Validation of the Netherlands physical activity questionnaire in Brazilian children

Child, family and household characteristics associated with physical activity in Samoan children aged 3-8 years: A cross-sectional study

Physical activity is a key component of many obesity prevention strategies. The aim of this analysis was to identify child, family, and household characteristics associated with parent-reported physical activity in Samoan children aged 3-8 years. Children (n = 445; 51.2% female, mean age 5.4 years) were part of an ongoing, mixed-longitudinal study of child growth, development, and wellbeing (the Ola Tuputupua'e cohort). Bivariate analyses and multivariate generalized linear regressions were conducted to investigate the relationship of child, family, and household characteristics with physical activity level, measured using the Netherlands Physical Activity Questionnaire (NPAQ). Children were classified as being 'highly active' if they had NPAQ scores in the 75th percentile or above. Among the n = 111 children classified as 'highly active', n = 67 (60.4%) were boys. After adjusting for child, family, and household-level characteristics, hours of child sleep per night was the only variable significantly associated with odds of being highly active. Compared to children who slept less than 9 hours at night, those who slept 10-10.99 hours (OR: 5.97, 95% CI: 2.14-18.13) and 11+ hours (OR: 25.75, 95% CI: 8.14-90.12) had higher odds of being 'highly active'. Future research should examine the mechanisms driving the relationship between nighttime sleep and physical activity among Samoan children. Intervening on sleep duration and quality may improve physical activity and, in turn, obesity risk in this setting.

Heart rate variability in school-age children born moderate-to-late preterm

BACKGROUND

Prematurity is associated with reduced cardiac autonomic function. This study aimed to investigate the heart rate variability (HRV) in school-age children born moderately to late preterm (MLPT).

METHODS

This cross-sectional study investigated school-age children, aged 5 to 10 years, born moderate-to-late preterm. Electrocardiograms recordings were performed during fifteen-minutes. Time and frequency domain parameters were calculated, corrected for heart rate and compared between the groups.

RESULTS

A total of 123 children were evaluated and 119 were included in this study. HRV measures, studied in the time and frequency domains, were similar in both groups. Corrected values of root mean square of successive differences between normal cycles (RMSSD), percentage of successive cycles with a duration difference >50 ms (pNN50%), and high frequency (HF), indices that predominantly represent the parasympathetic activity of the autonomic nervous system, were 1.6E-7 and 1.8E-7 (p=0.226); 1.6E-13 and 1.6E-13 (p=0.506); 6.9E-12 and 7.4E-12 (p=0.968) in the preterm and control groups, respectively.

CONCLUSION

This study did not find differences in heart rate variability between school-age children born MLPT and those born at term, suggesting that plasticity of cardiac autonomic modulation continues to occur in children up to school age or there is less impairment of the autonomic system in MLPT.

Prospective Teachers' Knowledge of Physical Activity in Children and Adolescents

Over the past few years, organizations around the world have tried to reach different populations with recommendations about physical activity (PA), due to this subject playing an important role in the phases of intention development and in preparation for it. Thus, the knowledge of future educators in the fields of health and PA is of vital importance when improving the levels of the latter in students. The objective of this research is to determine what knowledge future teachers have about health and PA, examining possible disparities according to the gender, age, and level of physical exercise of the participants. In addition, the psychometric properties of the instrument used were explored. A total of 321 Colombian university students from the Faculty of Education between the ages of sixteen and thirty-five participated in this study, providing sociodemographic information by filling out the CUAFYS-A questionnaire. Significant differences were found in the scale items according to sex and self-perception of being physically active. Also, the findings revealed a single-factor structure with nine items that had satisfactory reliability (α = 0.71; CR = 0.72) and excellent goodness-of-fit indices (RMSEA = 0.055 (90% CI (0.3, 0.8), RMSR = 0.02, CFI = 0.935, NNFI = 0.912, CMIN/DF = 1.97). Therefore, strategies and campaigns to promote PA knowledge in prospective teachers should be tailored according to gender and PA levels. Similarly, the CUAFYS-A questionnaire can be considered a valid and reliable instrument to identify the PA knowledge of future educators.

