Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

BACKGROUND

Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories.

METHODS

We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median).

FINDINGS

From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness.

INTERPRETATION

The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.

FUNDING

UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union.

Physical Activity During Adolescence and Mental Health in Early Adulthood: Findings From the 1993 Pelotas Birth Cohort Study

BACKGROUND

Low prevalence of physical activity (PA) and a high prevalence of mental health problems are common among youth. The aim of this study was to evaluate the association between PA during adolescence and depression and anxiety disorders in young adulthood.

METHODS

Data from the 1993 Pelotas (Brazil) Birth Cohort Study were analyzed. Leisure-time PA and total PA (leisure plus commuting) were evaluated at 11, 15, and 18 years using self-reported data. PA was evaluated at each age separately and during adolescence, considering the number of times participants reached PA recommendations. Depression and anxiety were assessed through Mini International Neuropsychiatric Interview at 22 years. Crude and adjusted association analyses were performed using Poisson regression with robust error variance, providing prevalence ratios and 95% confidence intervals.

RESULTS

Three thousand two hundred and forty-seven participants were included in the study. In the adjusted analyses, active participants in leisure-time PA (≥300 min/wk) and total PA at 11 years were less likely to be depressed at age 22 (prevalence ratios: 0.54; 95% confidence interval, 0.33-0.89; prevalence ratios: 0.63; 95% confidence interval, 0.41-0.97). For leisure-time PA, the more PA recommendations were met during adolescence, the lower the prevalence of depression. There was no association when PA variables were evaluated separately at 15 and 18 years and between PA and anxiety after controlling for potential confounders.

CONCLUSIONS

Early adolescence appears to be a sensitive period for PA benefits on depression in early adulthood. The more timepoints reaching PA recommendations during adolescence, the lower the risk of depression. On the other hand, PA during adolescence was not associated with anxiety in young adults.

Diminishing benefits of urban living for children and adolescents' growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1-6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5-19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m-2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.

Physical Activity and Multimorbidity Among Community-Dwelling Older Adults: A Systematic Review With Meta-Analysis

OBJECTIVE

This study evaluated the relationship between physical activity (PA) and multimorbidity in community-dwelling older adults.

DATA SOURCE

A systematic review and meta-analysis in the following databases: Pubmed, Lilacs, Scielo, Web of Science, Scopus, and AgeLine.

STUDY INCLUSION AND EXCLUSION CRITERIA

It included observational studies investigating the association between physical activity and multimorbidity, with older adults, published until May 2021. Studies with institutionalized individuals or that assessed specific diseases were excluded.

DATA EXTRACTION

Two reviewers independently extracted the studies based on previous inclusion and exclusion criteria, started by selecting titles, followed by abstracts and full-text reading.

DATA SYNTHESIS

Meta-analysis results were reported as Odds Ratio (OR) with a 95% confidence interval using R language. The Newcastle Ottawa scale was used to assess the quality of the studies.

RESULTS

Fifteen studies were included in the systematic review, from which 12 reported an inverse association between physical activity and multimorbidity. In the meta-analysis, from over 77 000 older adults, there was an inverse association between physical activity and multimorbidity [OR: .81; 95% CI: .73-.89]. We found significant results only for men in the analysis by sex.

CONCLUSIONS

Low levels of physical activity were associated with a higher risk of multimorbidity in older adults. It is expected that public policies will be conducted aimed at the practice of physical activity among older adults.

Physical activity in birth cohorts of three Brazilian cities (Ribeirão Preto, Pelotas, and São Luís): A cross-sectional study

OBJECTIVE

To describe the prevalence of physical activity among subjects from birth cohorts of three cities located in different regions of Brazil according to sociodemographic characteristics and sex, comparing the relationships within and between cohorts.

