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Viana RS, Nascimento-Ferreira MV, Schaan BD, Bloch KV, de Carvalho KMB, Cureau FV, De Moraes ACF. Prevalence of the Double Burden of Malnutrition among Adolescents: Associations with Lifestyle Behaviors and Clusters of Social Determinants. CHILDREN (BASEL, SWITZERLAND) 2024; 11:620. [PMID: 38929200 PMCID: PMC11201642 DOI: 10.3390/children11060620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 06/28/2024]
Abstract
The double burden of malnutrition (DBM) is a condition in which malnutrition coexists with overweight, reflecting a new layer of malnutrition. Our objectives were to assess prevalence; test associations between DBM and 24-hour movement behaviors; and investigate whether DBM is associated with clusters of social determinants. Methods: This multicenter cross-sectional study included 1152 adolescents (12 to 17 years old) from four Brazilian cities. Body mass index (BMI, kg/m2) was used to estimate overweight, and the adopted cutoff points took into account the curves established for age and sex: Z-score > 1 and ≤2 (overweight) and Z-score > 2 (obesity). The serum concentration of 25-hydroxyvitamin D [25(OH)D] was stratified into three levels: vitamin D deficiency ≤ 20 ng/mL; vitamin D insufficiency = 21-29 ng/mL; optimal vitamin D ≥ 30 ng/mL. We used multilevel Poisson regression models to estimate prevalence ratios (PRs) and their respective 95% confidence intervals (95%CI) and to analyze the association between DBM and covariates. A significance level of p < 0.05 was considered. Cluster analyses were performed by applying a combination of hierarchical and non-hierarchical methods. Results: A population prevalence of DBM of 7.3% (95% CI: 5.9-8.9) was revealed. A percentage of 19.2% (95% CI: 17.0-21.6) of adolescents were overweight, and 8.3% (95% CI: 6.8-10.1) were obese. A total of 41.5% (95% CI: 38.7-44.4) had vitamin D deficiency, and 25.8% (95% CI: 23.4-28.4) had vitamin D insufficiency. However, 24-hour movement behaviors were not associated with DBM. Adolescents living in the southern region of the country, from public schools whose mothers have higher education, have a 1.94 [PR = 2.94 (95% CI: 1.20-7.23)] times greater chance of developing DBM. These results highlight the importance of specific factors to improve the nutritional health of adolescents, considering the specific social determinants identified in this study.
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Affiliation(s)
- Raytta Silva Viana
- Postgraduate Program in Public Health, Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil;
- YCARE Research Group (Youth/Child Cardiovascular Risk Environmental Research Group), Faculdade de Medicina, University of São Paulo, São Paulo 01246-903, Brazil
| | - Marcus Vinicius Nascimento-Ferreira
- YCARE Research Group (Youth/Child Cardiovascular Risk Environmental Research Group), Faculdade de Medicina, University of São Paulo, São Paulo 01246-903, Brazil
- Research Group on Health, Physical Activity and Behavior (HEALTHY-BRA), Federal University of Tocantins, Miracema do Tocantins 77650-000, Brazil
| | - Beatriz D. Schaan
- Faculty of Medicine, Postgraduate Program in Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre 90035-003, Brazil
- Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, Brazil
- Faculty of Medicine, Postgraduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035003, Brazil
| | - Katia Vergetti Bloch
- Institute of Studies in Public Health, Federal University of Rio de Janeiro, Rio de Janeiro 21941-592, Brazil
| | | | - Felipe Vogt Cureau
- Faculty of Medicine, Postgraduate Program in Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre 90035-003, Brazil
| | - Augusto César Ferreira De Moraes
- The University of Texas Health Science Center at Houston, School of Public Health in Austin, Department of Epidemiology, Michael & Susan Dell Center for Healthy Living, Texas Physical Activity Research Collaborative (Texas PARC) 1836 San Jacinto Blvd., Ste. 510, Austin, TX 78701, USA
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Melo G, Aguilar-Farias N, López Barrera E, Chomalí L, Moz-Christofoletti MA, Salgado JC, Swensson LJ, Caro JC. Structural responses to the obesity epidemic in Latin America: what are the next steps for food and physical activity policies? LANCET REGIONAL HEALTH. AMERICAS 2023; 21:100486. [PMID: 37096192 PMCID: PMC10122054 DOI: 10.1016/j.lana.2023.100486] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 02/12/2023] [Accepted: 03/20/2023] [Indexed: 04/26/2023]
Abstract
Obesity is among the most complex public health challenges, particularly in Latin America, where obesity rates have increased faster than in any other region. Many countries have proposed or enacted comprehensive policies to promote adequate diet and physical activity under a structural framework. We summarize articles discussing the scope and impact of recently implemented obesity-related interventions in the light of a structural response framework. Overall, we find that: (1) market-based food interventions, including taxes on junk food, nutrition labelling, and marketing restrictions, decrease the consumption of targeted foods, (2) programs directly providing healthy foods are effective in reducing obesity, and (3) the construction of public areas for recreation increases the average frequency of physical activity. Although obesity-related interventions in the region have somewhat improved health behaviours, obesity prevalence remains on an upward trend. We discuss some opportunities to continue tackling the obesity epidemic in LATAM under a structural framework.
