied with a loss of a physical fitness levels. Thus, extracurricular sports might not be enough to enhance fitness among adolescents.

Adherence to Mediterranean diet associated with health-related quality of life in children and adolescents: a systematic review

BACKGROUND

Health-related quality of life (HRQoL) has become a significant outcome in assessing interventions in the pediatric population and could be influenced by diet patterns. The Mediterranean diet (MD) pattern has been related to multiple positive health outcomes, including decreased cardiovascular risk and better mental health. We aimed to evaluate the association between MD adherence and HRQoL in children and adolescents.

METHODS

The literature search was conducted in PubMed, Cochrane Library, Scopus, Web of Science, Embase, and Ovid-MEDLINE databases from inception to May 2022. Two researchers independently checked titles and abstracts, evaluated full-text studies, extracted data, and appraised the risk of bias using the Newcastle-Ottawa Scale (NOS).

RESULTS

Eleven studies (1 longitudinal and 10 cross-sectional), totaling 6,796 subjects, were included. Ten studies assessed MD adherence with KIDMED index, and one assessed MD adherence with Krece Plus test, while all included studies assessed HRQoL with a KIDSCREEN test. All studies analyzed the association between MD adherence and HRQoL with linear regression, and eight used adjusted models. Five studies found a significant positive association of MD adherence with HRQoL, with β-values ranging from 0.13 to 0.26. Two found a nonsignificant positive relationship, while one found a negative association. According to the NOS criteria, the risk of bias assessment showed four studies with a low risk of bias and seven with a high risk of bias.

CONCLUSION

Our findings suggest a positive correlation of MD adherence with HRQoL in children and adolescents. However, future research is needed to strengthen the evidence of this relationship.

TRIAL REGISTRATION

CRD42021236188 (PROSPERO).

Health-Related Quality of Life in Spanish Schoolchildren and Its Association with the Fitness Status and Adherence to the Mediterranean Diet

Background: Health-related quality of life (HRQoL) allows knowing the subject’s feelings in distress and well-being, as well as perception of current and future health. Objective: To assess associations between health-related quality of life, fitness status, and adherence to the Mediterranean diet in Spanish children and adolescents. Methods: A cross-sectional study was carried out in a sample of 305 (47.2% women) children and adolescents aged between 8 and 16 years, in the primary and secondary schools of the province of Ávila (central Spain) (NCT05380674). Subjects were classified according to their quality of life: group 1 (highest quality of life) > group 2 (medium quality of life) > group 3 (lowest quality of life). Results: More participants in group 1 showed higher adherence to Mediterranean diet (70.8%) than other groups (group 2: 55.0%; group 3: 43.4%). It was less likely to find optimal levels of muscle strength as quality of life decreased (OR; 95% CI: group 2: 0.535; 0.303−0.955; and group 3: 0.424; 0.234−0.768). Similar trends were found for speed and agility, but only group 3 showed significant results (OR; 95% CI: group 3: 0.297; 0.162−0.545). Flexibility was also the worst in groups 2 and 3 (OR; 95% CI: G2: 0.403; 0.213−0.762; and group 3: 0.520; 0.282−0.958). Conclusion: High fitness status and adherence to the Mediterranean diet were associated with improved health-related quality of life in schoolchildren of central Spain.

Health-related quality of life, Mediterranean diet, physical activity and socioeconomic factors of Greek adolescents during COVID-19: A cross sectional study

BACKGROUND: Health related quality of life of the adolescents during quarantine and social isolation potentially decreases, with significant alteration on physical activities and nutrition behaviour. OBJECTIVE: The present study investigates the relationship between Greek adolescents’ health related quality of life and socioeconomic factors, lifestyle and dietary characteristics, along with their adherence to the Mediterranean Diet immediately after the lockdown period in Greece. METHODS: A total sample of 459 students aged 12–16 years old were recruited from secondary schools in the area of Athens. The KIDSCREEN-27 questionnaire for children and adolescents, the KIDMED test, the Godin and Shephard Leisure Time Physical Activity Questionnaire and the Family Affluence Scale III, were used for the statistical analysis. T-tests, Kruskal Wallis, Chi-square, Anova tests and multiple regression analyses were employed. RESULTS: Econometric analysis reveals that adolescents’ health related quality of life is higher among boys, adolescents who live with both parents, tend to sleep more during night and do not spend many hours on screen viewing. Also, adolescents with higher family affluence level, being physically active and with a high adherence to the Mediterranean Diet have higher health related quality of life. CONCLUSIONS: Adolescents’ adherence to the Mediterranean Diet, physical activity, socioeconomic characteristics and life style behaviors are highly correlated with perceived health related quality of life during COVID-19 period.

Physical Activity Levels and Self-perception of Fitness in COVID-19-Recovered Individuals

Background: The preventative measures to reduce the incidence of coronavirus disease 2019 (COVID-19) have reduced the physical activity level (PAL) that might also affect physical and mental health. Objectives: The present study investigated the relationship between self-perception of fitness (SPF) and PAL in COVID-19-recovered individuals (CRI). Methods: The population of this descriptive-analytical study included all CRI (men and women, in the age range of 20 to 70 years) in Kermanshah. In the present study, 890 volunteers (438 men and 452 women) were sampled using a multistage cluster sampling method. The International Physical Activity Questionnaire (IPAQ-SF) was used to assess the PAL and the Delignières et al. questionnaire to assess the SPF. The Pearson correlation coefficient test and independent t-test were used to analyze the data using SPSS version 24 software. Results: The results showed low PAL (men: 876.11 ± 40.23; women: 739.27 ± 8.02) and poor SPF (men: 6.64 ± 1.62; women: 5.27 ± 1.39) in CRI. Also, there was a significant positive relationship between high and moderate PAL and SPF in men (r = 0.67, P = 0.032; r = 0.77, P = 0.018, respectively) and women (R = 0.56, P = 0.041; r = 0.66, P = 0.035, respectively), while there was a significant inverse relationship between low PAL and SPF among men (r = -0.85, P = 0.001) and women (r = -0.89, P = 0.001). Conclusions: Based on the results, wrong SPF in individuals with low PAL might be one reason for being insufficiently active. Thus, a proper understanding of PAL could be the first step of a regular physical activity schedule to enhance the immune system.