METHODS

Cross-sectional study involving 12,724 adolescents and young adults who participated in five birth cohorts: Ribeirão Preto [1978/79 (37/39 years old in 2016) and 1994 (22 years in 2016)]; Pelotas [1982 (30 years in 2012) and 1993 (22 years in 2015)], and São Luís [1997/98 (18/19 years in 2016)]. Leisure-time physical activity was evaluated with questionnaires (insufficiently active: <150 min/week and active: ≥150 min/week) and moderate and vigorous physical activity (MVPA) was objectively measured by accelerometry. Those, in each city, were evaluated accordingly to skin color, socioeconomic classification, and study/work activities.

RESULTS

The prevalence of leisure-time physical activity ranged from 29.2% at 30 years old in Pelotas to 54.6% among adolescents from São Luís. The prevalence of leisure-time physical activity was higher among younger people (54.6% in São Luís 1997), while the same was not observed for total physical activity. MVPA (3rd tercile) was higher in the cohorts from Pelotas and São Luís. The prevalence of leisure-time physical activity and MVPA was higher in men. The data showed that the variation in physical activity was associated with sex and sociodemographic conditions in all cohorts.

CONCLUSION

Sociodemographic characteristics should be considered when promoting leisure-time physical activity and actions aimed at young people, and adults who are more socioeconomically vulnerable should be encouraged.

Maternal smoking during pregnancy and intelligence quotient of offspring aged 18 and 30 years: Evidence from two birth cohorts in southern Brazil

Maternal smoking during pregnancy causes several harmful effects, including deficits in the intelligence quotient (IQ), a measure associated with academic achievements and higher socioeconomic position. We aimed to measure the association between maternal smoking during pregnancy and offspring's IQ in two birth cohorts from Pelotas, Brazil. Data from the 1982 and 1993 birth cohorts were analyzed. Smoking during pregnancy was ascertained at the perinatal follow-up, and IQ was measured at 30 years (1982) and 18 years (1993). Simple and multiple linear regressions were used for crude and adjusted analysis. Mediation analysis was performed using birth weight and breastfeeding as possible mediators. Data analysis was conducted in 2020. There were 3611 and 4050 participants from the 1982 and 1993 cohorts, respectively. After adjustment for potential confounders, the inverse association between smoking during pregnancy and children's IQ remained significant in both cohorts. Offspring of mothers who smoked during pregnancy had an average of 1.32 less IQ points (95%CI: -2.23, -0.242) in the 1982 cohort, and an average of 1.66 less IQ points (95%CI: -2.42, -0.90) in the 1993 cohort. Neither cohort showed association with paternal smoking (negative controls) after adjustment. Breastfeeding's mediated effects accounted for 26.2% and 23.9% of the association in the 1982 and 1993 cohorts, respectively, while birth weight's accounted for 6.8% and 30.1%, respectively; indirect effects were not significant. The inverse association between maternal smoking and IQ and the lack of association with paternal smoking reinforces our findings of a negative association between exposure and outcome.

Ultra-processed food and risk of type 2 diabetes: a systematic review and meta-analysis of longitudinal studies

BACKGROUND

The consumption of some food groups is associated with the risk of diabetes. However, there is no evidence from meta-analysis which evaluates the consumption of ultra-processed products in the risk of diabetes. This study aimed to review the literature assessing longitudinally the association between consumption of ultra-processed food and the risk of type 2 diabetes and to quantify this risk through a meta-analysis.

METHODS

We conducted a systematic review and meta-analysis with records from PubMed, Latin American and Caribbean Literature in Health Sciences (LILACS), Scielo, Scopus, Embase, and Web of Science. We included longitudinal studies assessing ultra-processed foods and the risk of type 2 diabetes. The review process was conducted independently by two reviewers. The Newcastle Ottawa scale assessed the quality of the studies. A meta-analysis was conducted to assess the effect of moderate and high consumption of ultra-processed food on the risk of diabetes.

RESULTS

In total 2272 records were screened, of which 18 studies, including almost 1.1 million individuals, were included in this review and 72% showed a positive association between ultra-processed foods and the risk of diabetes. According to the studies included in the meta-analysis, compared with non-consumption, moderate intake of ultra-processed food increased the risk of diabetes by 12% [relative risk (RR): 1.12; 95% confidence interval (CI): 1.06-1.17, I2 = 24%], whereas high intake increased risk by 31% (RR: 1.31; 95% CI: 1.21-1.42, I2 = 60%).

