Background We investigated the validity of REE predictive equations before and after 12-week energy-restricted diet intervention in Spanish obese (30 kg/m2>BMI<40 kg/m2) women. Methods We measured REE (indirect calorimetry), body weight, height, and fat mass (FM) and fat free mass (FFM, dual X-ray absorptiometry) in 86 obese Caucasian premenopausal women aged 36.7±7.2 y, before and after (n = 78 women) the intervention. We investigated the accuracy of ten REE predictive equations using weight, height, age, FFM and FM. Results At baseline, the most accurate equation was the Mifflin et al. (Am J Clin Nutr 1990; 51: 241–247) when using weight (bias:−0.2%, P = 0.982), 74% of accurate predictions. This level of accuracy was not reached after the diet intervention (24% accurate prediction). After the intervention, the lowest bias was found with the Owen et al. (Am J Clin Nutr 1986; 44: 1–19) equation when using weight (bias:−1.7%, P = 0.044), 81% accurate prediction, yet it provided 53% accurate predictions at baseline. Conclusions There is a wide variation in the accuracy of REE predictive equations before and after weight loss in non-morbid obese women. The results acquire especial relevance in the context of the challenging weight regain phenomenon for the overweight/obese population. ; The present study was supported by the University of the Basque Country (UPV 05/80), Social Foundation of the Caja Vital- Kutxa and by the Department of Health of the Government of the Basque Country (2008/111062), and by the Spanish Ministry of Science and Innovation (RYC-2010-05957).
Aims Cardiorespiratory fitness, muscular strength, and obesity in adulthood are risk factors for cardiovascular disease (CVD). However, Little is known regarding the associations of these risk factors, already in adolescence, with later disability due to chronic CVD. Hence, we investigated associations of cardiorespiratory fitness, muscular strength, and body mass index (BMI) in adolescence with Later chronic disability due to specific causes of CVD disability (i.e. cerebrovascutar disease, ischaemic heart disease and heart failure). Methods and results This population-based cohort study included 1 078 685 male adolescents (16-19 years) from the Swedish military conscription register from 1972 to 1994. Cardiorespiratory fitness (bicycle ergometer test), muscular strength (knee extension strength), and BMI were measured during the conscription examination. Information about disability pension due to CVD was retrieved from the Social Insurance Agency during a mean follow-up of 28.4 years. Cardiorespiratory fitness was strongly and inversely associated with later risk of chronic CVD disability for all investigated causes. The association was particularly strong for ischaemic heart diseases (hazard ratio 0.11, 95% confidence interval 0.05-0.29 for highest vs. lowest fitness-quintiles). Furthermore, overweight/obesity were associated with CVD disability for all investigated causes. Conversely, associations of muscular strength with CVD disability were generally weak. Conclusions This study provides evidence for associations between low levels of cardiorespiratory fitness and obesity with later risk of chronic disability due to CVD. Preventive actions may begin at young ages and include promotion of cardiorespiratory fitness and healthy body weight. ; Funding Agencies|Karolinska InstitutetKarolinska Institutet [201802043]; Swedish Society of Medicine; County Council of Ostergotland, Sweden; Henning and Johan Throne-Holst Foundation; Strategic Research Area Health Care Science, Karolinska Institutet/Umea University; European UnionEuropean Union (EU) [667 302]; University of Granada Plan Propio de Investigacion 2016-Excellence actions: Unit of Excellence on Exercise and Health (UCEES); Junta de Andalucia, Consejeria de Conocimiento, Investigacion y Universidades European Regional Development Fund (ERDF) [SOMM17/6107/UGR]; SAMID III network, RETICS - PN IthornDthornI 2017-2021 (Spain), ISCIII-Sub-Directorate General for Research Assessment and Promotion (ERDF) [RD16/0022]; EXERNET Research Network on Exercise and Health in Special Populations [DEP200500046/ACTI]