Adherence to the Mediterranean diet and subjective well-being among Chilean children

Scientific literature has demonstrated positive associations between psychological health (e.g., self-esteem, self-concept) and quality of diet in young population. However, the relationship between subjective well-being (SWB) (referred to the way in which individuals experience and evaluate their lives in positive versus negative ways) and adherence to the MD, as well as the specific eating MD patterns in this population is unexplored. The aim of this study was two-fold: first, to explore the association between subjective well-being (SWB) and adherence to the MD, and second, to determine the possible MD specific eating patterns that could be associated with SWB among Chilean schoolchildren. This cross-sectional study includes a sample of 1490 children aged 8-12 (33.6% girls). SWB was evaluated according to Diener's tripartite model, evaluating the life satisfaction (CUBE questionnaire), positive affect and negative affect (PANAS-C8 questionnaire). Adherence to the MD was assessed by the Mediterranean Diet Quality Index for Children and Adolescents (KIDMED) questionnaire. Both life satisfaction (p = 0.009) and positive affect (p = 0.041) are significant higher in children with high adherence to the MD in comparison to non-adherence peers. Similarly, daily intake of fruit or fruit juice was associated with life satisfaction (β = 0.117, p = 0.008) and positive affect (β = 0.087, p = 0.050). This association was also found for the intake of a dairy product for breakfast (life satisfaction: β = 0.117, p = 0.005; positive affect: β = 0.104, p = 0.013). Our study demonstrated that higher life satisfaction and SWB are related with higher adherence to the MD, as well as, with the intake of fruit/fruit juice and dairy intake (for breakfast); not being so for negative affect.

Mediterranean diet quality index is associated with better cardiorespiratory fitness and reduced systolic blood pressure in adults: A cross-sectional study

BACKGROUND

Literature suggests higher cardiorespiratory fitness (CRF) is inversely related to chronic diseases such as metabolic syndrome and cardiovascular disease and hypertension. The aim of this study was to assess the association of Mediterranean dietary quality index (Med-DQI) with CRF and hypertension in a sample of Iranian adults.

METHODS

This was a cross-sectional study on 270 healthy men and women, aged 18-45 years. Dietary intake and physical activity level were assessed through a validated food frequency questionnaire (FFQ); and the International Physical Activity Questionnaires (IPAQ), respectively. Cardiorespiratory fitness was assessed by using a graded exercise treadmill test. The association between Med-DQI and CRF was investigated using multiple regression models.

RESULTS

Participants in the top tertiles of Med-DQI, had higher VO2 max (mL/kg/min) (p = 0.02) and lower SBP (p = 0.01). When we controlled for age, sex, weight, smoking, physical activity and energy intake, the significant results were remained. Results of unadjusted linear regression shows that CRF was positively associated with cholesterol (p < 0.001) and fish (p < 0.001). Also, CRF was positively associated with vegetables and fruits (p < 0.001) and olive oil (p = 0.05). After adjustments for confounders, the significant associations of olive oil and cholesterol with CRF were disappeared while vegetables and fruits and total score of Med-DQI remained significant. There were no significant relations between saturated fatty acids meat, and cereals with Med-DQI.

CONCLUSIONS

Our results demonstrated that Med-DQI was associated with better CRF in Iranian adults and SBP. Further studies with interventional approaches are needed to better clarify the causal inference of these associations.

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

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

Dietary patterns and health-related quality of life among Iranian adolescents

PURPOSE

Examining the associations of a-posteriori-defined dietary patterns and health-related quality of life (HRQOL) among Iranian adolescents.

METHODS

This cross-sectional study was conducted among 900 apparently healthy students (mean age 15.33 years; 53.0% female) during 2020-21. The validated Persian version of self-report Pediatric Quality of Life Inventory™ Version 4.0 Generic Core Scales (PedsQL) for healthy adolescents was used in an online survey to assess HRQOL. Total, physical health, psychosocial health, emotional functioning, social functioning, and school functioning PedsQL scores were calculated, and impaired HRQOL was defined as > 1 standard deviation below the total population sample mean PedsQL scores. A validated food frequency questionnaire was used to assess dietary intakes during telephone interviews. Daily intakes of 20 predefined food groups were calculated and submitted to the principal component factor analysis to identify a-posteriori-defined dietary patterns.

RESULTS

Three major dietary patterns labeled as Mediterranean, mixed, and unhealthy were identified, of which only the Mediterranean pattern characterized by high intakes of vegetables, fruits, olives, potatoes, eggs, nuts and legumes, pickles, low-fat dairy, fish, poultry, and vegetable oils was consistently associated with HRQOL. Controlling for covariates in the multivariable-adjusted binary logistic regression analysis, participants in the top tertile of Mediterranean pattern score were less likely to have impaired HRQOL than those in the bottom tertile (total: OR 0.25; physical health: OR 0.35; psychosocial health: OR 0.15; emotional functioning: OR 0.17; social functioning: OR 0.15; and school functioning: OR 0.18; all P < 0.010).

