Associations between health-related quality of life and body mass index in Portuguese adolescents: LabMed physical activity study

Changes in health-related quality of life and sleep habits after a 6-month non-randomised cluster-controlled trial among children with overweight or obesity

Being overweight or obese can have severe negative psychological impacts and reduce health-related functioning. To improve health-related quality of life (HRQoL) and sleep habits for children with overweight or obesity, it is important to design and implement effective interventions. The aim of this study was to evaluate the effects of a 6-month family-based lifestyle intervention on HRQoL and sleep habits in Norwegian children with overweight or obesity in a primary-care setting. This 6-month, non-randomised, cluster-controlled trial included Norwegian children aged 5-13 years with overweight or obesity and their parents. A questionnaire was filled out by the parents. A total of 33 and 52 children in the control group and 41 and 78 children in the intervention group answered the HRQoL and sleep habits questions, respectively, and were included. The intervention group received individual family counselling and participated in physical activity groups and nutrition courses. The Children's Sleep Habits Questionnaire (CSHQ) and Kidscreen-10 index were used to assess sleep habits and HRQoL. At baseline, the mean average scores for HRQoL were 50.0 [standard deviation (SD) 8.1] for the intervention group and 49.0 (SD 10.1) for the control group. For sleep habits at baseline, the mean average scores were 45.2 (SD 11.8) for the intervention group and 46.0 (SD 11.9) for the control group. No significant changes in HRQoL and sleep habits after the intervention were revealed. Overall, the family-based lifestyle intervention targeting overweight and obese children in a primary-care setting showed no significant effect on HRQoL or sleep quality.

Encouraging physical fitness in Brazilian adolescents with excess weight: can they outperform their eutrophic peers in some activities?

BACKGROUND

There is the need to encourage physical activity (PA) among adolescents with overweight or obesity.

OBJECTIVES

The present study aimed to assess the relationship between health-related physical fitness (PF) and nutritional status, and to identify those activities more suited to adolescents with excess weight.

METHODS

This cross-sectional study included 3,062 in-school adolescents, aged 10-18 years. We collected information on sex, age, weight, height, skinfold thickness, trunk height and leg length, and calculated body mass index (BMI) z-score, fat mass percentage, and peak height velocity (PHV). Participants were tested for PF by the 20-m shuttle run test (cardiorespiratory fitness); medicine ball throw and standing long jump tests (musculoskeletal fitness) and sit and reach test (flexibility). We used generalized linear mixed models (GLMM) to analyze the relationship between nutritional status and performance in the fitness tests, controlled for maturity offset and fat mass percentage.

RESULTS

1,563 (51%) were boys, mean age 12.6 years (±1.8), 22.8% were overweight and 12.5% had obesity. In both sexes, adolescents with obesity did better in the upper body strength test than their eutrophic peers. Boys with obesity had worse cardiorespiratory fitness and lower body muscular strength than eutrophic boys. Girls with obesity had similar cardiorespiratory fitness and better lower body strength than eutrophic girls.

CONCLUSION

In muscular strength fitness tests, adolescents with obesity performed similarly to, or better than, their eutrophic peers. Motivation to maintain regular PA is reinforced by positive experiences. Interventions that emphasize muscular strength PF should be developed for adolescents with obesity.

Using Multilevel Regression and Poststratification to Estimate Physical Activity Levels from Health Surveys

BACKGROUND

Large-scale health surveys often consider sociodemographic characteristics and several health indicators influencing physical activity that often vary across subpopulations. Data in a survey for some small subpopulations are often not representative of the larger population.

OBJECTIVE

We developed a multilevel regression and poststratification (MRP) model to estimate leisure-time physical activity across Brazilian state capitals and evaluated whether the MRP outperforms single-level regression estimates based on the Brazilian cross-sectional national survey VIGITEL (2018).

METHODS

We used various approaches to compare the MRP and single-level model (complete-pooling) estimates, including cross-validation with various subsample proportions tested.

RESULTS

MRP consistently had predictions closer to the estimation target than single-level regression estimations. The mean absolute errors were smaller for the MRP estimates than single-level regression estimates with smaller sample sizes. MRP presented substantially smaller uncertainty estimates compared to single-level regression estimates. Overall, the MRP was superior to single-level regression estimates, particularly with smaller sample sizes, yielding smaller errors and more accurate estimates.

CONCLUSION

The MRP is a promising strategy to predict subpopulations' physical activity indicators from large surveys. The observations present in this study highlight the need for further research, which could, potentially, incorporate more information in the models to better interpret interactions and types of activities across target populations.

Development and content validity of an instrument for assessing the motivation for weight loss in adolescents with overweight and obesity

Objective

To develop and validate the content of an instrument for assessing the motivation for weight loss in adolescents with overweight and obesity.