Is overweight or obesity associated with anemia in children? Follow-up of Samoans in the Ola Tuputupua'e "Growing Up" study

OBJECTIVES

Globally, there is growing evidence of a double burden of malnutrition with obesity coexisting alongside micronutrient deficiencies across the life course. An emergent double burden poses a threat to health during childhood in Samoa: among 2-4-year-olds with overweight/obesity, 42.9% were anemic. Previous research suggests that obesity-related inflammation may increase the risk of iron deficiency or anemia in children. To test this hypothesis, we examined whether overweight/obesity at 2-4 is associated with anemia at 3.8-6 years old among Samoan children.

METHODS

Data were obtained from the Ola Tuputupua'e "Growing Up" cohort study. Overweight/obesity at 2-4 years old was classified by body mass index-for-age Z-score > +2 SD. Anemia was defined as hemoglobin < 110 g/L for under 5-year-olds and < 115 g/L for 5-6-year-olds. Prevalence ratios (PRs) for anemia at 3.8-6 years old were estimated by fitting modified Poisson regression models.

RESULTS

In our sample of 197 children, 16.24% (n = 32) were affected by overweight/obesity at 2-4 years old and 26.90% (n = 53) had anemia at 3.8-6 years old. After covariate adjustment, the prevalence of anemia was 18% lower among children with overweight/obesity at 2-4 years old compared to those without (PR:0.82; 95% CI:0.42-1.63); however, the corresponding confidence interval was imprecise and inclusive of a higher prevalence.

CONCLUSIONS

There was not strong evidence to support a relationship between overweight/obesity and anemia in Samoan children, suggesting that obesity-related inflammation may not be related to iron deficiency nor anemia in this setting. Further investigation of the antecedents of overweight/obesity and anemia is critical to inform integrated action to improve health in Samoa.

Can a Multicomponent-Overnight Camp Increase Physical Activity Among Danish Children? A Retrospective Cross-Sectional Study

BACKGROUND

In Denmark, most children are not sufficiently physically active and only a few interventions have been found to increase long-term physical activity among overweight and obese children. The aim of our study was to investigate if children are physically active in correspondence to Danish recommendations after attending a multicomponent-overnight camp.

METHODS

A questionnaire was developed to estimate children's physical activity level and behavior and investigate how transport, economy, availability, time, motivation, and knowledge about physical activity affect children's physical activity level and behavior.

RESULTS

In this study, 60.9% of the children did vigorous physical activity (VPA) minimum 30 minutes 3 times per week up to 3 years after camp. Most children were physically active at a sports club (44.3%) and only 5.7% of the children did not participate in physical activity. Parental physical activity and child motivation toward physical activity were significantly (P < .05) associated with children doing VPA.

CONCLUSION

Our findings suggest that 60.9% of children who attended camp engage in VPA after camp, which compared with a recent Danish study, is more frequent than children who did not attend camp. Further investigations are needed to determine the long-term health effects in children attending interventions such as multicomponent-overnight camps.

Comparability of The Netherlands Physical Activity Questionnaire with Accelerometer-Measured Physical Activity in Samoan Children: A Retrospective Analysis of Ola Tuputupua'e Data

Accurate measurement of physical activity is critical to understand its role in cardiometabolic health and obesity development in children and to monitor trends in behavior and evaluate interventions. An ongoing mixed-longitudinal study of child growth and development in Samoa is collecting physical activity data with both accelerometers and the Netherlands Physical Activity Questionnaire (NPAQ). The aims of our analyses were to (1) describe the response frequency and correlations of individual questions in the NPAQ, (2) develop modified NPAQ scores with selected questions and (3) examine the concordance of modified NPAQ scores with accelerometer outcomes among children aged 2-4 years. We developed two modified NPAQ scores with combinations of questions and assessed concordance of the modified scores with accelerometer data using estimated marginal means adjusted for monitor wear time. Although the evenly distributed tertiles of the modified 15-point NPAQ score showed promising trends of increasing minutes of accelerometer-assessed high-intensity physical activity with increasing tertile, the estimated marginal means were imprecise with high variance, demonstrating that NPAQ score could not accurately assess physical activity levels of preschool-aged children in Samoa. Considering that questionnaires are often considered more cost-effective tools for physical activity measurement than accelerometry, further research is necessary to develop a culturally and age-appropriate physical activity questionnaire in this population.