There is a general belief that having breakfast is an important healthy lifestyle factor; however, there is scarce evidence on the influence of breakfast quality and energy density on cardiometabolic risk in children, as well as on the role of physical activity in this association. The aims of this paper were (i) to examine the associations of breakfast quality and energy density from both solids and beverages with cardiometabolic risk factors, and (ii) to explore whether physical activity levels may attenuate these relationships in children with overweight/obesity from two projects carried out in the north and south of Spain. Breakfast consumption, breakfast quality index (BQI) score, BEDs/BEDb (24 h-recalls and the KIDMED questionnaire), and physical activity (PA; accelerometry) were assessed, in 203 children aged 8–12 years who were overweight or obese. We measured body composition (Dual X-ray Absorptiometry), uric acid, blood pressure, lipid profile, gamma-glutamyl-transferase (GGT), glucose, and insulin, and calculated the HOMA and metabolic syndrome z-score. The BQI score was inversely associated with serum uric acid independently of a set of relevant confounders β = -0.172, ρ = 0.028), but the relationship was attenuated after further controlling for total PA (ρ < 0.07). BEDs was positively associated with total and HDL cholesterol, and systolic blood pressure regardless of confounders (all ρ < 0.05), while BEDb was positively associated with HOMA in either active/inactive children (all ρ < 0.03). In conclusion, higher breakfast quality and lower breakfast energy density should be promoted in overweight/obesity children to improve their cardiometabolic health. ; EFIGRO and ActiveBrains projects were supported by the Spanish Ministry of Industry and Competitiveness (DEP2016-78377-R and DEP2013-47540) by "Fondos Estructurales de la Unión Europea (FEDER), Una manera de hacer Europa". The EFIGRO project was also supported by the University of the Basque Country (GIU14/21). LA was supported by a grant from the Education Department of the Government of Basque Country (PRE_2016_1_0057 and PRE_2017_2_0224), MM is supported by a grant from the Spanish Ministry of Education, Culture, and Sport (FPU14/03329) and EST17/00210, MO was supported by a grant from the Spanish Ministry of Science, Innovation, and Universities (BES-2017-080770), whereas MA was supported by a grant from the University of the Basque Country (PIF 17/186). JRR, FBO, and CC-S were also supported by grants from the Spanish Ministry of Economy and Competitiveness (RYC 2010-05957; RYC-2011-09011 and BES-2014-068829).
The objective of the present cross-sectional study was to examine the associations of physical activity and the adherence to the Mediterranean dietary pattern (MDP) with bone mineral content (BMC) and density (BMD) in children with overweight and obesity. A total of 177 (n = 80 girls) children with overweight and obesity aged 8 to 12 years old participated in the study. Both BMC and BMD were assessed by Dual-Energy X-ray absorptiometry. Dietary patterns were assessed by the KIDMED questionnaire and two 24-hour recalls. Physical activity was assessed by accelerometers for 7 consecutive days (24 hours/day). Low adherence to the MDP was observed in 82.4% of participants. Higher physical activity levels (of at least moderate intensity) and lower sedentary time were significantly associated with BMC and BMD in children with low adherence to the MDP (all p < 0.05). No associations were observed between physical activity and BMC and BMD in children with high adherence to the MDP. In conclusion, engaging in moderate to vigorous physical activity and reducing the time spent in sedentary behavior might be particularly beneficial for improving bone health in overweight or obese children with poor adherence to the Mediterranean dietary pattern. ; The ActiveBrains Project was funded by the Spanish Ministry of Economy and Competitiveness (Reference DEP2013-47540 and DEP2016-79512-R). EFIGRO was supported by the Spanish Ministry of Health, "Fondo de Investigación Sanitaria del Instituto de Salud Carlos III" (PI13/01335), "Fondos Estructurales de la Unión Europea (FEDER), Una manera de hacer Europa", by the University of the Basque Country (GIU14/21), and by the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES). LGM is funded by Programa de Captación de Talento-UGR Fellows. MM is supported by grant from the Spanish Ministry of Education, Culture and Sport (FPU14/03329) and EST17/00210. LA is supported by a grant from Education, Linguistic Policy, and Culture Department of the Government of the Basque Country (PRE_2016_1_0057).