CONCLUSIONS

The consumption of ultra-processed foods increased the risk for type 2 diabetes as dose-response effect, with moderate to high credibility of evidence.

Influence of parental physical activity on offspring's nutritional status: an intergenerational study in the 1993 Pelotas birth cohort

OBJECTIVE

To investigate the influence of parental physical activity on offspring's nutritional status in the 1993 Pelotas (Brazil) birth cohort.

DESIGN

Birth cohort study.

SETTING

The main outcomes were overweight and obesity status of children. The main exposure was parental physical activity over time, measured during the 11, 15 and 18 years of age follow-ups. The exposure was operationalised as cumulative, and the most recent measure before the birth of child. We adjusted Poisson regression models with robust variance to evaluate crude and adjusted associations between parental physical activity and offspring's nutritional status. All analyses were stratified according to the sex of the parent.

PARTICIPANTS

A total of 874 members from the 1993 Pelotas (Brazil) birth cohort followed-up at 22 years of age with their first-born child were analysed.

RESULTS

Children were, on average, 3·1 years old. Crude analyses showed that the mother's cumulative physical activity measure had an indirect association with the prevalence of children's obesity. The most recent maternal physical activity measure before the birth of the child was associated with 41 % lower prevalence of obesity in children, even after adjustment for confounders.

CONCLUSIONS

The most recent maternal physical activity measure was indirectly associated with the prevalence of obesity in children. No associations were found for fathers, reinforcing the hypothesis of a biological effect of maternal physical activity on offspring's nutritional status.

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

BACKGROUND

Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories.

METHODS

We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age.

FINDINGS

The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran.

INTERPRETATION

Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings.

FUNDING

WHO.

[Validation study on self-reported visual impairment among undergraduate students at the Federal University of Pelotas]

The objectives of the study were to assess the prevalence of self-reported visual impairment among undergraduate students between 18 and 39 years of age at the Federal University of Pelotas, and to validate a question about visual impairment in a subsample of the participants. A cross-sectional study was conducted by asking the question "Do you have any difficulty seeing up close and/or in the distance?" As the gold standard for the validation study, visual acuity (VA) was measured using the Snellen chart. Patients with VA less than 20/40 in either eye were considered to have reduced VA. The prevalence of self-reported visual impairment was 37.3% (95% CI: 35.1-39.6) and VA less than 20/40 in either eye was 6.9% (95% CI: 5.3-8.9). The question revealed sensitivity of 71.4% (95 CI: 57.8-82.7), specificity of 66.9% (95% CI: 63.4-70.2), positive predictive value of 13.8% (95% CI: 10.0-18.3), and negative predictive value of 96.9% (95% CI: 95,1-98.2). The results indicated a high prevalence of self-reported visual impairment among university students. The question showed reasonable sensitivity and specificity and high negative predictive value and may be used for screening for ophthalmological evaluation among young adult university students.

Effects of omega-3 supplementation on body weight and body fat mass: A systematic review

BACKGROUND

Omega-3 is a supplement that promotes several health benefits. The evidence on omega-3 in weight loss or body fat mass is inconclusive. This study aimed to review the literature on studies that evaluated the effect of omega-3 supplementation and changes in weight and/or body fat mass in humans.

METHODS

A systematic review, following the recommendations of PRISMA, in the databases Pubmed, Lilacs, and Scielo. Only experimental studies in humans that evaluated the effects of supplementation with omega-3 on weight loss and/or body fat mass were included.

RESULTS

In total, 20 studies were selected, of which 11 found no effect, and the other nine find some benefits. Two studies found a reduction in individuals' body fat, and a third found these results in women and a fourth only in men. In children and adolescents, one study found a difference in weight loss between groups. Four studies reported decreased body weight in women, and in men, only one found this result.

CONCLUSION

To date, there is no consistency in the literature that omega-3 has benefits in weight loss or body fat mass in humans. Due to the studies' heterogeneity and inconsistency in the results, further studies on the subject are necessary.