CONCLUSION

Current findings indicate that an a-posteriori-defined Mediterranean-style dietary pattern is associated with better HRQOL among healthy Iranian adolescents.

Adherence to the Mediterranean diet in health personnel from the province of Las Palmas

INTRODUCTION AND OBJECTIVES

Given the proven protective effect of the Mediterranean Diet, adherence to it by healthcare personnel and the influence of different factors on dietary compliance were evaluated.

METHODS

A cross-sectional study was conducted on healthcare personnel, obtaining the data through anonymous surveys that collected demographic characteristics, professional activity, history of cardiovascular risk factors, alcohol, and tobacco consumption, physical activity, and adherence to the Mediterranean Diet, using the 14-point Mediterranean Diet Adherence Score (MEDAS). Adherence and related factors were measured.

RESULTS AND CONCLUSIONS

Of a total of 922 respondents (664 women) mean aged 42.61 years (range 20-69), 61.2% showed a good adherence to the Mediterranean Diet. Adherence was significantly associated with the professional categories of physicians (OR = 1.92; 95% CI: 1.20-3.06; p = 0.01) and nurses (OR = 1.67; 95% CI: 1.08-2.57). Furthermore, it was associated with physical exercise (OR = 1.78; 95% CI: 1.29-2.47; p < 0.001) and cooking at home (OR = 1.35; 95% CI: 1.00-1.80; p = 0.05). However, adherence was not significantly associated with age or sex, comorbidities, working hours, alcohol, or tobacco consumption. Quantifying knowledge of the diet would be useful, as well as increasing educational programs, promoting physical exercise and cooking habits.

The social and psychological health of children is associated with Mediterranean diet adherence items, cardiorespiratory fitness, and lifestyle

BACKGROUND

Mediterranean diet (MD) adherence, physical activity (PA) patterns, and physical fitness are associated with physical, social, and psychological health in children.

OBJECTIVE

the purpose of this study was to determine the association of items of MD adherence, fitness components, and lifestyle with psychological and social health in Chilean schoolchildren.

MATERIAL AND METHODS

this cross-sectional study included 615 schoolchildren, both girls (n = 271, 11.7 ± 1.00 years old) and boys (n = 344, 11.8 ± 1.1 years old). Anthropometric parameters, fitness components, lifestyle, health-related quality of life (HRQoL), and self-esteem were measured.

RESULTS

HRQoL showed an association with cardiorespiratory fitness (β: 0.12, p < 0.001) and PA (β: 0.32, p = 0.023). Self-esteem was inversely associated with screen time (β: -1.35, p < 0.001). Moreover, social health presented a positive association with PA after school (β: 0.06, p = 0.037). In relation to MD adherence items, HRQoL was linked to the items "Takes a fruit or fruit juice every day" (β: 1.93, p = 0.004) and "Consumes fresh or cooked vegetables ˃ 1 time/day" (β: 1.12, p = 0.018). Self-esteem was associated to "Consumes a dairy product ˃ 1 time/day" (β: 3.30, p = 0.030). Social health was inversely related to "Eats at a fast food restaurant ≥ 1 time/week" (β: -0.26, p = 0.003) and positively to "Consumes pasta or rice almost every day" (β: 0.35, p = 0.049).

CONCLUSION

MD adherence items, fitness, and lifestyle were linked to psychological and social health, therefore it is necessary to develop preventive strategies for schoolchildren to change in a positive way these modifiable lifestyle behaviors.

Lifestyle mediates the relationship between self-esteem and health-related quality of life in Chilean schoolchildren

A healthy lifestyle, including food habits, physical activity (PA) and screen time (ST), is an important factor for well-being. The main purpose of this study was to analyze the association between lifestyle (i.e., PA, ST and food habits), self-esteem and health-related quality of life (HRQoL). A second objective was to determine the association between self-esteem with HRQoL, considering the mediating effect of lifestyle. A descriptive and cross-sectional study was performed, involving both girls (n = 282, 11.86 ± 0.82 years) and boys (n = 352, 12.02 ± 0.87 years). Lifestyle, self-esteem, HRQoL and anthropometrics parameters were evaluated. The study reported that self-esteem (β; 0.04, P = 0.49) and PA (β; 1.15, P < 0.001) had positive association with HRQoL. By contrast,ST was linked in an inverse way to HRQoL (β; -1.82,, P < 0.001). According to the second objective, self-esteem had a significant association with HRQoL (total effect = 0.48, p < 0.01), and ST mediated this association negatively, instead, PA and food habits positively mediated this association. In conclusion, self-esteem presented association with HRQoL and lifestyle mediates this relationship positively (PA, MD adherence) and negatively (ST). Therefore, promoting healthy lifestyle among children should be a target of community- and school-based interventions to promote well-being.

Trends in the adherence to the Mediterranean diet in Israeli adolescents: results from two national health and nutrition surveys, 2003 and 2016

PURPOSE

To compare the adherence to the Mediterranean diet (MD) in Israeli adolescents in 2003-4 and in 2015-6, and associated factors.

METHODS

Adolescents (aged 11-19 years) from two cross-sectional, school-based, nationally representative surveys, Mabat Youth I (2003-4, n 5005) and II (2015-6, n 3906), completed self-administered questionnaires on food frequency, eating behaviors and lifestyle. The Mediterranean Diet Quality Index for Children and Adolescents (KIDMED index), derived from these questionnaires, was used; higher scores indicate better diet quality. The samples comprised eight subgroups, according to population group (Jews/Arabs), school level (middle/high) and sex.