Methods

The development and validation of the instrument were conducted in five stages, for which two systematic reviews were conducted. The first one, for the identification of questionnaires assessing the motivation for weight loss, included six studies and contributed to the selection of the domains for the instrument. The second one, conducted to identify the motivations for weight loss in adolescents with overweight and/or obesity, included six studies and contributed to the selection of 17 motivations included in the initial version of the instrument. The motivations most commonly identified were: having better health, improving my appearance, improving my self-esteem and avoiding bullying. The content validity was confirmed by a committee of 12 experts from the areas of nutrition, endocrinology, psychology, and physical education. Based on these evaluations, the content validity index was calculated. Only the items with a content validity index >0.80 for practical relevance were held in the instrument.

Results

Five of the 17 motivations included in the initial version of the instrument were excluded because they had content validity index <0.80 for practical relevance. Of the 12 items held in the instrument, five were revised by experts in order to standardize wording and make the language more appropriate for adolescents. Experts categorized the items into the health, personal satisfaction, appearance and social domains.

Conclusions

This is the first instrument assessing the motivation for weight loss in adolescents with overweight and obesity in Brazil. The content validity evaluation by the panel of experts provided more practical relevance, as well as contributed to a better presentation of the items. Further psychometric testing is needed to determine reliability and construct validity of the instrument.

Health-related quality of life of Portuguese children and adolescents according to diet quality and food intake

PURPOSE

The implication of adolescence diet quality and of certain specific foods' intake on HRQoL remain underexplored, and little importance has been given to biological changes (e.g. growth, maturation, dimorphism, body composition), that remarkably increase the variability of diet and physical activity behaviours. The aim of this study was to analyse the relationship between diet quality and food intake with HRQoL in adolescents, considering maturity, body composition, and physical activity level.

METHODS

In total 669 Portuguese adolescents aged 10-17 years, attending three secondary schools, were enrolled in this cross-sectional study. Diet quality was assessed by Diet Quality International-Index (DQI-I), physical activity level was self-reported, and the HRQoL was assessed by the KIDSCREEN-52 questionnaire. The KIDSCREEN-52 includes ten dimensions (physical well-being, psychological well-being, moods and emotions, self-perception, autonomy, parent relations and home life, social support and peers, school environment, social acceptance and bullying and financial resources) and it allowed to compute a general index of the HRQoL (KIDSCREEN-10 index) through a selection of 10 items out of the KIDSCREEN-52 list. Fat mass was obtained by skinfold thickness. Maturity was objectively measured. The level of significance was set at α = 0.05.

RESULTS

Boys scored higher in HRQoL and in physical well-being, self-perception, autonomy, parent relations and home life than girls. Intakes of unhealthy foods were negatively correlated with physical well-being, self-perception, and social acceptance and bullying, while healthy foods were positively correlated with psychological well-being, moods and emotions, self-perception, and school environment. The DQI-I showed to be positively correlated with physical well-being. Participants who reported to have a higher DQI-I (≥ 60) perceived better their school environment and social acceptance and bullying. However, those results were not determined by diet quality but rather by bone age and physical activity level.

CONCLUSION

Our results showed that boys reported higher HRQoL and higher scores in the majority of HRQoL dimensions, compared to girls. The intake of unhealthy foods was negatively correlated with some HRQoL dimensions, whilst healthy foods showed positive correlations with some HRQoL dimensions. Biological maturity and physical activity level revealed to be important confounders in the study of diet quality and perception of school environment and social acceptance and bullying in adolescents.

Quality of Life and Physical Performance in Patients with Obesity: A Network Analysis

BACKGROUND

The aim of this study was to investigate the interconnections between specific quality-of-life domains in patients with obesity and high or low physical performance using a network approach.

METHODS

716 consecutive female and male patients (aged 18-65 years) with obesity seeking weight-loss treatment were included. The 36-item Short Form Health Survey (SF-36) and the six-minute walking test (6MWT) were used to assess quality of life and physical performance, respectively. The sample was split into two groups according to the distance walked in the 6MWT. Network structures of the SF-36 domains in the two groups were assessed and compared, and the relative importance of individual items in the network structures was determined using centrality analyses.

RESULTS

35.3% (n = 253) of participants covered more distance than expected, and 64.7% (n = 463) did not. Although low-performing patients showed lower quality of life domain scores, the network structures were similar in the two groups, with the SF-36 Vitality representing the central domain in both networks. Mental Health was a node with strong connections in patients who walked less distance.

CONCLUSIONS

These findings indicate that psychosocial variables represent the most influential and interconnected features as regards quality of life in both groups.

Eccentric Cycling Training Improves Health-Related Quality of Life in Adolescents with Obesity

INTRODUCTION

While eccentric (ECC) training appears to be more efficient than concentric (CON) training at improving body composition in adolescent with obesity, its impact on health-related quality of life (HRQOL) has never been studied.