Maternal smoking during pregnancy and intelligence quotient in offspring: A systematic review and meta-analysis

BACKGROUND

Exposure to tobacco during pregnancy may disrupt fetal brain development and impact offspring cognitive development.

AIMS

To perform a systematic review and meta-analysis on maternal smoking during pregnancy and intelligence quotient (IQ) in childhood, adolescence, and adulthood.

METHODS

We searched PubMed, Lilacs, PsycINFO, and Web of Science. Original articles evaluating tobacco use/exposure during pregnancy and the offspring's IQ as the outcome. The review protocol is registered in PROSPERO (number CRD 42,019,116,257). For the meta-analysis, we included studies with information on the regression coefficient and its confidence interval (CI) or standard error. Random effects model was used for pooling the estimates.

RESULTS

25 studies were included in the review, and of these 14 met the inclusion criteria for the meta-analysis. The overall pooled estimate showed that subjects who were exposed to maternal smoking during pregnancy presented lower IQ scores, compared to those not exposed to maternal smoking (β -1.30; 95 % CI -1.74, -0.86; I² = 87.8 %); IQ scores were also lower in crude (β -5.46; 95 % CI -7.31, -3.60; I²: 79.0 %) and adjusted pooled estimates (β =-0.45; 95 % CI -0.76, -0.13; I² = 80.4 %), for the group exposed to maternal smoking. In the stratified analysis, an inverse association was also observed in studies with large sample size (n≥1000 participants) (β=-0.49; 95 % CI -0.96, -0.02), among those performed with adolescents (β=-1.16; 95 % CI -2.18, -0.14), and among those adjusted for maternal education (β=-0.57; 95 % CI -1.05, -0.08).

CONCLUSIONS

Our findings suggest that exposure to tobacco during pregnancy may have negative effects on IQ. However, the findings of this meta-analysis should be interpreted with caution.

Omega-3 supplementation and diabetes: A systematic review and meta-analysis

This study aimed to review the literature on studies that evaluated the effects of omega-3 supplementation on parameters of diabetes in humans. An online search was conducted in the following databases: Pubmed, LILACS, Scielo, Scopus, and Web of Science. It included experimental studies that investigated the effects of omega-3 supplementation for diabetes treatment or prevention and its relationship with fasting blood glucose, insulin resistance, and glycated hemoglobin. Observational, non-human studies and non-randomized clinical trials were excluded. The Cochrane scale assessed the quality of the studies. A meta-analysis was carried out to evaluate the effect of omega-3 on fasting blood glucose, insulin resistance, and glycated hemoglobin. Thirty studies were included in the review. Almost 70% (n = 20) demonstrated at least one significant effect of the omega-3 supplementation related to diabetes. In the meta-analysis, there was a significant effect on the reduction of fasting blood glucose [SMD: -0.48; CI95%: -0.76, -0.19; p = 0.01; I2 = 88%] and insulin resistance [SMD: -0.61; CI95%: -0.98, -0.24; p = 0.01; I2 = 90%]. For glycated hemoglobin, there was no significant effect in the meta-analysis. This systematic review with meta-analysis demonstrated that supplementation with omega-3 has protective effects on diabetes parameters.

Global, regional, and national trends and patterns in physical activity research since 1950: a systematic review

Background

National, regional and global scientific production and research capacity for physical activity - PA may contribute to improving public health PA policies and programs. There is an uneven distribution of research productivity by region and country income group, where countries with the highest burden of non-communicable diseases attributable to physical inactivity having low research productivity. A first step towards improving global research capacity is to objectively quantify patterns, trends, and gaps in PA research. This study describes national, regional and global trends and patterns of PA research from 1950 to 2019.

Methods

A systematic review using searches in PubMed, SCOPUS and ISI Web of Knowledge databases was conducted in August 2017 and updated between January and May 2020. The review was registered at the PROSPERO database number CRD42017070153. PA publications per 100,000 inhabitants per country was the main variable of interest. Descriptive and time-trend analyses were conducted in STATA version 16.0.