RESULTS

The percentages with poor, average and good KIDMED scores were 11.6, 45.3 and 43.1% in 2015-6, compared to 25.5, 55.2 and 19.3%, respectively, in 2003-4. Significant improvement was seen in all subgroups (all p < 0.001), and was attributed to increased consumption of fruits, vegetables, cereals, dairy products, and decreased negative eating behaviors. In Mabat Youth II, physical activity at least 1 h/day was positively associated with good KIDMED scores among Jewish adolescents; dieting and sleeping at least 7 h/day were associated with good MD adherence in Jewish boys; always/often reading food labels predicted good MD adherence among Jewish boys and Arab girls. Overweight and obesity were negatively associated with better KIDMED scores in Jewish boys.

CONCLUSION

MD adherence in Israeli adolescents has improved overall. The changes in MD components and the associated behavioral factors indicate the initiatives, relevant to the different subgroups, that are necessary to promote healthier nutrition and lifestyles.

Mediterranean-Type Dietary Pattern and Physical Activity: The Winning Combination to Counteract the Rising Burden of Non-Communicable Diseases (NCDs)

Non-communicable diseases (NCDs) (mainly cardiovascular diseases, cancers, chronic respiratory diseases and type 2 diabetes) are the main causes of death worldwide. Their burden is expected to rise in the future, especially in less developed economies and among the poor spread across middle- and high-income countries. Indeed, the treatment and prevention of these pathologies constitute a crucial challenge for public health. The major non-communicable diseases share four modifiable behavioral risk factors: unhealthy diet, physical inactivity, tobacco usage and excess of alcohol consumption. Therefore, the adoption of healthy lifestyles, which include not excessive alcohol intake, no smoking, a healthy diet and regular physical activity, represents a crucial and economical strategy to counteract the global NCDs burden. This review summarizes the latest evidence demonstrating that Mediterranean-type dietary pattern and physical activity are, alone and in combination, key interventions to both prevent and control the rise of NCDs.

[Evaluation of food habits and physical activity in Galician students]

Introduction

Introduction: obesity causes millions of deaths each year. Its high prevalence in children and adolescents from southern European countries, including Spain, is associated with the new food preferences and decreased physical activity. Objective: to evaluate diet quality and physical activity in Galician schoolchildren in order to assess if modifying the current intervention strategies in lifestyles is required. Methods: in the present study, 662 students from the south of Galicia were studied (9-17 years). Body mass index (BMI) was calculated as adiposity indicator. The dietary pattern was evaluated through the Kidmed test and physical activity with PAQ-C. The sample was stratified by BMI according to Cole international standards. Data were analysed with the SPPS software. Results: fifty-six per cent of children are at high risk of overnutrition or need to improve their nutrition. The average adherence to the Mediterranean diet was low (7.64 ± 2.28), worsening with age and adiposity significantly. The average level of physical activity was moderate (3.02 ± 0.74) and it was lower in girls and adolescents; 58% showed a low-moderate level of physical activity. Quality diet was positively correlated with physical activity and negatively with BMI. Conclusions: Galician students showed a diet and physical activity risky pattern according to international/national recommendations. After several years of awareness campaigns and lifestyle interventions, improving their diet and increasing physical activity is still necessary.

Comparison of inequity in health-related quality of life among unemployed and employed individuals in China

BACKGROUND

In China, achieving health equity has been regarded as a key issue for health reform and development in the current context. It is well known that unemployment has a negative effect on health. However, few studies have addressed the association between unemployment and inequity in health-related quality of life (HRQOL). This study aims to compare the inequality and inequity in HRQOL between the unemployed and employed in China.

METHODS

The material regarding this study was derived from the Chinese National Health Services Survey of Shaanxi Province for 2013. We controlled for confounding factors by utilizing the coarsened exact matching method. Finally, 7524 employed individuals and 283 unemployed individuals who were 15 to 64 years old in urban areas were included in this study. We used HRQOL as the outcome variable, which was evaluated by using the Chinese version of EQ-5D-3L. The health concentration index, decomposition analysis based on the Tobit model, and the horizontal inequity index were employed to compute the socioeconomic-related equity between the unemployed and employed and the contribution of various factors.

RESULTS

After matching, unemployed people tended to have poorer EQ-5D utility scores than employed people. There were statistically pro-rich inequalities in HRQOL among both employed and unemployed people, and the pro-rich health inequity of unemployed people was substantially higher than that of employed people. Economic status, age, education, smoking and health insurance were the factors influencing inequality in HRQOL between employed and unemployed individuals. Education status and basic health insurance have reduced the pro-rich inequity in HRQOL for unemployed people.

CONCLUSION

It is suggested that unemployment intensifies inequality and inequity in HRQOL. According to policymakers, basic health insurance is still a critical health policy for improving health equity for the unemployed. Intervention initiatives aiming to tackle long-term unemployment through active labour market programmes, narrow economic gaps, improve educational equity and promote the health status of the unemployed should be considered by the government to achieve health equity.

The longitudinal relationship between dietary intake, physical activity and muscle strength among adolescents

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.

Association of Adipocytokines and Inflammatory Biomarkers with Blood Pressure in Adolescents: A Longitudinal Analysis

BACKGROUND AND AIMS

Several cross-sectional, but few prospective, studies suggest that inflammation may be involved in the development of high blood pressure. We examined markers of inflammation for their associations with blood pressure levels over a two-year period in healthy adolescents.

