Carla Moreira

Abstract: The aim of this study was to verify the relation between body mass index (BMI) and sitting time in a sample of 4,091 Azorean men. BMI was calculated from self-reported weight and height. Total physical activity (PA) time and total sitting time were assessed with the IPAQ (short version). Linear Regression analysis showed that total sitting time (hours/day) was positively associated with BMI (B = 0.078; p < 0.001) after adjustments for age, meal frequency, alcohol and tobacco consumptions, island of residence, education level and total PA time. Although the cross sectional design precludes us from establishing causality, our findings emphasize the importance of reducing sedentary behavior to decrease the risk of obesity.

Lack of physical activity is a global public health problem causing not only morbidity and premature mortality, but it is also a major economic burden worldwide. One of the cornerstones of a physically active lifestyle is Motor Competence (MC). MC is a complex biocultural attribute and therefore, its study requires a multi-sectoral, multi-, inter- and transdisciplinary approach. MC is a growing area of research, especially in children and adolescents due to its positive association with a plethora of health and developmental outcomes. Many questions, however, remain to be answered in this field of research, with regard to: (i) Health and Developmental-related Associations of MC; (ii) Assessment of MC; (iii) Prevalence and Trends of MC; (iv) Correlates and Determinants of MC; (v) MC Interventions, and (vi) Translating MC Research into Practice and Policy. This paper presents a narrative review of the literature, summarizing current knowledge, identifying key research gaps and present...

This study aimed to investigate the association between dairy product consumption and metabolic and inflammatory biomarkers in Portuguese adolescents, and whether the association differed by weight status. A cross-sectional study was conducted during the school year 2011/2012 with 412 Portuguese adolescents (52.4% girls) in 7th and 10th grade (aged 12 to 18 years old). The World Health Organization cutoffs were used to categorize adolescents as non-overweight (NW) or overweight (OW). Blood samples were collected to analyze C-reactive protein (CRP), interleukin-6 (IL-6), leptin, and adiponectin. Dairy product intake was evaluated using a food frequency questionnaire. Participants were divided by tertiles according to the amount of dairy product consumed. The associations between dairy product consumption with metabolic and inflammatory biomarkers were evaluated using generalized linear regression models with logarithmic link and gamma distribution and adjusted for potential confounde...

The purpose of this study was to examine the longitudinal associations between cardiorespiratory fitness and health‐related quality of life (HRQoL) in a sample of adolescents, and to determine whether changes in cardiorespiratory fitness were associated with HRQoL over a 2‐year follow‐up.

Low-grade inflammation leads to several metabolic disorders, and adherence to a Mediterranean diet (MedDiet), cardiorespiratory fitness (CRF), and muscular fitness (MF) has been considered important markers of metabolic healthy in youth. We investigated the combined association of adherence to Mediterranean diet, and muscular and cardiorespiratory fitness on high-sensitivity C-reactive protein (hs-CRP) in adolescents. This is a cross-sectional analysis with 1462 adolescents (625 girls) aged 9-18 years from Colombia and Portugal. MedDiet was assessed by Kidmed questionnaire. Shuttle run test was used to assess CRF. MF was assessed by the standing long-jump and handgrip tests. High-sensitivity assays were used to obtain the hs-CRP level. Logistic regression shows that subjects with a low adherence to MedDiet and LowMF/LowCRF had a similar odds (OR = 2.3; 95% CI 1.2-4.0) as those with an optimal adherence to MedDiet and LowMF/LowCRF (OR = 2.3; 95% CI 1.2-5.0) of expressing high inflamm...

The aims of this study were to examine the longitudinal association between muscular fitness (MF) and blood pressure (BP) 2 years later, and to determine whether changes in MF over a 2-year period were associated with BP at follow-up, in adolescents. The sample comprised 734 youths (349 girls) aged from 12 to 18 years. MF was assessed with the standing long jump and handgrip tests. Socioeconomic status, pubertal stage, waist circumference, resting BP, and cardiorespiratory fitness were measured according to standard procedures. Regression analyses showed a significant inverse association between MF at baseline and systolic BP (β = - 0.072; p = 0.032) and rate pressure product (β = - 0.124; p < 0.001) at follow-up, after adjustments for age, sex, height, pubertal stage, and socioeconomic status. However, when analyses were further adjusted for waist circumference and cardiorespiratory fitness, these associations did not remain significant. Adolescents with persistently high and in...