Results

The search retrieved 555,468 articles of which 75,756 were duplicates, leaving 479,712 eligible articles. After reviewing inclusion and exclusion criteria, 23,860 were eligible for data extraction. Eighty-one percent of countries (n = 176) had at least one PA publication. The overall worldwide publication rate in the PA field was 0.46 articles per 100,000 inhabitants. Europe had the highest rate (1.44 articles per 100,000 inhabitants) and South East Asia had the lowest (0.04 articles per 100,000 inhabitants). A more than a 50-fold difference in publications per 100,000 inhabitants was identified between high and low-income countries. The least productive and poorest regions have rates resembling previous decades of the most productive and the richest.

Conclusion

This study showed an increasing number of publications over the last 60 years with a growing number of disciplines and research methods over time. However, striking inequities were revealed and the knowledge gap across geographic regions and by country income groups was substantial over time. The need for regular global surveillance of PA research, particularly in countries with the largest data gaps is clear. A focus on the public health impact and global equity of research will be an important contribution to making the world more active.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-020-01071-x.

How many days are needed to estimate wrist-worn accelerometry-assessed physical activity during the second trimester in pregnancy?

Background

Objective methods to measure physical activity (PA) can lead to better cross-cultural comparisons, monitoring temporal PA trends, and measuring the effect of interventions. However, when applying this technology in field-work, the accelerometer data processing is prone to methodological issues. One of the most challenging issues relates to standardizing total wear time to provide reliable data across participants. It is generally accepted that at least 4 complete days of accelerometer wear represent a week for adults. It is not known if this same assumption holds true for pregnant women.

Aim

We assessed the optimal number of days needed to obtain reliable estimates of overall PA and moderate-to-vigorous physical activity (MVPA) during the 2nd trimester in pregnancy using a raw triaxial wrist-worn accelerometer.

Methods

Cross-sectional analyses were carried out in the antenatal wave of the 2015 Pelotas (Brazil) Birth Cohort Study. Participants wore the wrist ActiGraph wGT3X-BT accelerometer for seven consecutive days. The daily average acceleration, which indicated overall PA, was measured as milli-g (mg), and time spent in MVPA (minutes/day) was analyzed in 5-minute bouts. ANOVA and Kruskal-Wallis tests were used to compare variability across days of the week. Bland-Altman plots and the Spearman-Brown Prophecy Formula were applied to determine the reliability coefficient associated with one to seven days of measurement.

Results

Among 2,082 pregnant women who wore the accelerometer for seven complete days, overall and MVPA were lower on Sundays compared to other days of the week. Reliability of > = 0.80 to evaluate overall PA was reached with at least three monitoring days, whereas seven days were needed to estimate reliable measures of MVPA.

Conclusions

Our findings indicate that obtaining one week of accelerometry in adults is appropriate for pregnant women, particularly to obtain differences on weekend days and reliably estimate overall PA and MVPA.

Efficacy of Regular Exercise During Pregnancy on the Prevention of Postpartum Depression: The PAMELA Randomized Clinical Trial

IMPORTANCE

Interventions to reduce postpartum depression have mainly focused on enhancing screening to increase treatment rates among women. Preventive approaches are timely from a population health perspective, particularly in low- and middle-income countries where access to mental health services is limited.

OBJECTIVE

To assess the efficacy of regular exercise during pregnancy on the prevention of postpartum depression.

DESIGN, SETTING, AND PARTICIPANTS

This randomized clinical trial examines a prespecified secondary outcome of the Physical Activity for Mothers Enrolled in Longitudinal Analysis (PAMELA) Study, a parallel-group, randomized clinical trial. This trial was nested in the 2015 Pelotas (Brazil) Birth Cohort Study. Between August 27, 2014, and March 14, 2016, pregnant women between 16 and 20 weeks of gestation with no contraindications to exercise were randomized 1:2 to the intervention group or control group via computer-generated randomization using a block size of 9. Data were analyzed from March 7 to May 2, 2018.

INTERVENTIONS

Participants assigned to the intervention were engaged in a 16-week supervised exercise program including aerobic and resistance training delivered in 60-minute sessions 3 times per week.