METHODS AND RESULTS

The sample comprised 406 adolescents (209 girls) aged 12-18 years in the LabMed Physical Activity Study were followed-up for 2 years. Anthropometric (weigh, height, BMI), markers of inflammation (high sensitivity C-reactive protein, complement factors C3 and C4, fibrinogen, leptin and adiponectin) and ambulatory blood pressure (BP) were collected. Socioeconomic status, pubertal development, adherence to Mediterranean diet and cardiorespiratory fitness were measured for adjustment for potential confounders. Adjusted linear regression models revealed a significant association of Leptin/Adiponectin (L/A) Ratio (baseline) with systolic BP (β = 0.120; p < 0.034) and with diastolic BP (β = 0.125; p < 0.036) at follow-up (full adjusted model). Leptin was associated with systolic BP at follow-up (β = 0.102; p < 0.038) after adjustment for systolic BP at baseline, height, pubertal stage, socioeconomic status, adherence to Mediterranean diet, cardiorespiratory fitness, however, not independently of BMI.

CONCLUSION

L/A ratio was positively associated with systolic BP and diastolic BP even after adjusting confounding variables. Therefore, a higher misbalance between leptin and adiponectin (higher L/A ratio) early adolescence may exert a negative effect BP levels in late adolescence regardless of several confounders factors.

The Mediating and Moderating Effects of Physical Fitness of the Relationship between Adherence to the Mediterranean Diet and Health-Related Quality of Life in University Students

The aim of this study was to estimate the relationship between the adherence to the Mediterranean diet (MD) and health-related quality of life (HRQoL) in university students and to assess whether this relationship is mediated or moderated by cardiorespiratory fitness (CRF) and handgrip strength. A cross-sectional study was performed involving 310 first-year Spanish university students. Adherence to the MD was evaluated with the 14-item Mediterranean Diet Adherence Screener (MEDAS), and the HRQoL was evaluated with the Short Form-12 (SF-12) questionnaire. CRF was assessed by the 20 m shuttle run test, and the handgrip strength was determined by dynamometry. ANCOVA models showed that participants with higher CRF and handgrip strength levels had significantly higher scores in the physical component summary (PCS) and mental component summary (MCS) of the SF-12 and in the MEDAS questionnaire than those with medium and low scores (p < 0.050). Additionally, the ANCOVA models showed that students with good adherence to the MD showed higher scores in the MCS of HRQoL than those with low adherence (p = 0.044, ES = 0.013), but these results did not appear for the PCS of HRQoL (p = 0.728, ES = 0.001). In the mediation analysis, it was found that CRF and handgrip strength acted as full mediators of the relationship between adherence to the MD and the MCS of HRQoL. In the moderation analysis, it was evidenced that CRF and handgrip strength did not act as moderators in the relationship between adherence to the MD and the MCS of HRQoL. In conclusion, adherence to the MD does not seem to have a direct effect on the MCS of HRQoL because this association seems to be fully mediated by CRF and handgrip strength.

Food Habits and Screen Time Play a Major Role in the Low Health Related to Quality of Life of Ethnic Ascendant Schoolchildren

The objective of the present study was to determine the association between lifestyle parameters (i.e., physical activity (PA) level, screen time (ST), fitness and food habits) and health-related quality of life (HRQoL) in ethnic ascendant schoolchildren (i.e., Mapuche ascendant). This cross-sectional study included 619 schoolchildren with ethnic (EA; n = 234, 11.6 ± 1.0 years) and non-ethnicity ascendant (NEA; n = 383, 11.7 ± 1.1 years) from Araucanía, Chile. HRQoL and lifestyle were measured using a standard questionnaire and cardiometabolic markers (body mass index (BMI), waist circumference (WC), waist-to-height ratio (WtHR), systolic (SBP) and diastolic blood pressure (DBP)) and cardiorespiratory fitness (CRF) were additionally included. In the EA schoolchildren, the HRQoL reported association with CRF adjusted by age and sex (β; 0.12, p = 0.018) and non-adjusted with foods habits (β; 0.11, p = 0.034). By contrast, ST adjusted by age and sex presented an inverse association with HRQoL (β; −2.70, p < 0.001). EA schoolchildren showed low HRQoL (p = 0.002), low nutritional level (p = 0.002) and low CRF (p < 0.001) than NEA peers. Moreover, children’s ethnic presence showed an association with low nutritional levels (odd ratio (OR): 3.28, p = 0.002) and ST 5 h/day (OR: 5.34, p = 0.003). In conclusion, in the present study, EA schoolchildren reported lower HRQoL than NEA schoolchildren, which could be explained by the lifestyle patterns such as a low nutritional level and more ST exposure.

Relación entre nivel de condición física y percepción de la calidad de vida relacionada con la salud en adolescentes del sureste español

Introducción. La condición física relacionada con la salud (CFS) es considerada como uno de los factores que determinan el concepto de calidad de vida relacionada con la salud (CVS).Objetivo. Analizar la relación entre el nivel de CFS y la percepción de la CVS en adolescentes españoles.Materiales y métodos. Estudio multicéntrico realizado en una población de 1 037 adolescentes (15.52±1.11 años) del sureste de España (Región de Murcia). La CFS y la CVS se evaluaron mediante la batería COFISA y el Cuestionario de Salud SF-36, respectivamente.Resultados. La prueba MANOVA mostró que los varones tuvieron un mejor rendimiento físico global (p<0.001). Respecto a la CVS, las mujeres tuvieron una mejor percepción en la dimensión salud general (p=0.011), mientras que la percepción de los varones fue mejor en las dimensiones rol emocional (p=0.010) y salud mental (p<0.001). Los adolescentes con mayor nivel CFS tuvieron valores superiores en la percepción global de la CVS (p<0.001 en todas las variables).Conclusión. La asociación entre niveles altos de CFS y puntajes superiores de percepción de la CVS hace necesario establecer estrategias y acciones que busquen aumentar los niveles de participación de los jóvenes en actividades físicas y deportivas.