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Affiliation(s)
- Grace Melo
- Accountability, Climate, Equity, and Scholarship (ACES), Department of Agricultural Economics, Texas A&M, College Station, TX, USA
| | - Nicolas Aguilar-Farias
- Department of Physical Education, Sports and Recreation, Universidad de la Frontera, Chile
| | | | | | | | - Juan Carlos Salgado
- Center for Nutrition and Health Research, National Institute of Public Health and National Council for Science and Technology, Mexico
| | - Luana Joppert Swensson
- Policy and Legal Specialist for Sustainable Public Procurement, Food and Agriculture Organization, Italy
| | - Juan Carlos Caro
- Department of Industrial Engineering, University of Concepción, Chile
- Corresponding author. Department of Industrial Engineering, University of Concepción, Chile, Edmundo Larenas 219, Concepción, Chile.
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Sales D, da Silva Junior JP, Bergamo RR, de Oliveira LC, Ferrari G, Matsudo V. Association between school environment with sedentary behavior and physical activity intensity in children. Sci Rep 2023; 13:6995. [PMID: 37117328 PMCID: PMC10147915 DOI: 10.1038/s41598-023-33732-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 04/18/2023] [Indexed: 04/30/2023] Open
Abstract
We examined the association between indicators of the school environment with sedentary behavior and different intensities of physical activity in children. The study that included 515 children (265 boys) aged 9-11 years old from public and private schools in the city of São Caetano do Sul. Sedentary behavior and different intensities of physical activity were evaluated with an accelerometer. Inside school environment (policies, supervision committee, extracurricular activities, breaks, and access to school facilities) was evaluated using a questionnaire. Policies and practice (β: 8.49; 95% CI: 3.62-13.36), supervision committee (5.42; 0.64-10.19), inter-school competitions (2.40, 2.25-2.55), breaks of 15-29 min/day (6.87; 2.20-10.75), and outdoor sports field (5.40; 0.37-10.44), were positively associated with moderate-to-vigorous-intensity physical activity. Furthermore, crossing guards (7.65; 3.00-12.30) were positively associated with moderate-to-vigorous-intensity physical activity. We concluded that an association was found between school environment indicators with higher levels of physical activity and greater odds of meeting physical activity guidelines.
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Affiliation(s)
- Diego Sales
- Study Center of the Physical Fitness Laboratory of São Caetano Do Sul (CELAFISCS), Rua Santo Antonio, 50 - 5º andar - salas 504/505 - Centro, São Caetano Do Sul, SP, Brazil.