Background The environmental correlates have been extensively studied in the last years, but most associations with physical fitness (PF) and body composition have been cross-sectional in nature. Objective This study aimed to determine if adolescents' environmental perceptions associated with PF and body composition in a 2-year follow-up. Subjects Participants were 583 adolescents aged 12-18 years (299 girls) from the LabMed Physical Activity Study. Methods PF and body composition were assessed with the protocols of the ALPHA health-related fitness battery and environmental perceptions with the ALPHA environmental questionnaire. Linear regression models were used to determine the associations between environmental perceptions at baseline and PF and anthropometric measures at follow-up. Results Results showed that perceptions of distant facilities at baseline were associated with lower fitness at follow-up in boys. Also, boys' lower study environment perceptions at baseline w...

Physical fitness (PF) and adherence to the Mediterranean diet are important indicators of healthy lifestyles. The purpose of this study is to analyze the independent and combined associations between PF and adherence to Mediterranean diet with health-related quality of life (HRQoL) in adolescents. This is a cross-sectional analysis with 956 Portuguese adolescents aged 12-18 years. HRQoL was measured with the Kidscreen-10 questionnaire. PF was assessed with the ALPHA health-related fitness battery. The 20-m shuttle run test was used for the estimation of cardiorespiratory fitness; handgrip strength and standing long jump tests were applied for the assessment of muscular fitness and the 4 × 10 m shuttle run test for the assessment of motor fitness (speed and agility). The results of the PF tests (cardiorespiratory fitness, muscular fitness and motor fitness) were transformed into standardized values (Z-scores) by age and sex. Adherence to the Mediterranean diet was assessed with the K...

To examine the association between cardiorespiratory fitness and cardiovascular indices 2 years later, and to determine whether changes in cardiorespiratory fitness are associated with cardiovascular indices at a 2-year follow-up in adolescents. The sample comprised 734 adolescents (349 girls) aged 12-18 years followed for 3 years from the LabMed Physical Activity Study. Cardiorespiratory fitness was assessed by the 20-meter shuttle run test. Height, weight, waist circumference, and resting blood pressure (BP) were measured according to standard procedures. Regression analyses showed a significant inverse association between cardiorespiratory fitness at baseline and systolic BP (B = -0.126; P = .047) and rate pressure product (B = -29.94; P = .016), at follow-up after adjustments for age, sex, height, pubertal stage, socioeconomic status, and waist circumference. Significant differences were found between cardiorespiratory fitness groups (fit vs unfit) at baseline and systolic BP an...

Background In adolescence there are several biological and physiological changes associated with overweight and obesity. Objective The purpose of this study was to analyze the associations between health-related quality of life (HRQoL) and body mass index (BMI) in adolescents. Methods This is a cross-sectional analysis of 957 Portuguese adolescents (446 girls and 511 boys) aged 12-18 years. A series of variables were collected: (a) HRQoL was assessed using the KIDSCREEN-10 questionnaire; (b) socioeconomic status (SES) was measured using the Family Affluence Scale; (c) body composition (weigh, height) were measured and BMI was calculated and, (d) pubertal stage was assessed with Tanner stages; (e) the 20-m shuttle-run was used to estimate cardiorespiratory fitness. Regression models and mediation analysis were performed to assess the association between HRQoL and BMI. Results HRQoL was significantly higher in boys than girls (p < 0.05). The prevalence of overweight and obesity was...