Validation of a Physical Activity and Health Questionnaire Evaluating Knowledge of WHO Recommendations among Colombians

Knowledge of physical activity (PA) can be considered a predictor of public health for society. Thus, this study aims to show content validity of the "Knowledge Questionnaire on World Health Organization (WHO) Recommendations on PA and Health" (CUAFYS-A) and reference values on adults' knowledge of the WHO recommendations on PA. This is a quantitative, non-experimental, descriptive, and cross-sectional study, in which 579 adults completed an online questionnaire with demographic data. The questionnaire was made up of 9 items to measure PA related to knowledge. For the elaboration of the items of the questionnaire a disciplinary team formed it and for the analysis of results, a descriptive analysis of these was applied. Then an inferential analysis was performed, content validity, construct validity, and reliability were analyzed. The CUAFYS-A after its content analysis, obtained appropriate results in terms of pertinence and relevance; additionally, it showed Cronbach's alpha coefficient of 0.62. Thereby, it was concluded the CUAFYS-A questionnaire proved to be a valid and reliable instrument to show reference values and to evaluate the knowledge of adults of PA and health according to the WHO recommendations.

Role of ultra-processed food in fat mass index between 6 and 11 years of age: a cohort study

BACKGROUND

Ultra-processed food consumption and obesity have been highlighted as an important relationship to public health. We aimed to evaluate the association between ultra-processed food consumption and body fat from 6 to 11 years of age.

METHODS

We assessed the association between ultra-processed food consumption (from food frequency questionnaires) and body fat (measured by air displacement plethysmography) between 6 and 11 years of age among participants of the Pelotas-Brazil 2004 Birth Cohort. The NOVA classification was used to classify foods according to the processing degree. Body fat was evaluated relative to the height using fat mass index (FMI). Generalized estimating equations were used to answer the main research question and mediation analyses were run to assess the direct and indirect effect of ultra-processed food in body fat.

RESULTS

At fully adjusted analysis, an increase of 100 g in contribution from ultra-processed food to daily food intake at between 6 and 11 years of age was associated with a gain of 0.14 kg/m² in FMI in the same period; 58% of the total effect of ultra-processed food intake at 6 years (in grams) over the change in FMI from 6 to 11 years was mediated by its calorie content.

CONCLUSIONS

Ultra-processed food consumption was associated with an increase in body fat from childhood to early adolescence, and this association was not just due to the effect of ultra-processed food on calorie content.

Longitudinal Assessment of Childhood Dietary Patterns: Associations with Body Mass Index z-Score among Children in the Samoan Ola Tuputupua'e (Growing Up) Cohort

Background: Intervention strategies to prevent childhood obesity in the Pacific Islands encourage eating a variety of local and traditional foods, but context-specific data to support this approach are limited. The objective was to assess the association between 2-year adherence to modern and neotraditional dietary patterns and body mass index z-scores (BMIz) among Samoan children. Methods: A convenience sample of 214 Samoan biological mother-child dyads who participated in the Ola Tuputupua'e "Growing Up" cohort study in 2015 and 2017 was included. At each time point, modern and neotraditional dietary patterns were identified using food frequency data and factor analysis. Children were assigned to categories based on diet pattern adherence: consistently high, high to low, low to high, and consistently low. Associations between 2-year adherence to dietary patterns, BMIz (in 2017 and 2015-2017), and weight and height z-scores were examined using linear models adjusted for potential confounders. Results: Consistently high adherence to the modern pattern was associated with a 0.36 standard deviation (SD)-adjusted change in BMIz between 2015 and 2017 (95% confidence interval [CI]: 0.04-0.69, p = 0.03). While the estimates for the individual components of BMI were imprecise, on average, children with consistently high adherence to the modern pattern had a 0.13 SD greater change in weight z-score (95% CI: -0.10 to 0.37) and 0.15 SD lower change in height z-score (95% CI: -0.43 to 0.13). The change in BMIz between 2015 and 2017 did not significantly differ by adherence to the neotraditional pattern. Conclusion: A neotraditional dietary pattern, comprising local produce, should be encouraged as a possible childhood obesity prevention strategy in Samoa.

Critical evaluation of physical activity questionnaires translated to Brazilian-Portuguese: a systematic review on cross-cultural adaptation and measurements properties

BACKGROUND

The number of questionnaires that measures physical activity levels has increased considerably. For Brazilian population it becomes a challenge, due to the need of a rigorous translation, adaptation and testing of measurement properties.