| | - João Pedro da Silva Junior
- Study Center of the Physical Fitness Laboratory of São Caetano Do Sul (CELAFISCS), Rua Santo Antonio, 50 - 5º andar - salas 504/505 - Centro, São Caetano Do Sul, SP, Brazil
| | - Raiany Rosa Bergamo
- Study Center of the Physical Fitness Laboratory of São Caetano Do Sul (CELAFISCS), Rua Santo Antonio, 50 - 5º andar - salas 504/505 - Centro, São Caetano Do Sul, SP, Brazil
| | - Luis Carlos de Oliveira
- Study Center of the Physical Fitness Laboratory of São Caetano Do Sul (CELAFISCS), Rua Santo Antonio, 50 - 5º andar - salas 504/505 - Centro, São Caetano Do Sul, SP, Brazil
| | - Gerson Ferrari
- Escuela de Ciencias de La Actividad Física, el Deporte Y La Salud, Universidad de Santiago de Chile, Santiago, Chile
- Facultad de Ciencias de La Salud, Universidad Autónoma de Chile, Providencia, Chile
| | - Victor Matsudo
- Study Center of the Physical Fitness Laboratory of São Caetano Do Sul (CELAFISCS), Rua Santo Antonio, 50 - 5º andar - salas 504/505 - Centro, São Caetano Do Sul, SP, Brazil
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Lima LRAD, Menezes EC, Tenório TRDS, Mendonça BCDA, Rodrigues NA, Victo ERD, Estrada-Saldaña E, Stingl-Zúñiga I, Zúñiga-Silví J, Ferrari G. Flexibility of Brazilian children and adolescents: a systematic review of the literature. REVISTA BRASILEIRA DE CINEANTROPOMETRIA E DESEMPENHO HUMANO 2022. [DOI: 10.1590/1980-0037.2022v24e87232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
abstract Flexibility is related to specific tissue properties of the body, which aim to determine the maximum range of motion of the joints without injury. This study aimed to identify and summarize the evidence on prevalence of adequate levels of flexibility in Brazilian children and adolescents (6 to 19 years old). We performed a systematic search of studies published from 2009 to 2019 in six databases (MEDLINE/PubMed; Scopus; SportDiscus; LILACS; Web of Science; SCIELO). Fourteen studies that compiled data from 11,666 participants in seven different Brazilian states were included. All studies conducted sit and reach tests to assess flexibility. Among all the children and adolescents in the analyzed studies, 58.9% of the total (62.0% of boys and 50.9% of girls) had adequate flexibility. We conclude that more than half of Brazilian children and adolescents have adequate flexibility for health.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Gerson Ferrari
- Universidad de Santiago de Chile, Chile; Universidad Católica del Maule, Chile
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How physical activity, diet, and sedentary behavior cluster according to age in adolescents? SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-021-00830-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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School environment and physical activity in adolescents from São Paulo city. Sci Rep 2021; 11:18118. [PMID: 34518611 PMCID: PMC8438037 DOI: 10.1038/s41598-021-97671-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/23/2021] [Indexed: 11/08/2022] Open
Abstract
We examined the association of physical activity (PA) facilities and access to school with total PA and domain-specific PA in adolescents. We enrolled 2610 adolescents (mean: 14.9 years) from Sao Paulo city. The number and presence of sports courts, swimming pools, locker rooms, running/athletics tracks, entrance accessible for student cyclists, bike racks, speed limit signal around the school, and pedestrian crossing were assessed in each school. All participants responded to a questionnaire about frequency and duration of physical education classes, leisure time, and active commuting. Total PA was obtained by adding up all PA domains. Presence of three or more (OR: 1.62; 95% CI: 1.15 to 2.30) sports courts, swimming pool available in usable conditions (OR: 1.45; 95% CI: 1.01 to 2.10), running/athletics tracks (OR: 2.35; 95% CI: 1.07 to 5.18), and bike racks (OR: 1.38; 95% CI: 1.07 to 1.78) were positively associated with total PA. Number of sports courts, swimming pool available in usable conditions, speed limit signals around the school, and pedestrian crossings were positively associated with physical education classes. The bike racks, speed limit signs around the school, and pedestrian crossings were positively associated with active commuting. School environment was associated with increased PA. Our findings should be considered in future epidemiologic studies and for educational and health policy makers.