The dietary inflammatory index (DII) is a tool to measure the diet's inflammatory potential and has been used with adults to predict low-grade inflammation. The present study aims to assess whether this dietary score predicts low-grade inflammation in adolescents. The sample comprises 329 adolescents (55.9% girls), aged 12-18 years, from LabMed Physical Activity Study. DII score was calculated based on a food-frequency questionnaire and categorized into tertiles. We collected blood samples to determine the follow inflammatory biomarkers: C-reactive protein (CRP), interleukin-6 (IL-6), complement component 3 (C3), and 4 (C4). In addition we calculated an overall inflammatory biomarker score. Odds ratios (OR) and 95% confidence intervals (95%CI) were computed from binary logistic regression models. DII score, comparing first with third tertile, was positively associated with IL-6 in crude model (OR = 1.88, 95%CI:1.09-3.24, p trend = 0.011) and in fully adjusted (for biological and...

Low muscular fitness (MF) and low-grade inflammation has been linked to insulin resistance (IR). To evaluate the associations between MF and a clustered score of inflammatory biomarkers on IR and to investigate the combined impact of MF and inflammation on IR in adolescents. This is a cross-sectional analysis with 529 adolescents (267 girls) aged 12 to 18 years. Pubertal stage, socioeconomic status, adherence to the Mediterranean diet, cardiorespiratory fitness, and waist circumference were assessed. Standing long-jump and isometric handgrip dynamometry were used as indicators of MF. Continuous score of clustered inflammatory biomarkers (InflaScore) (sum of Z-scores of C-reactive protein, C3, C4, fibrinogen, and leptin) and IR (homeostasis model assessment of insulin resistance [HOMA-IR] estimated from fasting serum insulin and glucose) were assessed. HOMA-IR and fasting insulin were positively associated with InflaScore and negatively associated with MF, independently of age, sex, ...

Then objective of this study was to evaluate the ability of several nontraditional cardiometabolic and inflammatory biomarkers in identifying high cardiometabolic risk in adolescents. A cross-sectional study was conducted with 529 Portuguese adolescents (267 girls) aged 14.3 ± 1.7 years. A clustered cardiometabolic risk score (body fat percentage, systolic blood pressure, ratio of total cholesterol to high-density lipoprotein cholesterol, triglycerides, homeostatic model assessment of insulin resistance, and negative values of cardiorespiratory fitness) was computed. The nontraditional cardiometabolic biomarkers assessed were complement factors (C3 and C4), C-reactive protein (CRP), fibrinogen, leptin, white blood cells (WBCs), albumin, interleukin-6, and a clustered score of inflammatory biomarkers (InflaScore) (C3, C4, CRP, fibrinogen, and leptin). Receiver operating characteristic curves analyses showed that C3, C4, CRP, fibrinogen, leptin, and the InflaScore were able to present...

High muscular fitness (MF) and high adherence to the Southern European Atlantic Diet (the SEADiet) have been associated with several positive metabolic outcomes. The purpose of the present study was two-fold: (i) to explore the independent associations between MF and C-reactive protein (CRP) levels; and (ii) to investigate the combined impact of MF and SEADiet on the CRP levels in a sample of adolescents. A cross-sectional school-based study was conducted on 463 adolescents (272 girls) aged 15-18 years, from the Portuguese Azorean Archipelago. Anthropometric indicators (stature, body mass, waist circumference (WC)) were measured by standardized protocols and pubertal stages were assessed by Tanner criteria. Blood samples were taken after an overnight fast. MF was assessed by the curl-up and push-up tests (from the Fitnessgram test battery). Adherence to the SEADiet was assessed with a semi-quantitative food frequency questionnaire. Linear regression models showed that MF was inverse...