OBJECTIVE

Evaluate the methodological quality and criteria of physical activity questionnaires translated to Brazilian-Portuguese.

METHODS

Methodological quality and quality criteria was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments checklist.

RESULTS

Sixty-nine studies were included, the most frequent questionnaires investigated were the International Physical Activity Questionnaire (n=16) and the Baecke Physical Activity Questionnaire (n=12). Translation (n=13), reliability (n=37) and construct validity (n=44) were the measurement properties commonly investigated. For reliability, most studies were rated as 'adequate' for methodological quality. The Intraclass Correlation Coefficient of the questionnaires ranged from 0.20 to 1.0. For construct validity, 31 analyses showed 'inadequate' methodological quality, due to poor description of the comparator instrument. High level of evidence on reliability were found for Baecke Physical Activity Questionnaire, Self-administered Physical Activity Checklist and Physical Activity Questionnaire of the Surveillance System of Risk Factors and Protection for Chronic Diseases; on construct validity for Self-administered Physical Activity Checklist, Physical activity Questionnaire for Adolescents, Physical activity Questionnaire for Older Children and Saúde naBoa Questionnaire.

CONCLUSION

Most questionnaires showed poor methodological quality and measurement properties. The Baecke Physical Activity Questionnaire and Self-administred Physical Activity Checklist showed better scorings for methodological quality and quality criteria. Further high methodological quality studies are still warranted.

Ultra-processed food consumption during childhood and asthma in adolescence: Data from the 2004 Pelotas birth cohort study

BACKGROUND

Diet has been of interest for asthma; however, it remains unknown whether the consumption of ultra-processed food (UPF) increases the risk of the disease. Our objective was to investigate whether UPF consumption during childhood was associated with wheeze, asthma, and severe asthma in adolescence.

METHODS

We included 2190 11-year-old children from the 2004 Pelotas Birth Cohort Study, without asthma at the age of 6 years. Consumption of UPF was assessed by Food Frequency Questionnaires at 6- and 11-year follow-ups. Wheeze, asthma, and severe asthma data were assessed at 11-year follow-up. We classified foods according to the processing degree in ultra-processed food. We used logistic regression to estimate the odds ratio (OR) and 95% confidence intervals (CIs), for the association between UPF consumption and the asthma outcomes.

RESULTS

Cumulative incidence of wheeze and asthma between 6 and 11 years was 12.7% and 23.2%, respectively. In prospective analyses, comparing children in the highest and the lowest quintile of UPF consumption at age 6, we found no association with wheeze (OR = 0.85; 95% CI = 0.54-1.34), asthma (OR = 0.84; 95% CI = 0.58-1.21), or severe asthma (OR = 1.12; 95% CI = 0.62-2.03) in early adolescence. In cross-sectional analyses, comparing adolescents in the highest and lowest quintile of UPF consumption at 11 years, we found no association with wheeze (OR = 1.12; 95% CI = 0.72-1.75), asthma (OR = 1.00; 95% CI = 0.7-1.44), or severe asthma (OR = 1.05; 95% CI = 0.59-1.86).

CONCLUSION

Our study provided evidence that UPF consumption during childhood or adolescence is not associated with asthma or wheeze among adolescents.

Assessment of physical activity intensity and duration in the paediatric population: evidence to support an a priori hypothesis and sample size in the agreement between subjective and objective methods

We aimed to provide evidence for an a priori hypothesis and sample size for subjectively assessing physical activity intensity and duration in paediatric population, adopting objective methods as the reference. We searched electronic databases, reference lists and author databases. Correlation coefficients were pooled as an indicator of agreement estimates. We found 183 agreement analyses (94.5% based on correlation coefficients) from 89 studies that met our inclusion criteria. We identified four physical activity parameters addressing intensity and two parameters addressing duration. The physical activity parameters focusing on intensity were measured only by questionnaires, and the best correlation was achieved by moderate-to-vigorous physical activity compared with a heart rate monitor. In addition, total physical activity duration had a stronger correlation with an accelerometer when measured by diaries or logs than when measured by questionnaires. In both cases, the correlation was moderate. Studies with sample sizes between 50 and 99 subjects showed measurements that were stable in both magnitude and interpretation. Our findings suggest that the agreement between subjective and objective methods for assessing physical activity intensity and duration is weak to moderate. Furthermore, sample sizes ranging from 50 to 99 subjects provide stable agreement estimates between methods.