Background: The global pandemic of obesity has led to an increased risk for prediabetes and type-2 diabetes (T2D). The aims of the current project are: (1) to evaluate the effect of a 22-week family based intervention program, including supervised exercise, on insulin resistance syndrome (IRS) risk in children with a high risk of developing T2D and (2) to identify the profile of microRNA in circulating exosomes and in peripheral blood mononuclear cells in children with a high risk of developing T2D and its response to a multidisciplinary intervention program including exercise. Methods: A total of 84 children, aged 8-12 years, with a high risk of T2D will be included and randomly assigned to control (N = 42) or intervention (N = 42) groups. The control group will receive a family based lifestyle education and psycho-educational program (2 days/month), while the intervention group will attend the same lifestyle education and psycho-educational program plus the exercise program (3 days/week, 90 min per session including warm-up, moderate to vigorous aerobic activities, and strength exercises). The following measurements will be evaluated at baseline prior to randomization and after the intervention: fasting insulin, glucose and hemoglobin A1c; body composition (dual-energy X-ray absorptiometry); ectopic fat (magnetic resonance imaging); microRNA expression in circulating exosomes and in peripheral blood mononuclear cells (MiSeq; Illumina); cardiorespiratory fitness (cardiopulmonary exercise testing); dietary habits and physical activity (accelerometry). Discussion: Prevention and identification of children with a high risk of developing T2D could help to improve their cardiovascular health and to reduce the comorbidities associated with obesity. ; The Spanish Ministry of Industry and Competitiveness (DEP2016-78377-R), by "Fondos Estructurales de la Unión Europea (FEDER), Una manera de hacer Europa." and by the University of the Basque Country (GIU14/21). This work was also supported by grants from Spanish Ministry of Economy and Competitiveness (RYC-2010-05957; RYC- 2011-09011), Spanish Ministry of Education, Culture and Sports (FPU14/ 03329) and by the Education, Linguistic Policy and Culture Department of the Government of the Basque Country (PRE_2016_1_0057).
The aim of this study was to examine whether metabolically healthy overweight/obese children have greater global and regional gray matter volumes than their metabolically unhealthy peers. We further examined the association between gray matter volume and academic achievement, along with the role of cardiorespiratory fitness in these associations. A total of 97 overweight/obese children (10.0 +/- 1.2 years) participated. We classified children as metabolically healthy/unhealthy based on metabolic syndrome cut-offs. Global and regional brain volumes were assessed by magnetic resonance imaging. Academic achievement was assessed using the Woodcock-Munoz standardized test. Cardiorespiratory fitness was assessed by the 20 m shuttle run test. Metabolically healthy overweight/obese (MHO) children had greater regional gray matter volume compared to those who were metabolically unhealthy (MUO) (all p 0.05). The findings of the present study support that metabolically healthy overweight/obese children have greater gray matter volume compared to those that are metabolically unhealthy, which is in turn related to better academic achievement. However, cardiorespiratory fitness seems to explain, at least partially, these findings. ; Funding Agencies|Spanish Ministry of Economy and Competitiveness [RTI2018-095284-J-100]; Fondo Europeo de Desarrollo Regional (FEDER)European Union (EU) [DEP2013-47540, DEP2016-79512-R, DEP2017-91544-EXP, RYC-2011-09011]; Government of Andalusian, Integrated Territorial Initiative 2014-2020 [PI-0002-2017]; Spanish Ministry of Science and InnovationSpanish Government [FJC2018-037925-I]; Alicia Koplowitz Foundation; Spanish Ministry of Education, Culture and Sport [FPU15/02645, FPU14/06837]; Spanish Ministry of Science, Innovation and Universities [FJCI-2017-33396]; Strategic Research Area Health Care Science, Karolinska Institutet/Umea University; University of Granada, Plan Propio de Investigacion 2016, Excellence actions: Units of Excellence; Scientific Excellence Unit on Exercise and Health (UCEES); Junta de AndaluciaJunta de Andalucia; Consejeria de Conocimiento, Investigacion y Universidades; European Regional Development FundsEuropean Union (EU) [SOMM17/6107/UGR]; SAMID III network; RETICS - PN I + D + I 2017-2021 (Spain); ISCIII-Sub-Directorate General for Research Assessment and Promotion; European Regional Development Fund (ERDF)European Union (EU) [RD16/0022]; EXERNET Research Network on Exercise and Health in Special Populations [DEP2005-00046/ACTI]; European Unions 2020 research and innovation programEuropean Union (EU) [667302]