MAIN OUTCOMES AND MEASURES

Postpartum depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale 3 months after birth. A score of 12 or greater was defined as screening positive for postpartum depression. Primary analysis was performed on a complete case basis (90% of participants who had the primary end point ascertained).

RESULTS

A total of 639 participants (mean [SD] age, 27.1 [5.1] years; mean gestational age, 16.5 [1.5] weeks) were randomly assigned to the intervention group (n = 213) or control group (n = 426). Compliance with the protocol, defined as having engaged in at least 70% of exercise sessions, was low (40.4%). There was no significant difference in mean (SD) scores for postpartum depression between the intervention group (4.8 [3.7]) and the control group (5.4 [4.1]) (mean difference, -0.6; 95% CI, -1.3 to 0.1). There was also no significant difference in rates of postpartum depression between the intervention group (12 of 192 [6.3%]) and the control group (36 of 387 [9.3%]) (odds ratio, 0.65; 95% CI, 0.33-1.28). Instrumental variable analysis indicated that noncompliance may have attenuated the effect estimates obtained in the primary analysis.

CONCLUSIONS AND RELEVANCE

Moderate-intensity exercise during pregnancy did not lead to significant reductions in postpartum depression. However, noncompliance to the intervention protocol was substantial and may have led to underestimations of the possible benefits of exercise. The point estimates for this study are in the same direction as the previous randomized clinical trial on this topic. Future studies on how to promote regular exercise during pregnancy to improve compliance, particularly targeting young and less educated women, are warranted before further trials are undertaken.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02148965.

A randomized controlled trial of exercise during pregnancy on maternal and neonatal outcomes: results from the PAMELA study

BACKGROUND

Women are encouraged to be physically active during pregnancy. Despite available evidence supporting antenatal physical activity to bring health benefits for both the mother and child, the most effective way to prevent some maternal and fetal outcomes is still unclear. The purpose of this study was to evaluate the efficacy of an exercise intervention to prevent negative maternal and newborn health outcomes.

METHODS

A randomized controlled trial (RCT) nested into the 2015 Pelotas (Brazil) Birth Cohort Study was carried-out with 639 healthy pregnant women, 213 in the intervention group (IG) and 426 in the control (CG) group. An exercise-based intervention was conducted three times/week for 16 weeks from 16-20 to 32-36 weeks' gestation. The main outcomes were preterm birth and pre-eclampsia. Gestational age was calculated based on several parameters, including routine ultrassounds and/or last menstrual period and categorized as < 37 weeks and ≥ 37 weeks for evaluation of preterm birth. Pre-eclampsia was self-reported. Secondary outcomes were gestational weight gain, gestational diabetes, birth weight, infant length, and head circumference. Analyses were performed by intention-to-treat (ITT) and per protocol (70% of the 48 planned exercise sessions). Odds ratio were derived using unconditional logistic regression.

RESULTS

The IG and CG did not differ at baseline regarding their mean age (27.2 years ± 5.3 vs. 27.1 years ± 5.7) and mean pre-pregnancy body mass index (25.1 ± 3.9 vs. 25.2 ± 4.1 kg/m2). The mean adherence to the exercise intervention was 27 ± 17.2 sessions (out of a potential 48) with 40.4% attending > = 70% of the recommended exercise sessions. A total of 594 participants (IG:198; CG: 396) were included in the ITT and 479 (IG: 83; CG: 396) were included in the per protocol analyses. There were no significant differences in the incidence of preterm birth and pre-eclampsia between groups in the ITT and per protocol analysis. There were also no differences between the two groups in mean gestational weight gain, gestational diabetes, birth weight, infant length, and head circumference.

CONCLUSIONS

While the RCT did not support the benefits of exercise performed during pregnancy on preeclampsia and preterm birth, the exercise program also did not present adverse impacts on newborn health. Our findings may contribute to promote intervention strategies that motivate health providers to encourage pregnant women to be more physically active.

TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT02148965 , registered on 22 May 2014.