Are consumption of dairy products and physical activity independently related to bone mineral density of 6-year-old children? Longitudinal and cross-sectional analyses in a birth cohort from Brazil

OBJECTIVE

To evaluate cross-sectional and longitudinal associations of consumption of dairy products and physical activity (PA) with bone mineral density (BMD).

DESIGN

Cohort study with children from the 2004 Pelotas (Brazil) Birth Cohort.

SETTING

Pelotas, a medium-sized Brazilian city.

SUBJECTS

The study started in 2004 and mothers/children were interviewed/measured periodically from birth to age 6 years. PA was measured by maternal proxy at 4 and 6 years and by accelerometry at 6 years. Consumption of dairy products was measured using 24 h food recall (at 4 years) and FFQ (at 6 years). Total-body and lumbar-spine BMD (g/cm2) were measured by dual-energy X-ray absorptiometry.

RESULTS

At 6 years, BMD was measured in 3444 children and 2636 children provided data on objectively measured PA by accelerometry. Consumption of dairy products at 4 years was associated with higher lumbar-spine BMD at 6 years in boys, while current consumption was positively associated with BMD in both sexes (P < 0·001). PA assessed by maternal report at 4 and 6 years of age was associated with higher BMD at 6 years in boys. PA assessed by accelerometry was positively related to total-body and lumbar-spine BMD in boys and lumbar-spine BMD in girls. We did not find evidence for an interaction between PA and consumption of dairy products on BMD.

CONCLUSIONS

We observed positive and independent longitudinal and cross-sectional associations between consumption of dairy products and PA with BMD in the total body and at the lumbar spine in young children.

Reliability and Validity of a Questionnaire for Physical Activity Assessment in South American Children and Adolescents: The SAYCARE Study

OBJECTIVE

The objective of this article is to test the reliability and validity of the new and innovative physical activity (PA) questionnaire.

METHODS

Subsamples from the South American Youth/Child Cardiovascular and Environment Study (SAYCARE) study were included to examine its reliability (children: n = 161; adolescents: n = 177) and validity (children: n = 82; adolescents: n = 60). The questionnaire consists of three dimensions of PA (leisure, active commuting, and school) performed during the last week. To assess its validity, the subjects wore accelerometers for at least 3 days and 8 h/d (at least one weekend day). The reliability was analyzed by correlation coefficients. In addition, Bland-Altman analysis and a multilevel regression were applied to estimate the measurement bias, limits of agreement, and influence of contextual variables.

RESULTS

In children, the questionnaire showed consistent reliability (ρ = 0.56) and moderate validity (ρ = 0.46), and the contextual variable variance explained 43.0% with -22.9 min/d bias. In adolescents, the reliability was higher (ρ = 0.76) and the validity was almost excellent (ρ = 0.88), with 66.7% of the variance explained by city level with 16.0 min/d PA bias.

CONCLUSIONS

The SAYCARE PA questionnaire shows acceptable (in children) to strong (in adolescents) reliability and strong validity in the measurement of PA in the pediatric population from low- to middle-income countries.

Dietary patterns are associated with child, maternal and household-level characteristics and overweight/obesity among young Samoan children

Objective

Among young Samoan children, diet may not be optimal: in 2015, 16·1 % of 24–59-month-olds were overweight/obese, 20·3 % stunted and 34·1 % anaemic. The present study aimed to identify dietary patterns among 24–59-month-old Samoan children and evaluate their association with: (i) child, maternal and household characteristics; and (ii) nutritional status indicators (stunting, overweight/obesity, anaemia).

Design

A community-based, cross-sectional study. Principal component analysis on 117 FFQ items was used to identify empirical dietary patterns. Distributions of child, maternal and household characteristics were examined by factor score quintiles. The regression of nutritional status indicators v. these quintiles was performed using logistic regression models.

Setting

Ten villages on the Samoan island of Upolu.

Subjects

A convenience sample of mother–child pairs (n 305).