Factors associated with adherence to a Mediterranean diet in adolescents from La Rioja (Spain)

The aim of the present study was to describe Mediterranean diet (MD) adherence within a population of adolescents and to analyse the association of multiple factors with adherence. This included a consideration of diverse physical and mental health indicators. The present study was conducted with a representative sample of 761 adolescents (14·51 (sd 1·63) years) from twenty-five educational centres in a northern region of Spain. MD adherence was evaluated, alongside their health-related quality of life, self-esteem, body image satisfaction, BMI, physical activity (PA) level, maximum oxygen consumption, hours of nightly sleep, socio-demographic factors and academic performance. Of the adolescent population, 49 % reported high MD adherence. Being female and having higher levels of PA were found to be predictive factors of adherence to the MD. In addition, maximum oxygen consumption, the presence of environments favourable towards PA engagement and higher self-esteem were also predictive in females, whilst better academic performance and more nightly sleep were additional predictors in males. The associations found between the MD and other health indicators and habits highlight the need to develop promotion strategies from an inter-disciplinary and transversal standpoint.

Eating Behaviour and Physical Fitness in 10-Year-Old Children Attending General Education and Sports Classes

The aim of this study was to evaluate the body mass index (BMI), selected eating behaviour and physical fitness of children aged 10 years attending general education and sports classes in Siedlce. Subject children were 272 girls and boys mean aged 10.8-years attending general education (GC) and sports classes (SC). Survey questionnaires consisted of 18 questions about eating behaviour and physical activity. The BMI was determined for each child and compared with reference percentile charts. Eurofit testing was used to measure physical fitness. Increased physical fitness was positively correlated with beneficial eating behaviour among children. SC children showed significantly more frequent dietary intakes of milk, dairy products, poultry, fish, wholegrain bread, groats and vegetables when compared to GC ones. However, significantly more GC children ate red meat more frequently along with snacking on confectionery and savouries than SC ones. Most subjects fell within correct BMI percentile ranges. Underweight was more frequent in SC children at 12.85% than in GC children 9.88%. Overweight and obesity was most often observed in GC children (respectively 19.73% and 5.51%) compared to SC ones (respectively 14.37% and 3.8%). SC children achieved significantly better results in the Eurofit tests. The highest levels of physical fitness and most favourable BMIs and eating behaviour were observed more often among SC children than GC ones. The results confirmed the beneficial health effects of physical fitness for children.

The Quality of Breakfast and Healthy Diet in School-aged Adolescents and Their Association with BMI, Weight Loss Diets and the Practice of Physical Activity

Dietary habits are an important factor in the protection of adolescent health. The quality and frequency of breakfast and the various food groups can affect the wellbeing of this population group in both the short and long term. Research indicates that there is a range of relevant variables in the study of diet at this stage: following a weight loss diet, body mass index and the practice of physical exercise, amongst others. In this paper, all three variables are analysed, together with others of a demographic nature (sex and age). This is a descriptive cross-sectional survey that was carried out on 1318 adolescents aged 11 to 18. The Health Behaviour in School-Aged Children (HBSC) international study questionnaire, sponsored by the World Health Organisation, was used. In general terms, the data revealed that the majority of adolescents do not have adequate eating patterns. The quality and frequency of breakfast and the consumption of food types are associated with almost all the variables under study; additionally, there are significant differences by sex and school year. Finally, proposals are made to prevent eating disorders, which are appearing at an increasingly young age.

Brazilian Vegetarian Population-Influence of Type of Diet, Motivation and Sociodemographic Variables on Quality of Life Measured by Specific Tool (VEGQOL)

The adoption of a vegetarian diet has been associated with positive health outcomes. However, few studies evaluate the effect of this eating pattern on quality of life. Moreover, no specific instrument for the vegetarian population to measure the quality of life is available worldwide. Therefore, this study aimed to elaborate and validate a specific questionnaire to measure the quality of life in vegetarians. The Specific Vegetarian Quality of Life Questionnaire (VEGQOL) was constructed based on other instruments and studies related to vegetarianism. The content and semantic validation were performed by a group of experts, followed by a pilot study to evaluate the questionnaire acceptability and reproducibility. Discriminant validation was tested using the WHOQOL as the gold standard measure (Pearson correlation ranging from 0.302 of the domain 3 to 0.392 of the domain 2). Afterward, a nationwide survey was conducted using VEGQOL. Content and semantic validation selected 19 of the initial 30 items. VEGQOL presented good reproducibility (Cohen's Kappa coefficient ranging from 0.361 to 0.730 and intraclass correlation coefficient of 0.820) and internal consistency (0.708), both adequate to evaluate the quality of life in vegetarians. The sample size (n = 5014 individuals, error of 3% at a level of significance of 5%) and distribution was representative of the Brazilian vegetarian population. In general, the quality of life of Brazilian vegetarians was considered satisfactory (VEGQOL cut off points 70-80). Among different types of vegetarians, the vegans showed better results with a VEGQOL mean value of 79.2 ± 10.7. Older individuals, the ones who adopted the diet for a longer time (VEGQOL mean value of 75.8 ± 12.7) and the ones who had other vegetarians in their social network (VEGQOL mean value of 74.6 ± 12.2) also had a better quality of life score. Individuals who adopted it for ethical or health reasons had a higher quality of life score. The questionnaire produced in this study is a useful tool for future research in this area. Results were better for vegans and for the ones who adopt the diet for ethical or health reasons.