Introduction: The lack of physical activity (PA) in children is an important health risk factor. Previous studies have shown that some environmental features may be associated with PA levels.Objectives: Find and comprehend which environmental features were mostly positively associated with children’s physical activity.Methods: Twenty-eight studies that assessed association between the environmental features and physical activity among children (ages 3 to 12-years) and fulfilled selection criteria were systematically reviewed.Results: Results across the various studies showed that facilities and parks/playgrounds are mostly positively associated with children’s PA. Sidewalks and bike lanes were positively associated to PA in all studies. Safety, traffic and weather showed inconsistent associations with children’s PA.Conclusions: Beginning to understand which environmental features contribute more to PA in children can lead to increased levels of PA.  Keywords: PHYSICAL ACTIVITY, ENVIRONMENT, CHILDREN

Circulating leptin and adiponectin levels have been associated with impaired vascular function, insulin resistance, and acute cardiovascular evens. This study aimed to evaluate the associations of leptin, adiponectin, and the leptin/adiponectin (L/A) ratio with a clustering of metabolic risk factors (MRF) in adolescents aged 12-18 years. This is a cross-sectional analysis with 529 Portuguese adolescents aged 12-18 years. Blood samples were taken to analyze total cholesterol (TC) and high-density lipoprotein (HDL) cholesterol (HDL-c), triglycerides glucose, insulin, leptin, and adiponectin levels. A continuous variable of clustered MRF score (sum of Z-scores of body fat percentage, systolic blood pressure, ratio TC/HDL, triglycerides, homeostatic model assessment insulin resistance, and cardiorespiratory fitness*[-1]) was computed. Regression analyses showed that adiponectin was a significant and negative predictor of MRF score (boys: β = -0.199; p < 0.001; girls: β = -0.200; p &l...

The dietary guidelines for the consumption of a variety of fruits and vegetables have been recognized as an important factor for achieving healthy eating patterns to reduce the risk of chronic disease throughout the lifespan. Our aim is to assess the association between fruit and vegetable variety and low-grade inflammation in adolescents. This cross-sectional analysis was conducted with 412 adolescents (ages 14.4 ± 1.7 years; 52% girls). The consumption of a variety of fruits and vegetables was assessed with a food-frequency questionnaire, considering the number of individual/category of fruit or vegetable intake at least once month, and categorized into tertiles. Blood samples were collected to determine C-reactive protein (CRP), interleukin-6 (IL-6), complement component 3 (C3), and 4 (C4). We created categories of lower or higher (inflammatory state) for each biomarker, considering sex- and age-adjusted median values. Then, we computed an overall inflammatory score, by adding al...

This study examined the independent associations between cardiorespiratory fitness and circulating adiponectin concentration in adolescents, controlling for several potential covariates. This is a cross-sectional study in Portuguese adolescents. A sample of 529 (267 girls) aged 12-18 years were included and categorized as overweight and non-overweight. Cardiorespiratory fitness was assessed by 20 meters shuttle run test. We measured serum adiponectin, high-sensitivity C-reactive protein, fasting glucose, insulin and HDL-cholesterol. After adjustment for age, sex, pubertal stage, adherence to the Mediterranean diet, socioeconomic status, body fat percentage, insulin resistance, HDL-cholesterol and C-reactive protein, regression analysis showed a significant inverse association between adiponectin and cardiorespiratory fitness in non-overweight participants (B=-0.359; p<0.042). Analysis of covariance showed a significant difference between the highest cardiorespiratory fitness Heal...

Introduction: The alarming increase in obesity worldwide and the decrease in cardiorespiratory fitness (CRF) levels among adolescents are of concern in the development of cardiovascular diseases. Therefore, the purpose of this study was to evaluate the association between body fatness, CRF, and inflammatory markers [C-reactive protein (C-RP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and leptin] in a sample of Portuguese adolescents. Hypothesis: We assessed the hypothesis that adolescents with higher body fatness and lower CRF levels will have an increased level of inflammatory markers. Methods: A cross-sectional school-based study was conducted on 529 Portuguese adolescents (268 girls) aged 12-18 years (mean age 14.3±1.7). Body fatness (BF) was assessed using the Bioelectric Impedance Analysis. Intravenous blood samples were taken after an overnight fast to determine inflammatory markers (C-RP, IL-6, TNF-α, and leptin). CRF was measured with the 20m-Shuttle-Run-Test from the Fitnessgram battery test as number of laps. Pearson correlation was used for bivariate associations between BF, CRF and inflammatory markers. Linear regression analyses were used to examine the association between BF, CRF and inflammation markers with adjustments for age and sex. Results: Pearson’s correlation analyses, adjusted for age and sex, revealed that BF was positively correlated with leptin (r=0.640, P No associations were found between BF, CRF and IL-6. Conclusions: Our findings emphasize the importance of increasing CRF levels and decrease body fatness among adolescents in order to prevent metabolic abnormalities predisposed to or associated inflammation and thus contribute to the prevention of cardiovascular diseases later in life.