Results

Two dietary patterns, modern and neo-traditional, emerged. The modern pattern was loaded with ‘westernized’ foods (red meat, condiments and snacks). The neo-traditional pattern included vegetables, local starches, coconuts, fish and poultry. Following the modern diet was associated with urban residence, greater maternal educational attainment, higher socio-economic status, lower vitamin C intake and higher sugar intake. Following the neo-traditional diet was associated with rural residence, lower socio-economic status, higher vitamin C intake and lower sugar intake. While dietary patterns were not related to stunting or anaemia, following the neo-traditional pattern was positively associated with child overweight/obesity (adjusted OR=4·23, 95 % CI 1·26, 14·17, for the highest quintile, P-trend=0·06).

Conclusions

Further longitudinal monitoring and evaluation of early childhood growth and development are needed to understand the influences of early diet on child health in Samoa.

Systemic arterial hypertension, blood pressure levels and associated factors in schoolchildren

Summary Introduction: Hypertension is a major public health problem in contemporary times and it has high prevalence throughout the world. Objective: To investigate the situation of Systemic Arterial Hypertension in schoolchildren aged 6 to 10 years in Divinópolis/MG-Brazil and associated factors. Method: This is a cross-sectional, epidemiological, descriptive and analytical study, whose population was children aged 6 to 10 years enrolled in public schools in Divinópolis-MG-Brazil. Data collection was conducted from October 2014 to May 2015. Multivariate linear regressions were used to test associations between blood pressure, socioeconomic, anthropometric, dietary and physical activity. Results: The prevalence of hypertension was 15.2% in a sample of 284 children and mean values of systolic blood pressure of 101.7 (±13.2) mmHg and diastolic blood pressure of 66.0 (±11.2) mmHg. The body fat percentage showed significant differences between the genders, with 24.2 and 26.2%, respectively for boys and girls. Significant associations were made between blood pressure levels, body weight, body mass index, waist circumference, body fat percentage, consumption of yogurt, beef /chicken, beans, pizza, sandwich and some behaviors variables. Conclusion: The presented data show important aspects of school profile in the age range 6-10 years, especially related to the behavior of blood pressure.

Objectively-measured physical activity in children is influenced by social indicators rather than biological lifecourse factors: Evidence from a Brazilian cohort

The aim of this study was to examine the longitudinal influences of early life social and biological indicators on objectively measured physical activity. All newborns in 2004 in the city of Pelotas, Southern Brazil were enrolled in a birth cohort study. At the age of 6years, a follow-up visit included objective assessment of overall physical activity (summarized in milli-g, 1mg=0.001g) by tri-axial wrist worn accelerometry. The associations between early life exposures, such as type of delivery, parity, birth weight, preterm delivery, maternal physical activity, socioeconomic position, and overall physical activity were examined. Valid accelerometry data were obtained from 2604 children (78.2% of the eligible individuals). Girls were less active than boys (β=-8.65mg; 95% CI -10.0; -7.30). Higher socioeconomic position was related to lower activity levels (β=-9.69mg. 95% CI -12.45; -6.93) and a similar association was found with maternal schooling. No associations were found with birthweight, type of delivery or preterm delivery. This study provides evidence for the role of some social factors in explaining children's physical activity behaviors, and minimizes the influence of some early life biological factors at determining physical activity levels.

Child, maternal and household-level correlates of nutritional status: a cross-sectional study among young Samoan children

OBJECTIVE

Young children are particularly vulnerable to malnutrition as nutrition transition progresses. The present study aimed to document the prevalence, coexistence and correlates of nutritional status (stunting, overweight/obesity and anaemia) in Samoan children aged 24-59 months.

DESIGN

A cross-sectional community-based survey. Height and weight were used to determine prevalence of stunting (height-for-age Z-score +2) based on WHO growth standards. Anaemia was determined using an AimStrip Hemoglobin test system (Hb <110 g/l).

SETTING

Ten villages on the Samoan island of Upolu.

SUBJECTS

Mother-child pairs (n 305) recruited using convenience sampling.

RESULTS

Moderate or severe stunting was apparent in 20·3 % of children, 16·1 % were overweight/obese and 34·1 % were anaemic. Among the overweight/obese children, 28·6 % were also stunted and 42·9 % anaemic, indicating dual burden of malnutrition. Stunting was significantly less likely among girls (OR=0·41; 95 % CI 0·21, 0·79, P<0·01) than boys. Overweight/obesity was associated with higher family socio-economic status and decreased sugar intake (OR per 10 g/d=0·89, 95 % CI 0·80, 0·99, P=0·032). The odds of anaemia decreased with age and anaemia was more likely in children with an anaemic mother (OR=2·20; 95 % CI 1·22, 3·98, P=0·007). No child, maternal or household characteristic was associated with more than one of the nutritional status outcomes, highlighting the need for condition-specific interventions in this age group.