The association between children's food habits, anthropometric parameters and health-related quality of life in Chilean school-age children

Introduction

Introduction: children's food habits have an influence on physical and mental health and should be monitored. Objective: the purpose of this study was to determinate the association between children's food habits (i.e., Mediterranean diet adherence), anthropometric parameters and health-related quality of life (HRQoL) in Chilean schoolchildren. Material and methods: girls (n = 282, 11.86 ± 0.82 years) and boys (n = 352, 12.02 ± 0.87 years) enrolled in public schools were included in this study (n = 634). Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WtHR), body fat (BF), nutritional level and HRQoL were evaluated. Results: the schoolchildren with high nutritional levels reported higher HRQoL (p = 0.018) and presented lower BMI, WC and WtHR (p < 0.001). Likewise, according to the following questions: Have your parent(s) treated you fairly? and Have you felt full of energy? The schoolchildren with high nutritional levels reported the major proportion in very and extremely answers (p < 0.001). The BMI was negatively correlated with HRQoL (r = -0.33, p < 0.05). Beside, children's food habits had significant correlation with HRQoL (r = 0.48, p = 0.002). The BMI (B = -0.41, 95% CI = -0.55, 0.93, p = 0.001) and children's food habits (B = -0.78, 95% CI = -0.09, -0.02, p = 0.002) reported associations with HRQoL. Conclusion: in conclusion, the nutritional level (i.e., Mediterranean diet adherence) and BMI presented associations with HRQoL in Chilean schoolchildren; therefore, it is important to consider these results and develop different strategies in schoolchildren to improve their nutritional levels, as HRQoL represents a measure of happiness or satisfaction with life.

Mediterranean diet adherence and weight status among Sicilian Middle school adolescents

During the last decades, an important modification of dietary habits has been observed in the Mediterranean countries, especially among young people. The aim of this study was to evaluate adherence to the Mediterranean diet (MedDiet) and its relationship with weight status in a group of Italian middle school adolescents by using the KIDMED test. The evaluation of weight status revealed that 61.5, 26.8, and 11.7% were normal weight, overweight, and obese, respectively. MedDiet adherence was high in 13.3%, average in 27.1%, and low in 59.6% of the students with no differences by gender and age. MedDiet adherence was found significatively higher in normal weight and in played sport adolescents, in comparison to the overweight and obese ones (p < .001) who showed incorrect nutritional habits. This cross-sectional study shows a very low MedDiet adherence among adolescent living in the Mediterranean basin and highlights the role of Mediterranean dietary pattern in the fight against obesity.

Impact of Vigorous-Intensity Physical Activity on Body Composition Parameters, Lipid Profile Markers, and Irisin Levels in Adolescents: A Cross-Sectional Study

In adolescence, health status is influenced by several factors, including dietary pattern and physical activity (PA) which are crucial elements of lifestyle in terms of prevention and treatment of metabolic and chronic diseases. The current study aimed to explore the impact of the different intensity levels of PA along with the adherence to a Mediterranean diet (MD), on body composition indices and metabolic parameters in a cohort of adolescents, thereby investigating potential predictors of health behavior in youth. This cross-sectional study was carried out among 92 participants (44 girls and 48 boys, aged 14 to 17 years), which were divided into the following three groups according to intensity levels of PA: Group A (physical inactivity), Group B (moderate PA), and Group C (vigorous-intensity PA). The Questionnaire of Adherence to the Mediterranean Diet (KIDMED test) was used to assess both diet composition and adherence to a MD. All subjects underwent anthropometric measurements, bio-impedentiometric analysis for body composition parameters, and biochemical and hormonal measurements. The majority of adolescents (60.87%) had a medium adherence to the MD, and even a better distribution of food rates was found in adolescents performing vigorous-intensity PA. A comparison of anthropometric measurements and body composition parameters among groups showed that body mass index and fat mass (FM) were significantly lower while body cell mass (BCM), free fat mass (FFM), phase angle (PhA), and total body water (TBW) were higher in Group C adolescents as compared with those of Group A. In Group C, insulin resistance (HOMA-IR) was reduced and insulin levels were inversely associated with FFM (r = −0.454 and p = 0.004) and directly correlated with FM (r = 0.331 and p = 0.003). In the same Group C, we observed elevated serum irisin levels and lower lipid profile markers as compared with Group A. Interestingly, irisin negatively correlated with both total cholesterol (r = −0.428 and p = 0.04) and LDL (r = −0.468 and p = 0.02) in Group C. Finally, a receiver operator characteristic curve (ROC) analysis revealed irisin, LDL, HDL, and body composition variables (FFM, BMC, PhA, and TBW) as the most predictive measures for vigorous-intensity PA. Our results highlight the importance of developing healthy lifestyle programs that include improving the intensity of PA among a young population as a superior strategy for ensuring a better quality of life.