Background: Best-practice early interventions to increase physical activity (PA) in children with overweight and obesity should be both feasible and evidence based. Walking is a basic human movement pattern that is practical, cost-effective, and does not require complex movement skills. However, there is still a need to investigate how much walking—as a proportion of total PA level—is performed by children who are overweight and obese in order to determine its utility as a public health strategy. Objective: This study aimed to (1) investigate the proportion of overall PA indicators that are explained by step-based metrics and (2) study step accumulation patterns relative to achievement of public health recommendations in children who are overweight and obese. Methods: A total of 105 overweight and obese children (mean 10.1 years of age [SD 1.1]; 43 girls) wore hip-worn accelerometers for 7 days. PA volumes were derived using the daily average of counts per 15 seconds, categorized using standard cut points for light-moderate-vigorous PA (LMVPA) and moderate-to-vigorous PA (MVPA). Derived step-based metrics included volume (steps/day), time in cadence bands, and peak 1-minute, 30-minute, and 60-minute cadences. Results: Steps per day explained 66%, 40%, and 74% of variance for counts per 15 seconds, LMVPA, and MVPA, respectively. The variance explained was increased up to 80%, 92%, and 77% by including specific cadence bands and peak cadences. Children meeting the World Health Organization recommendation of 60 minutes per day of MVPA spent less time at zero cadence and more time in cadence bands representing sporadic movement to brisk walking (ie, 20-119 steps/min) than their less-active peers. Conclusions: Step-based metrics, including steps per day and various cadence-based metrics, seem to capture a large proportion of PA for children who are overweight and obese. Given the availability of pedometers, step-based metrics could be useful in discriminating between those children who do or do not achieve MVPA recommendations. ; MINECO (Ministerio de Economia y COmpetitividad)/FEDER (Fondo Europeo de DEsarrollo Regional) DEP2013-47540 DEP2016-79512-R RYC-2011-09011 ; Spanish Ministry of Education, Culture and Sport FPU15/02645 FPU14/06837 ; Spanish Ministry of Economy and Competitiveness BES-2014-068829 ; European Union (EU) 667302 ; University of Granada, Plan Propio de Investigacion 2016, Excellence action: Units of Excellence University of Granada, Plan Propio de Investigacion 2016, Excellence action: Unit of Excellence on Exercise and Health (UCEES) ; Junta de Andalucia SOMM17/6107/UGR RD16/0022 ; Consejeria de Conocimiento, Investigacion y Universidades SOMM17/6107/UGR RD16/0022 ; European Union (EU) SOMM17/6107/UGR RD16/0022 ; SAMID III (red de SAlud Materno Infantil y Desarrollo) network, RETICS (REdes Tematicas de Investigacion Cooperativa en Salud) - PN (Plan Nacional) I+D+I (Investigacion + Desarrollo + Innovacion) 2017-2021 (Spain) ; ISCIII (Instituto de Salud Carlos III)-Sub-Directorate General for Research Assessment and Promotion DEP2005-00046/ACTI ; EXERNET Research Network on Exercise and Health in Special Populations DEP2005-00046/ACTI ; Intramural Research Program at the National Institute on Aging, USA
[Abstract] Introduction: Physical activity (PA) is essential to healthy mental and physical development in early life. However, the prevalence of physical inactivity, which is considered a key modifiable driver of childhood obesity, has reached alarming levels among European youth. There is a need to update the data for Spain, in order to establish if current measures are effective or new approaches are needed. Methods and analysis: We present the protocol for Physical Activity, Sedentarism, lifestyles and Obesity in Spanish youth (PASOS). This observational, nationally representative, multicentre study aims to determine the PA levels, sedentary behaviours and prevalence of physical inactivity (defined as <60 min of moderate to vigorous PA per day) in a representative sample of Spanish children and adolescents. The PASOS study has recruited a representative random sample of children and adolescents aged 8–16 years from 242 educational centres in the 17 'autonomous regions' into which Spain is divided. The aim is to include a total of 4508 youth participants and their families. Weight, height and waist circumference will be measured by standardised procedures. Adherence to the Mediterranean diet, quality of life, sleep duration, PA and sedentary behaviour are being measured by validated questionnaires. PA is measured by the Physical Activity Unit 7-item Screener. A representative subsample (10% of participants) was randomly selected to wear accelerometers for 9 days to obtain