CONCLUSIONS

The observed prevalences of stunting, overweight/obesity and anaemia suggest that it is critical to invest in nutrition and develop health programmes targeting early childhood growth and development in Samoa.

Validation of an iPad activity to measure preschool children's food and physical activity knowledge and preferences

Background

Preschool children’s knowledge of, and preference for food and physical activity play an important role in the development of lifestyle behaviors throughout childhood. Valid and reliable instruments that are interactive and appealing to preschool children are needed, to obtain quality information in a way that actively engages children and encourages willing participation. The purpose of the current research is to assess the reliability and validity of an adapted computerized (iPad) version of the photo-pair food and exercise questionnaire (PPFEQ).

Methods

The adaptation of the PPFEQ involved generating the questionnaire as an iPad-based tool, updating the photo-pairs within the questionnaire and testing for validity and reliability. This involved four phases of investigation to assess test-retest reliability, internal consistency, sensitivity to change and percent agreement of the questionnaire.

Results

The adaption of the PPFEQ resulted in an 18-item questionnaire, titled the preschool food and play questionnaire (Pre-FPQ). The Pre-FPQ demonstrated acceptable reliability and sensitivity to change. Test-retest reliability and internal consistency improved with age, however, it was evident that the tool was not suitable for children younger than 4 years of age.

Conclusions

Children encounter a dynamic world that shapes their knowledge, preferences, choices and behaviors. The Pre-FPQ is an innovative tool to measure preschool children’s knowledge of and preference for food and physical activity. The questionnaire offers the advantage of being presented in a well-received modality for preschool children as well as being easy and inexpensive to administer. This new tool is likely to be useful for the assessment of the effectiveness of healthy lifestyle programs implemented in the childcare setting. Future work is needed to refine and improve measures of physical activity preference in preschool children.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0469-z) contains supplementary material, which is available to authorized users.

Reliability and validity of the modifiable activity questionnaire for an Iranian urban adolescent population

BACKGROUND

The purpose of this study was to evaluate the validity and reliability on the Persian translation of the Modifiable Activity Questionnaire (MAQ) in a sample of Tehranian adolescents.

METHODS

Of a total of 52 subjects, a sub-sample of 40 participations (55.0% boys) was used to assess the reliability and the validity of the physical activity questionnaire. The reliability of the two MAQs was calculated by intraclass correlation coefficients, and validation was evaluated using Pearson correlation coefficients to compare data between mean of the two MAQs and mean of four physical activity records.

RESULTS

Intraclass correlation coefficient was calculated to assess the reliability between two MAQs and the results of leisure time physical activity over the past year were 0.97. Pearson correlation coefficients between mean of two MAQs and mean of four physical activity records were 0.49 (P < 0.001), for leisure time physical activities.

CONCLUSIONS

High reliability and relatively moderate validity were found for the Persian translation of the MAQ in a Tehranian adolescent population. Further studies with large sample size are suggested to assess the validity more precisely.

Factors Associated With Hyperphagic Behavior in Patients With Dementia Living at Home

OBJECTIVE

To investigate the prevalence and patterns of and factors associated with hyperphagic behavior in Taiwanese patients with dementia living at home.

METHODS

A cross-sectional and correlational design was used. A total of 104 patients with dementia and their primary caregivers were recruited from the geriatric, neurology, and memory clinics of a regional hospital, a medical center and two day-care centers in central Taiwan. The data related to hyperphagic behavior, functional abilities, medical conditions, body weight, and demographic characteristics of patients as well as the demographic characteristics of their primary caregivers were collected between January and May 2013.

RESULTS

Based on a strict criterion (a median score of 3 for the hyperphagic subscale), the prevalence of hyperphagia in patients with dementia was 53.8%. Specific hyperphagic patterns exhibited included increased food intake (49% of patients with dementia), hoarding (8.7%), oral exploration (6.8%), and pica (3.9%). Years of education of the patient, the use of antipsychotics in patients, and the age of primary caregivers explained 16.3% of the variance in hyperphagic behavior subscale scores (F = 6.47, p < .001).