OBJECTIVE

The aim of this study is to compare the effects of 2 cycling training modalities, i.e., ECC vs. CON, in adolescents with obesity on HRQOL and health perception (HP).

METHODS

A total of 24 adolescents with obesity, aged 12-16 years, were randomized to either a 12-week ECC or a CON cycling training program performed at the same oxygen consumption (VO2). Anthropometric measurements, body composition, maximal incremental tests, HRQOL (Vécu et Santé Percue de l'Adolescent [VSP-A], Medical Outcome Study Short Form [SF-36]), and HP were assessed at before and after training.

RESULTS AND CONCLUSION

Both CON and ECC cycling trainings promoted significant improvements in BMI, VO2peak, total fat mass, and fat-free mass, with better improvements in body composition parameters in the ECC group (p < 0.05). The VSP-A total score increased after CON (p < 0.01) and ECC (p < 0.001) training, with better enhancement for the ECC group (p < 0.05). The SF-36 physical score increased after both CON (p < 0.01) and ECC (p < 0.001) trainings. The global HP score increased only after ECC training (p < 0.001). Except for the energy-vitality item, no significant correlation was found between changes in HRQOL and its subdomains and anthropometric, body composition, and functional parameters. Both ECC and CON cycling trainings are associated with positive changes in HRQOL and HP. However, ECC seems to induce greater improvements in HRQL and HP than CON cycling training, which is probably not due to the anthropometric, body composition, and functional changes.

Health-related quality of life and perceived health status of adolescents with obesity are improved by a 10-month multidisciplinary intervention

BACKGROUND

Although multidisciplinary weight management interventions have been shown effective in improving body composition and cardio-respiratory fitness, their effects on HRQOL and perceived health status remain uncertain in adolescents with obesity.

OBJECTIVE

To assess the impact of a 10-month multidisciplinary weight management intervention on HRQOL and health perception in adolescents with obesity, exploring whether these changes were associated with changes in body weight and body composition.

METHODS

Thirty-six adolescents with obesity (28 girls and 8 boys; mean age: 13 ± 1.32 years) enrolled in a multidisciplinary weight management intervention composed of nutritional counseling, physical activity and health-related therapeutic education. Validated self-report questionnaires were used to assess HRQOL (SF-36) and health perception (HP questionnaire) at baseline (T0) after5 months (T1) and after 10 month of intervention (T2). In addition, anthropometric parameters and body composition (DXA) were measured at T0, T1 and T2.

RESULTS

Items of the SF-36 significantly improved at T1 and T2, such as physical functioning (P < .01), general health (P < .01), physical (P < .001) and mental score (T1: P < .05, T2: P < .01). Dimensions of health perception improved significantly such as physical condition (P < .01 at T2), adiposity (P < .001 at T1 and T2), healthy balanced diet (P < .01 at T1 and P < .001 at T2), general health (P < .05), and perceived general health (T1: P < .01, T2: P < .001). Body weight, BMI, and fat mass (in Kg and in %) were significantly decreased (P < .001) at T1 and T2. No relationship was observed between variations of weight, BMI and Fat mass and variations of HRQOL and health perception.

CONCLUSION

A 10-month multidisciplinary weight-management intervention was associated with positive changes in HRQOL and perceived health status, which might not be explained by body weight and adiposity improvements.

Multidisciplinary obesity treatment program improved health-related quality of life and positively correlated with anthropometric and body composition but not with cardiorespiratory fitness parameters in adolescents

PURPOSE

The aim of the present study was to verify the effects of a 16-week multidisciplinary obesity treatment program (MOTP) on health-related quality of life (HRQoL) in adolescents with weight excess. In addition, we verified a possible association between changes on HRQoL and anthropometric, body composition, and cardiorespiratory fitness (CRF) parameters.

METHODS

Two hundred four adolescents aged from 15 to 18 years were distributed in control group (CG) and intervention group (IG). They underwent a 16-week MOTP composed by nutritional, psychological, and health-related physical activity group sessions. Moreover, they performed physical exercise sessions three times per week during the whole 16-week program. Data on HRQoL, body composition, CRF and anthropometry were collected using standard protocols and validated questionnaires.

RESULTS

The MOTP promoted significant enhancements in all HRQoL domains, except for the school domain in IG. Furthermore, positive correlations between HRQoL and body weight (BW), body fat (BF), waist circumference (WC), and body mass index (BMI) z-score were verified. Higher scores of HRQoL might be achieved by improving these variables.

CONCLUSIONS

The 16-week MOTP was effective to improve HRQoL in adolescents with weight excess. This improvement has a positive correlation with enhancements in BW, BMI z-score, WC, and BF. Nevertheless, these findings have not reached a consensus on literature and still need to be further enlightened.