objective data on PA. Parents are asked about their educational level, time spent doing PA, diet quality, self-perceived stress, smoking habit, weight, height, their child's birth weight and if the child was breast fed. ; PASOS study has been funded mainly by Fundación PROBITAS and Gasol Foundation. Additional funds were received from the Barça Foundation, Banco Santander, IFA, Viena and Fundación Deporte Jóven. MMB is funded by the official funding agency for biomedical research of the Spanish government, Institute of Health Carlos III (ISCIII), which is cofunded by the European Regional Development Fund (CIBEROBN CB12/03/30038), grant of support to research groups number 35/2011 (Balearic Islands Gov) and EU COST Action CA16112. PASOS has the institutional support of Spain's Ministry of Education and Vocational Training, the Ministry of Health, Consumption and Social Welfare through the Spanish Agency for Food Safety and Nutrition (ASEAN), the High Commission against Child Poverty, the High Sports Council, the General College of Professional Associations of Physical Education and Sports, and the Departments of Education and/or Health and/or Sports of Spain's 17 autonomous regions. The CIBERESP and the CIBEROBN are initiatives of the Institute of Health Carlos III, Madrid, Spain. ; Gobierno de las Islas Baleares; 35/2011 ; European Cooperation in Science and Technology; CA16112
Background: Previous studies suggest that dietary protein might play a beneficial role in combating obesity and its related chronic diseases. Total, animal and plant protein intakes and their associations with anthropometry and serum biomarkers in European adolescents using one standardised methodology across European countries are not well documented. ; Objectives: To evaluate total, animal and plant protein intakes in European adolescents stratified by gender and age, and to investigate their associations with cardio-metabolic indicators (anthropometry and biomarkers). ; Methods: The current analysis included 1804 randomly selected adolescents participating in the HELENA study (conducted in 2006–2007) aged 12.5-17.5 y (47% males) who completed two non-consecutive computerised 24-h dietary recalls. Associations between animal and plant protein intakes, and anthropometry and serum biomarkers were examined with General linear Model multivariate analysis. ; Results: Average total protein intake exceeded the recommendations of World Health Organization and European Food Safety Authority. Mean total protein intake was 96 g/d (59% derived from animal protein). Total, animal and plant protein intakes (g/d) were significantly lower in females than in males and total and plant protein intakes were lower in younger participants (12.5-14.9 y). Protein intake was significantly lower in underweight subjects and higher in obese ones; the direction of the relationship was reversed after adjustments for body weight (g/(kg.d)). The inverse association of plant protein intakes was stronger with BMI z-score and body fat percentage (BF%) compared to animal protein intakes. Additionally, BMI and BF% were positively associated with energy percentage of animal protein. ; Conclusions: This sample of European adolescents appeared to have adequate total protein intake. Our findings suggest that plant protein intakes may play a role in preventing obesity among European adolescents. Further longitudinal studies are needed to investigate the potential beneficial effects observed in this study in the prevention of obesity and related chronic diseases. ; The HELENA-study took place with the financial support of the European Community Sixth RTD Framework Programme. This work was also partially supported by the European Union in the framework of the Public Health Programme, the Swedish Council for Working Life and Social Research (FAS), the Spanish Ministry of Education, and the Spanish Ministry of Health, Maternal, Child Health and Development Network and the Spanish Ministry of Science and Innovation AGL2007-29784-E. The content of this paper reflect only the authors' views and the rest of HELENA-study members and the European Community is not liable for any use that may be made of the information contained therein. Augusto César F. de Moraes is in receipt of a PhD scholarship from the São Paulo State Research Foundation (FAPESP: proc. 2011/11137-1 and 2011/20662-2) and Postdoctoral Research Fellow scholarship from National Counsel of Technological and Scientific Development (CNPq: proc. 313772/2014-2); Luis A. Moreno was given scholarship of Visiting Professor from Brazilian government by Science without Borders Program by CNPq and CAPES (Coordination of Improvement of Higher Education Personnel) (proc. 007/2012). The GENUD Research Group co-financed by the European Regional Development Fund (MICINN-FEDER).