CONCLUSIONS

For the early identification and treatment of hyperphagic behavior in patients with dementia in home care or in clinic services provided by health professionals, specific attention should be paid to the usual eating behaviors of patients with lower levels of education or who are taking antipsychotic medication or those who have a female primary caregiver.

Preferência por comportamentos favoráveis à prática de atividade física e nível de atividade física de crianças de uma cidade do sul do Brasil

O artigo objetiva descrever preferências por comportamentos favoráveis à prática de atividade física (AF) e avaliar sua influência sobre o nível de AF de crianças da cidade de Pelotas, RS. Estudo transversal de base populacional com crianças de 4 a 11 anos. Comportamentos favoráveis à prática de AF foram avaliados pelo Netherlands Physical Activity Questionnaire (NPAQ). O tempo de AF moderada ou vigorosa (AFMV) foi medido por acelerometria. Análise de variância e regressão linear foram usadas para avaliar associações entre as perguntas do NPAQ e variáveis independentes e entre cada comportamento e o tempo de AFMV, respectivamente. Crianças de maior nível econômico gostaram mais de desenhar e preferiram menos brincadeiras agitadas e brincar na rua do que crianças de menor nível econômico. Crianças de maior idade foram menos extrovertidas e gostaram menos de desenhar do que crianças mais novas. Gostar de esportes, ter falta de interesse por desenhar e preferir brincar na rua foram positivamente associados ao tempo diário de AFMV. Algumas das características estudadas mostraram-se associadas a comportamentos favoráveis à prática de AF, sendo a maior influência observada para o nível econômico. Preferências como gostar de esportes influenciaram positivamente o tempo gasto em AFMV.

Range of variation of genu valgum and association with anthropometric characteristics and physical activity: comparison between children aged 3-9 years

The lower limbs of children aged 3-9 years present varying knock-knee deformities that have a direct impact on the diversification of the load-bearing axis of the valgus limb and on the modification of gait kinematics. The purpose of our study was to establish the reference values of knee alignment in a Greek population and whether this is linked to a change in the physical activity of children depending on the severity of the genu valgum. Using a clinical method, we measured both the tibiofemoral (TF) angle and the intermalleolar (IM) distance of the lower extremities of normal children. Subsequently, forms of the Netherlands Physical Activity Questionnaire (NPAQ) for young children and the Baecke questionnaire on habitual physical activity, modified especially for children, were completed by the parents. We examined both the development of the TF angle and the IM distance in relation to age and the degree of restriction of physical activity in relation to the severity of the genu valgum. We analysed 316 unaffected lower extremities in children aged 3-9 years. The average value of the TF angle starts around 7° at the age of 3 years and gradually decreases to 4° at the age of 7-8 years. The average value of the IM distance ranges over 3.5 cm at the age of 3 years and progressively decreases to 2 cm at the age of 7-8 years. Physical activity appears to be influenced by sex and the severity of the genu valgum. We provide age-specific values for limb alignment and joint orientation of the lower extremity in children aged 3-9 years. A statistical correlation between all indexes (sport, leisure time and total) of the Baecke and the NPAQs and measurements of genu valgum was noted depending on the severity of the valgus deformity.

Reliability and validity of a physical activity questionnaire in children

BACKGROUND

valid and appropriate assessment of physical activity in children is still needed.

AIM

to determine the test-retest reliability and validity of the Arabic version of the Questionnaire l'Activite Physique en Altitude Chez les Enfants.

METHODS

POPULATION

6- to 9-year-old children were recruited in Al Ain, United Arab Emirates. Reliability: questionnaire was administered twice, 3 weeks apart. Intraclass correlation coefficients and 95% confidence interval calculated.

VALIDITY

comparison between the questionnaire and pedometer. Spearman's correlation coefficients were calculated. Bland-Altman method was used to detect potential bias.

RESULTS

a fair-to-good reliability was found, with the highest values for running during breaks at school and total active time during weekdays. No significant difference between the two measurements was observed. The validity was acceptable for total active time during weekdays.

DISCUSSION

for the first time, a questionnaire was identified as very promising to assess physical activity in Arabic children.