Physical activity patterns in a representative sample of adolescents from the largest city in Latin America: a cross-sectional study in Sao Paulo

Prevalence of the Double Burden of Malnutrition among Adolescents: Associations with Lifestyle Behaviors and Clusters of Social Determinants

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.

Structural responses to the obesity epidemic in Latin America: what are the next steps for food and physical activity policies?

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.

Association between school environment with sedentary behavior and physical activity intensity in children

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.

Flexibility of Brazilian children and adolescents: a systematic review of the literature

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.

School environment and physical activity in adolescents from São Paulo city

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.

Baseline risk factor prevalence among adolescents aged 15-17 years old: findings from National Non-communicable Disease Monitoring Survey (NNMS) of India

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.

Changes in total physical activity, leisure and commuting in the largest city in Latin America, 2003-2015

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.