This article reviews the effectiveness of physical activity (PA) interventions at the workplace to reduce musculoskeletal pain among employees and assesses the effect size of these programs using meta-analysis. Four databases (i.e., PubMed, EBSCO, Web of Science, and Cochrane) were searched for research trials, which included comparison groups of employees that assessed PA programs, musculoskeletal pain, and health-related behaviors, published between January 1990 and March 2013. The meta-analysis estimates of standardized mean differences (Hedges' g) present significant evidence of less general pain (g = -.40 with a 95% confidence interval [CI] = [-0.78, -0.02]) and neck and shoulder pain (g = -.37 with a 95% CI = [-0.63, -0.12]) in intervention groups. The few studies of low back pain and arm, elbow, wrist, hand, or finger pain did not present sufficient statistically significant evidence. Consistent evidence demonstrates that workplace PA interventions significantly reduce ge...

The goal of this study was to investigate the association of physical activity (PA) and cardiorespiratory fitness with C-reactive protein (CRP) concentration in adolescents. The sample included 386 Portuguese adolescents (n = 207, female), age 12-18 years, assessed in the year 2012. The PA was assessed with the use of accelerometers, and the cardiorespiratory fitness was assessed by the Fitnessgram Pacer test. Blood samples were collected after a 10-hour fasting, and high-sensitivity PCR concentration was further assessed. Significant associations between CRP and cardiorespiratory fitness were found for females (r = -0.313; p < 0.001) and males (r = -0.163; p < 0.05); however, when adjusted by the BMI, the associations remained significant only for females (r = -0.215; p < 0.001). Regarding the association between CRP and PA, no significant associations were found for both genders. Therefore, CRP is apparently negatively associated with cardiorespiratory fitness, with diffe...

To examine the combined association of cardiorespiratory fitness (CRF), muscular fitness (MF), and adherence to a Mediterranean diet (MeDiet) on cardiovascular risk in adolescents, a pooled study, including cross-sectional data from two projects [2477 adolescents (1320 girls) aged 12⁻18 years], was completed. A shuttle run test was used to assess CRF. MF was assessed by the standing-long jump and handgrip tests. Adherence to a MeDiet was assessed by the Kidmed questionnaire. A cardiovascular risk score was computed from the following components: Age and sex, waist circumference, triglycerides, systolic blood pressure, high-density lipoprotein cholesterol (HDL), and glucose. Analysis of covariance showed that participants classified as having optimal (High) adherence to a MeDiet/HighMF/HighCRF, as well those classified as low adherence to a MeDiet/HighMF/HighCRF, had, on average, the lowest cardiovascular risk score (F = 15.6; < 0.001). In addition, the high adherence to a MeDiet/...

Background: The prominence of sedentary behavior research in health science has grown rapidly. With this growth there is increasing urgency for clear, common and accepted terminology and definitions. Such standardization is difficult to achieve, especially across multi-disciplinary researchers, practitioners, and industries. The Sedentary Behavior Research Network (SBRN) undertook a Terminology Consensus Project to address this need. Method: First, a literature review was completed to identify key terms in sedentary behavior research. These key terms were then reviewed and modified by a Steering Committee formed by SBRN. Next, SBRN members were invited to contribute to this project and interested participants reviewed and provided feedback on the proposed list of terms and draft definitions through an online survey. Finally, a conceptual model and consensus definitions (including caveats and examples for all age groups and functional abilities) were finalized based on the feedback r...