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Mathur P, Kulothungan V, Leburu S, Krishnan A, Chaturvedi HK, Salve HR, Amarchand R, Nongkynrih B, Ganeshkumar P, Urs K S V, Laxmaiah A, Boruah M, Kumar S, Patro BK, Raghav PR, Rajkumar P, Sarma PS, Sharma R, Tambe M, Arlappa N, Mahanta TG, Bhuyan PJ, Joshi RP, Pakhare A, Galhotra A, Kumar D, Behera BK, Topno RK, Gupta MK, Rustagi N, Trivedi AV, Thankappan KR, Gupta S, Garg S, Shelke SC. Baseline risk factor prevalence among adolescents aged 15-17 years old: findings from National Non-communicable Disease Monitoring Survey (NNMS) of India. BMJ Open 2021; 11:e044066. [PMID: 34187814 PMCID: PMC8245441 DOI: 10.1136/bmjopen-2020-044066] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To generate national estimates of key non-communicable disease (NCD) risk factors for adolescents (15-17 years) identified in the National NCD Monitoring Framework and, study the knowledge, attitudes and practices towards NCD risk behaviours among school-going adolescents. DESIGN AND SETTING A community-based, national, cross-sectional survey conducted during 2017-2018. The survey was coordinated by the Indian Council of Medical Research-National Centre for Disease Informatics and Research with 10 reputed implementing research institutes/organisations across India in urban and rural areas. PARTICIPANTS A multistage sampling design was adopted covering ages between 15 and 69 years-adolescents (15-17 years) and adults (18-69 years). The sample included 12 000 households drawn from 600 primary sampling units. All available adolescents (15-17 years) from the selected households were included in the survey. MAIN OUTCOME MEASURES Key NCD risk factors for adolescents (15-17 years)-current tobacco and alcohol use, dietary behaviours, insufficient physical activity, overweight and obesity. RESULTS Overall, 1402 households and 1531 adolescents completed the survey. Prevalence of current daily use of tobacco was 3.1% (95% CI: 2.0% to 4.7%), 25.2% (95% CI: 22.2% to 28.5%) adolescents showed insufficient levels of physical activity, 6.2% (95% CI: 4.9% to 7.9%) were overweight and 1.8% (95% CI: 1.0% to 2.9%) were obese. Two-thirds reported being imparted health education on NCD risk factors in their schools/colleges. CONCLUSION The survey provides baseline data on NCD-related key risk factors among 15-17 years in India. These national-level data fill information gaps for this age group and help assess India's progress towards NCD targets set for 2025 comprehensively. Though the prevalence of select risk factors is much lower than in many developed countries, this study offers national evidence for revisiting and framing appropriate policies, strategies for prevention and control of NCDs in younger age groups.
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Affiliation(s)
- Prashant Mathur
- National Centre for Disease Informatics and Research, Bangalore, Karnataka, India
| | | | - Sravya Leburu
- National Centre for Disease Informatics and Research, Bangalore, Karnataka, India
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Harshal Ramesh Salve
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Ritvik Amarchand
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Baridalyne Nongkynrih
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Vinay Urs K S
- National Centre for Disease Informatics and Research, Bangalore, Karnataka, India
| | - A Laxmaiah
- Division of Public Health Nutrition, National Institute of Nutrition, Hyderabad, Telangana, India
| | - Manjit Boruah
- Department of Community Medicine, Assam Medical College and Hospital, Dibrugarh, Assam, India
| | - Sanjeev Kumar
- Department of Community and Family Medicine, All India Institute of Medical Sciences-Bhopal, Bhopal, Madhya Pradesh, India
| | - Binod Kumar Patro
- Department of Community and Family Medicine, All India Institute of Medical Sciences-Bhubaneswar, Bhubaneswar, Orissa, India
| | - Pankaja Ravi Raghav
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India
| | - Prabu Rajkumar
- Division of Health Systems Research, National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - P Sankara Sarma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Rinku Sharma
- Centre for Non-communicable Diseases, National Centre for Disease Control, New Delhi, Delhi, India
| | - Muralidhar Tambe
- Department of Community Medicine, BJ Government Medical College and Sasoon General Hospitals, Pune, Maharashtra, India