Adherence to Mediterranean Diet Related with Physical Fitness and Physical Activity in Schoolchildren Aged 6-13

The relationship between adherence to the Mediterranean Diet (MD) and both physical fitness (PF) and physical activity (PA) level has been analysed in several studies. The aim of this research was to describe, compare and analyse the level of PF and PA in schoolchildren aged 6–13 in the Region of Murcia, according to adherence to the MD. A descriptive and cross-sectional study was performed. A total of 370 schoolchildren (44.9% girls) aged 6–13 (8.7 ± 1.8) from six primary schools in the Region of Murcia (Spain). Mediterranean Diet Quality Index for children and teenagers (KIDMED) was used to determinate the adherence to the MD. The ALPHA-FIT Test Battery was applied for assess body composition and PF. PA level was determined using Physical Activity Questionnaire for Older Children (PAQ-C). Only 25.9% of the schoolchildren had optimal adherence to the MD. Regarding the scores of the different PF tests in MD groups, only statistically significant differences were found for cardiorespiratory fitness (CRF) (p = 0.048) in boys. PA level showed statistically significant differences in both boys (p = 0.040) and girls (p = 0.016). A positive relationship was found between the KIDMED and PA level (p = 0.235). A higher probability of having a greater CRF (OR = 1.17; CI = 1.02–1.34) and PA level (OR = 7.84; CI = 2.84–21.60) was found in high MD group. These results suggest that an optimal adherence to the MD is associated with higher CRF and PA level in the selected schoolchildren.

The Influence of Physical Activity, Diet, Weight Status and Substance Abuse on Students' Self-Perceived Health

The objective of this study was to determine the level and relationship between the self-perceived health of adolescents in relation to the level of practice of physical activity, adherence to the Mediterranean diet, weight status and consumption of substance abuse, such as alcohol and tobacco. A total of 516 adolescent students between the ages of 12 and 16 completed a series of questionnaires to assess their health, physical activity, compliance with the Mediterranean diet and alcohol and tobacco consumption. Adolescents who practice more physical activity have better health and greater adherence to the Mediterranean diet. The level of health is higher among adolescents with greater adherence to the Mediterranean diet, evidencing better health among those who consume less tobacco. These results show the need to involve the educational community, families and the media to promote healthy lifestyle habits that can help physical activity and sports professionals in the development of theoretical-practical proposals aimed at improving the health of students.

Adherence to the Mediterranean Diet and Its Association with Body Composition and Physical Fitness in Spanish University Students

The aims of this study were to assess the association of adherence to the Mediterranean diet (MD) with physical fitness and body composition in Spanish university students and to determine the ability to predict the MD adherence of each Mediterranean Diet Adherence Screener (MEDAS) item. A cross-sectional study was performed involving 310 first-year university students. Adherence to the MD was evaluated with MEDAS-14 items. Anthropometric variables, body composition, and physical fitness were assessed. Muscle strength was determined based on handgrip strength and the standing long jump test. Cardiorespiratory fitness (CRF) was measured using the Course-Navette test. Only 24% of the university students had good adherence to the MD. The ANCOVA models showed a significant difference between participants with high adherence to the MD and those with medium and low adherence in CRF (p = 0.017) and dynamometry (p = 0.005). Logistic binary regression showed that consuming >2 vegetables/day (OR = 20.1; CI: 10.1-30.1; p < 0.001), using olive oil (OR = 10.6; CI: 1.4-19.8; p = 0.021), consuming <3 commercial sweets/week (OR = 10.1; IC: 5.1-19.7; p < 0.001), and consuming ≥3 fruits/day (OR = 8.8; CI: 4.9-15.7; p < 0.001) were the items most associated with high adherence to the MD. In conclusion, a high level of adherence to the MD is associated with high-level muscular fitness and CRF in Spanish university students.

Mediterranean Diet, Physical Fitness and Body Composition in Sevillian Adolescents: A Healthy Lifestyle

Childhood and adolescent obesity has become one of the most vital challenges to overcome in the present age. Physical fitness, physical activity and the Mediterranean diet (MD) are valuable tools for its prevention and treatment. The main objective of this study is to analyze the associations between health-related physical fitness components, body composition and adherence to the MD in 917 adolescents aged from 13- to 16-years-old. The ALPHA-Fitness Test was used to measure physical fitness and body composition, and the Adherence to the Mediterranean Diet (KIDMED) questionnaire was employed to assess the adherence to the MD. The associations between variables were tested according to gender and age a generalized linear model (GLM) univariate analysis (two factors) and one-way analysis of variance (ANOVA, with Bonferroni posthoc). As to the body composition and physical fitness variables, significant differences were obtained in both genders but not in relation to the adherence to the MD. The boys performed better in the physical fitness tests. Age was a determinant factor in adherence to the MD in the total sample, lowering as the age of the sample increases. Both the boys and girls who had a significantly higher performance in the endurance test were those who showed high/medium adherence to the MD. It is concluded that higher levels of cardiovascular endurance in boys and girls are associated with a medium and high adherence to the MD.

Healthy Lifestyle: Relationship between Mediterranean Diet, Body Composition and Physical Fitness in 13 to 16-Years Old Icelandic Students

Childhood and adolescent obesity are currently among the greatest challenges for public health. Physical activity, physical fitness, and adherence to the Mediterranean diet (MD), representing powerful indicators of healthy lifestyles, are shown as determinant factors in the prevention and treatment of obesity. The aim of the present study has been to analyse the relationship between health-related physical fitness components, body composition, and adherence to MD in 387 Icelandic adolescents of 13⁻16-years old (54% boys). The ALPHA Fitness Test was used to measure physical fitness and body composition. The KIDMED questionnaire was used to assess the adherence to MD among participants. Associations between variables were tested according to gender and age using linear regression models and analysis of variance. Participants with high/medium adherence to MD showed significantly higher endurance scores in both the boys and the girls. Gender differences were found. The boys in high/medium MD categories had significantly lower fat percentages and ran a 4 × 10 m sprint faster than the girls. The girls scored higher than the boys in endurance and speed-agility tests. It can be concluded that a high and medium adherence to MD is associated with high and very high endurance in both the girls and the boys.