[Abstract] The aim of this study is to evaluate if screen time and parents' education levels are associated with adherence to a Mediterranean dietary pattern. This cross-sectional study analyzed a representative sample of 3333 children and adolescents (8 to 16 years) included in the Physical Activity, Sedentarism, lifestyles and Obesity in Spanish youth (PASOS) study in Spain (which ran from March 2019 to February 2020). Data on screen time (television, computer, video games, and mobile phone) per day, Mediterranean diet adherence, daily moderate or vigorous physical activity, and parents' education levels were gathered using questionnaires. A descriptive study of the variables according to sex and parents' education level was performed. Logistic regression models (adjusted by sex and weight status) were fitted to evaluate the independent association between screen time and Kids' level of adherence to the Mediterranean diet (KIDMED) index, as well as some of its items. A greater amount of screen time was associated with worse adherence to the Mediterranean diet; a lower consumption of fruit, vegetables, fish, legumes, and nuts; and a greater consumption of fast food, sweets, and candies. A lower parents' education level was associated with worse adherence to the Mediterranean diet. It is necessary to promote the responsible, limited use of screen time, especially in children with parents with a lower education level. ; The PASOS study was funded by Fundación PROBITAS and the Gasol Foundation. Additional funds were received from the Barça Foundation, Banco Santander, IFA, Vienna and the Fundación Deporte Jóven. J.A.T. and M.M.B. are funded by the official funding agency for biomedical research of the Spanish government, the Institute of Health Carlos III (ISCIII), which is co-funded by the European Regional Development Fund (CIBEROBN CB12/03/30038).
The online version contains supplementary material available at https://doi.org/10.1186/s12966-021-01169-w Additional file 1 Supplementary Table 1.Characteristics of the validation study participants and the remaining participants of the population-based PASOS cohort. Additional file 2 Supplementary Table 2.Correlation coefficients and between-method agreement of moderate to vigorous physical activity measurements derived by the Physical Activity Unit 7-item screener, non-calibrated and calibrated, and the reference method (accelerometer),stratified by age ; [Abstract] Background Validation of self-reported tools, such as physical activity (PA) questionnaires, is crucial. The aim of this study was to determine test-retest reliability, internal consistency, and the concurrent, construct, and predictive validity of the short semi-quantitative Physical Activity Unit 7 item Screener (PAU-7S), using accelerometry as the reference measurement. The effect of linear calibration on PAU-7S validity was tested. Methods A randomized sample of 321 healthy children aged 8–16 years (149 boys, 172 girls) from the nationwide representative PASOS study completed the PAU-7S before and after wearing an accelerometer for at least 7 consecutive days. Weight, height, and waist circumference were measured. Cronbach alpha was calculated for internal consistency. Test-retest reliability was determined by intra-class correlation (ICC). Concurrent validity was assessed by ICC and Spearman correlation coefficient between moderate to vigorous PA (MVPA) derived by the PAU-7S and by accelerometer. Concordance between both methods was analyzed by absolute agreement, weighted kappa, and Bland-Altman statistics. Multiple linear regression models were fitted for construct validity and predictive validity was determined by leave-one-out cross-validation. Results The PAU-7S overestimated MVPA by 18%, compared to accelerometers (106.5 ± 77.0 vs 95.2 ± 33.2 min/day, respectively). A Cronbach alpha of 0.76 showed an acceptable internal consistency of the PAU-7S. Test-retest reliability was good (ICC 0.71 p < 0.001). Spearman correlation and ICC coefficients of MVPA derived by the PAU-7S and accelerometers increased from 0.31 to 0.62 and 0.20 to 0.62, respectively, after calibration of the PAU-7S. Between-methods concordance improved from a weighted kappa of 0.24 to 0.50 after calibration. A slight reduction in ICC, from 0.62 to 0.60, yielded good predictive validity. Multiple linear regression models showed an inverse association of MVPA with standardized body mass index (β − 0.162; p < 0.077) and waist to height ratio (β − 0.010; p < 0.014). All validity dimensions were somewhat stronger in boys compared to girls. Conclusion The PAU-7S shows a good test-retest reliability and acceptable internal consistency. All dimensions of validity increased from poor/fair to moderate/good after calibration. The PAU-7S is a valid instrument for measuring MVPA in children and adolescents. ; PASOS study has been funded mainly by Fundación PROBITAS and Gasol Foundation. Additional funds were received from the Barça Foundation, Banco Santander, Grupo IFA, Viena and Fundación Deporte Jóven, grant of support to research groups number 35/2011 (Balearic Islands Gov) and EU COST Action CA16112. J.A.T. and M.M.B. are funded by the official funding agency for biomedical research of the Spanish government, Institute of Health Carlos III (ISCIII), which is cofunded by the 333 European Regional Development Fund (CIBEROBN CB12/03/30038). PASOS has the institutional support of Spain's Ministry of Education and Vocational Training, the Ministry of Health, Consumption and Social Welfare through the Spanish Agency for Food Safety and Nutrition (ASEAN), the High Commission against Child Poverty, the High Sports Council, the General College of Professional Associations of Physical Education and Sports, and the Departments of Education and/or Health and/or Sports of Spain's 17 autonomous regions. The CIBERESP and the CIBEROBN are initiatives of the Institute of Health Carlos III, Madrid, Spain. ; Gobierno de las Islas Baleares; 35/2011 ; European Cooperation in Science and Technology; CA16112
The aim of this study is to evaluate if screen time and parents' education levels are associated with adherence to a Mediterranean dietary pattern. This cross-sectional study analyzed a representative sample of 3333 children and adolescents (8 to 16 years) included in the Physical Activity, Sedentarism, lifestyles and Obesity in Spanish youth (PASOS) study in Spain (which ran from March 2019 to February 2020). Data on screen time (television, computer, video games, and mobile phone) per day, Mediterranean diet adherence, daily moderate or vigorous physical activity, and parents' education levels were gathered using questionnaires. A descriptive study of the variables according to sex and parents' education level was performed. Logistic regression models (adjusted by sex and weight status) were fitted to evaluate the independent association between screen time and Kids' level of adherence to the Mediterranean diet (KIDMED) index, as well as some of its items. A greater amount of screen time was associated with worse adherence to the Mediterranean diet; a lower consumption of fruit, vegetables, fish, legumes, and nuts; and a greater consumption of fast food, sweets, and candies. A lower parents' education level was associated with worse adherence to the Mediterranean diet. It is necessary to promote the responsible, limited use of screen time, especially in children with parents with a lower education level. ; The PASOS study was funded by Fundación PROBITAS and the Gasol Foundation. Additional funds were received from the Barça Foundation, Banco Santander, IFA, Vienna and the Fundación Deporte Jóven. J.A.T. and M.M.B. are funded by the official funding agency for biomedical research of the Spanish government, the Institute of Health Carlos III (ISCIII), which is co-funded by the European Regional Development Fund (CIBEROBN CB12/03/30038).