Mortalidade materna no Brasil no período de 2001 a 2012: tendência temporal e diferenças regionais

RESUMO: Objetivo: Avaliar a tendência de mortalidade materna no Brasil e nas cinco regiões brasileiras, de 2001 a 2012, e descrever suas principais causas. Métodos: Trata-se de uma série temporal, a partir de dados obtidos no Sistema de Informação sobre Mortalidade e no Sistema de Informação sobre Nascidos Vivos. A razão de mortalidade materna e as causas de morte materna foram descritas conforme as categorias da 10ª revisão da Classificação Internacional de Doenças, nos anos de 2001, 2006 e 2011. Para estimar a tendência temporal foi utilizada a regressão linear. Resultados: A razão de mortalidade materna mais elevada no Brasil foi no ano de 2009 (77,31 por 100 mil nascidos vivos). Foi observada tendência significativa de diminuição da razão de mortalidade materna para as regiões Nordeste e Sul e de aumento na região Centro-Oeste. Houve incremento nas mortes por outras afecções obstétricas e uma queda nas mortes por edema, proteinúria e transtornos hipertensivos. Conclusão: Embora tenham sido observadas tendências de diminuição da razão de mortalidade materna para o Nordeste e o Sul, as elevadas taxas observadas para o Brasil evidenciam a necessidade de melhoria à assistência pré-natal, ao parto e ao puerpério.

Burden of physical inactivity and hospitalization costs due to chronic diseases

OBJECTIVE

To evaluate the physical inactivity-related inpatient costs of chronic non-communicable diseases.

METHODS

This study used data from 2013, from Brazilian Unified Health System, regarding inpatient numbers and costs due to malignant colon and breast neoplasms, cerebrovascular diseases, ischemic heart diseases, hypertension, diabetes, and osteoporosis. In order to calculate the share physical inactivity represents in that, the physical inactivity-related risks, which apply to each disease, were considered, and physical inactivity prevalence during leisure activities was obtained from Pesquisa Nacional por Amostra de Domicílio (Brazil’s National Household Sample Survey). The analysis was stratified by genders and residing country regions of subjects who were 40 years or older. The physical inactivity-related hospitalization cost regarding each cause was multiplied by the respective share it regarded to.

RESULTS

In 2013, 974,641 patients were admitted due to seven different causes in Brazil, which represented a high cost. South region was found to have the highest patient admission rate in most studied causes. The highest prevalences for physical inactivity were observed in North and Northeast regions. The highest inactivity-related share in men was found for osteoporosis in all regions (≈ 35.0%), whereas diabetes was found to have a higher share regarding inactivity in women (33.0% to 37.0% variation in the regions). Ischemic heart diseases accounted for the highest total costs that could be linked to physical inactivity in all regions and for both genders, being followed by cerebrovascular diseases. Approximately 15.0% of inpatient costs from Brazilian Unified Health System were connected to physical inactivity.

CONCLUSIONS

Physical inactivity significantly impacts the number of patient admissions due to the evaluated causes and through their resulting costs, with different genders and country regions representing different shares.

Physical activity during pregnancy and maternal-child health (PAMELA): study protocol for a randomized controlled trial

Background

Preterm birth is associated with most cases of neonatal deaths and negative health outcomes, and hypertensive disorders. Hypertension is influenced by maternal behavior, such as physical activity. Physical activity is associated with better outcomes for mother and fetus, besides healthier weight gains during pregnancy. Few women are physically active during pregnancy and few clinical trials have been carried out with pregnant women. The aim of this paper is to describe the protocol of a controlled trial evaluating whether regular exercise during pregnancy may result in improved maternal-child health and neonatal outcomes.

Methods/Design

The PAMELA (Physical Activity for Mothers Enrolled in Longitudinal Analysis) trial is a randomized controlled trial nested in a birth cohort study. Eligible women belonging to the birth cohort will be invited (between the 16th and 20th week of gestation) to enroll in the trial. Baseline data (blood and urine samples, anthropometry and pulmonary function) will be collected at enrollment. The same assessments will be repeated eight and 16 weeks after baseline. After randomization, women will be allocated into either one of these groups: control, 426 women who will be advised to keep their usual daily activities; and intervention, 213 women who will engage in an exercise program, three sessions a week. At least 70 % attendance over 16 weeks will be required to be considered compliant to the intervention. Exercise protocol will include aerobics, strength and flexibility training. Maternal and child outcomes will be measured at the 36th week of gestation, at birth and at three, 12, 24 and 48 months postpartum. An intention-to-treat analysis will be performed.