| | - N Arlappa
- Division of Public Health Nutrition, National Institute of Nutrition, Hyderabad, Telangana, India
| | - Tulika Goswami Mahanta
- Department of Community Medicine/Prevention and Social Medicine, Tezpur Medical College, Tezpur, Assam, India
| | - Pranab Jyoti Bhuyan
- Regional Director Office, Ministry of Health and Family Welfare, Guwahati, Assam, India
| | - Rajnish P Joshi
- Department of General Medicine, All India Institute of Medical Sciences-Bhopal, Bhopal, India
| | - Abhijit Pakhare
- Department of Community and Family Medicine, All India Institute of Medical Sciences-Bhopal, Bhopal, Madhya Pradesh, India
| | - Abhiruchi Galhotra
- Department of Community and Family Medicine, All India Institute of Medical Sciences-Raipur, Raipur, Chhattisgarh, India
| | - Dewesh Kumar
- Department of Preventive and Social Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Binod Kumar Behera
- Department of Community and Family Medicine, All India Institute of Medical Sciences-Bhubaneswar, Bhubaneswar, Orissa, India
| | - Roshan K Topno
- Department of Epidemiology, Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| | - Manoj Kumar Gupta
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India
| | - Neeti Rustagi
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India
| | - Atulkumar V Trivedi
- Department of Community Medicine, Government Medical College Bhavnagar, Bhavnagar, Gujarat, India
| | - K R Thankappan
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod Town, Kerala, India
| | - Sonia Gupta
- Centre for Non-communicable Diseases, National Centre for Disease Control, New Delhi, Delhi, India
| | - Suneela Garg
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Sangita Chandrakant Shelke
- Department of Community Medicine, BJ Government Medical College and Sasoon General Hospitals, Pune, Maharashtra, India
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Figueiredo TKF, Aguiar RGD, Florindo AA, Alves MCGP, Barros MBDA, Goldbaum M, Ferrari G, Fisberg RM, Cesar CLG. Changes in total physical activity, leisure and commuting in the largest city in Latin America, 2003-2015. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210030. [PMID: 34076092 DOI: 10.1590/1980-549720210030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/22/2021] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To analyze the prevalence of physical inactivity and the average time of practice of total physical activity and by domains (leisure and commuting), according to gender, age group and schooling, between 2003 and 2015, in residents of the urban area of the city of São Paulo. METHODS Data from Household Health Surveys in the Municipality of São Paulo (2003: n = 2,514; 2015: n = 4,043). The International Physical Activity Questionnaire was used to measure total, leisure, and commuting physical activity. Results were presented in < 10 minute/week periods, physical inactivity and minutes/week, according to evaluation period, sex, age and schooling. RESULTS Prevalence of < 10 minutes/week periods in 2003 and 2015 were: 22.5 and 28.9% for the total; 56.7 and 58.3% for leisure; and 35.2 and 39.9% for commuting, with significant change only in the total item, among adolescents (10.3 to 18.8%). For physical inactivity, prevalence rates were: 54.9 and 61.6% (total); 78.2 and 78.9% (leisure); and 72 and 79.9% (commuting), with significant changes only for commuting among adults (67.8 to 77.4%). For the average in minutes per week, in total, there was a significant decrease for female adolescents (138.2 minute/week) and adults with 0-8 (122.6 minutes/week) and 9-11 years (96.7 minutes/week) years of schooling; in commuting, there was a reduction for female adolescents (95 minutes/week); and male adults (95 minutes/week) and female adults (82 minutes/week). CONCLUSIONS There were no reductions in the prevalence of < 10 min/week periods or leisure physical inactivity. Commuting physical inactivity has become even more common.
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Affiliation(s)
| | | | - Alex Antonio Florindo
- School of Arts, Sciences and Humanities, Universidade de São Paulo - São Paulo (SP), Brazil
| | | | | | - Moisés Goldbaum
- Medical School, Universidade de São Paulo - São Paulo (SP), Brazil
| | - Gerson Ferrari
- Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile - Santiago, Chile
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