Discussion

Few women are active during pregnancy and a vast majority decrease their activities or even quit exercising. We present a population-based regular exercise intervention focused on the prevention of hypertension, pre-eclampsia and preterm birth. Data on the underlying cohort will allow future analysis using different outcomes with low probability of recall bias or misclassification of exposure status. Results will potentially influence prenatal care counseling in regards to physical activity.

Trial registration

Clinicaltrials.gov identifier: NCT02148965, registered on 22 May 2014.

Inter-machine reliability of the Biodex and Cybex isokinetic dynamometers for knee flexor/extensor isometric, concentric and eccentric tests

OBJECTIVES

To assess the inter-machine reliability of the Biodex System 3 Pro and Cybex Humac Norm Model 770 dynamometers for knee extensor and knee flexor peak torque measurements in isometric, concentric and eccentric tests.

DESIGN

Randomized/crossover.

SETTING

Exercise Research Laboratory, Federal University of Rio Grande do Sul (Brazil).

PARTICIPANTS

25 healthy male subjects.

MAIN OUTCOME MEASURES

Isometric, concentric and eccentric knee extensor and knee flexor peak torques recorded in the same test procedure performed on both isokinetic dynamometers. One-way ANOVA, intraclass correlation coefficient (ICC), standard error of measurement (SEM) and coefficient of variation (CV) were used to verify significant differences, relative and absolute reliability between devices.

RESULTS

No significant differences were found between tests performed on Biodex and Cybex (p > 0.05). ICC values indicated a high to very high reproducibility for isometric, concentric and eccentric peak torques (0.88-0.92), and moderate to high reliability for agonist-antagonist strength ratios (0.62-0.73). Peak torque did not show great difference between dynamometers for SEM (3.72-11.27 Nm) and CV (5.27-7.77%). Strength ratios presented CV values of 8.57-10.72%.

CONCLUSION

Maximal knee extensor and knee flexor tests performed in isometric (60° of knee flexion), concentric and eccentric modes at 60°/s in Biodex and Cybex dynamometers present similar values.

Avaliação Isocinética em Jogadores de Futebol Profissional e Comparação do Desempenho Entre as Diferentes Posições Ocupadas no Campo

O objetivo geral deste estudo foi o de analisar os dados de pico de torque (PT) e índice de fadiga coletados em testes isocinéticos de atacantes (A), meias (M) e defesas (D), a fim de traçar um perfil destes atletas. A amostra foi constituída de 27 jogadores profissionais de futebol com média de idade de 26,55 ± 5,1 anos, divididos nos grupos A (seis), M (sete) e D (14). Os atletas foram submetidos a teste isocinético com cinco repetições máximas de flexão (concêntrica e excêntrica) e extensão (concêntrica) do joelho na velocidade de 60°/s e 30 repetições máximas de flexão e extensão (concêntricas) do joelho na velocidade de 300°/s. A partir dos dados coletados, foi observado que o grupo D apresentou valores significativamente mais elevados de PT concêntrico de flexores do lado dominante (LD) a 60°/s em comparação ao M (p = 0,05). No entanto, para as demais variáveis de PT e índice de fadiga não foram encontradas diferenças entre as posições. Com relação ao déficit bilateral (DB), os atletas apresentaram valores dentro da normalidade. Quanto às razões, foi observado que os jogadores encontravam-se dentro dos valores normativos para razão convencional, porém estavam abaixo dos valores normais para a razão funcional. Conclui-se que, apesar de desempenharem funções diferentes dentro do campo, isso não parece influenciar decisivamente a maioria das características neuromusculares dos membros inferiores nos atletas de futebol avaliados.