On the contrary, having experi-enced some marital events is associated with a lower risk of over-weight. Among women, the experience of childhood and adolescence are associated with overweight, but with different meanings. Among men, living (or having lived in the past) with a partner suffering from a serious disease is associated with a higher risk of overweight when having experienced a serious disease before 18 years of age is associated with a lower risk. Conclusion: These results suggest that life events may have an asso-ciation with weight profile, and differently according to gender. In order to qualify the chronological meaning of these associations and thus better take them into account when preventing obesity, further studies are needed, ideally prospective in a life-course approach. Introduction: This study aimed to analyze the relations between a clustered metabolic risk score (MRS), cardiorespiratory fitness (CRF) and adherence to Mediterranean dietary patterns in Azore...

Introduction: The alarming increase in obesity worldwide and the decrease in cardiorespiratory fitness (CRF) levels among adolescents are of concern in the development of cardiovascular diseases. Therefore, the purpose of this study was to evaluate the association between body fatness, CRF, and inflammatory markers [C-reactive protein (C-RP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and leptin] in a sample of Portuguese adolescents.Hypothesis: We assessed the hypothesis that adolescents with higher body fatness and lower CRF levels will have an increased level of inflammatory markers.Methods: A cross-sectional school-based study was conducted on 529 Portuguese adolescents (268 girls) aged 12-18 years (mean age 14.3±1.7).Body fatness (BF) was assessed using the Bioelectric Impedance Analysis. Intravenous blood samples were taken after an overnight fast to determine inflammatory markers (C-RP, IL-6, TNF-α, and leptin). CRF was measured with the 20m-Shuttle-Run-Test f...

ABSTRACT Physical activity (PA) in childhood and adolescence plays an important role in the prevention of cardiovascular disease (CVD) in adulthood. The association between physical activity and cardiorespiratory fitness (CRF) with C-reactive protein (CRP), is relatively well reported in adults; however, in childhood and adolescence that knowledge is still lower. Therefore, the purpose of this study was to evaluate the association between physical activity, cardiorespiratory fitness and C-reactive protein in children and adolescents. A cross-sectional school-based study was conducted on 386 Portuguese adolescents (179 girls) aged 12–18 years (mean age 14.03 ± 1.64). The blood samples were taken after an overnight fast and measured for hsCRP, physical activity was measured by accelerometry and CRF was measured by the 20-m-shuttle-run-test from the Fitnessgram Battery Tests, body mass index (BMI) was calculated. Spearman correlation was used for associations between PA, CRF and CRP, with adjustments for BMI, age and sex. The results of the tests showed a negative correlation between CRP and CRF in females (−0.31, p < 0.001) and males (−0.16, p < 0.05), however, independent of BMI only in females (−0.21, p < 0.001). No significant associations were found between CRP and PA. Thus, it was observed that apparently CRP is associated negatively with the CRF, but differently according to gender, and in the female it seems less dependent on BMI. Our findings emphasize the importance of increasing CRF levels; however, longitudinal studies in larger scale are necessary to better explain this relationship.

Background: Although changes in eating patterns may occur during gestation, predictors of these changes have not been explored. This study aimed to identify predictors of adherence to the Mediterranean diet (MD) from the first to second trimester of pregnancy. Methods: A prospective study was conducted with 102 pregnant women aged 18-40, from the city of Porto, Portugal. Socio-demographic and lifestyle characteristics were assessed through a questionnaire. Food consumption was assessed with a three-day food diary completed during the first and second trimesters. Participants were categorized according to their change in adherence to the MD into the negative change group (i.e., women who had low adherence in each trimester or had high adherence in the first trimester and then low adherence in the second) and the positive change group (i.e., women who had high adherence in both trimesters or had low adherence in the first trimester and then high adherence in the second). Conditional s...

Few studies have reported associations between clustering metabolic risk factors and socioeconomic status (SES) in youth. This study aimed to analyze the association between clustering metabolic risk factors and SES in adolescents. It was hypothesized that SES is inversely related to clustering metabolic risk factors. This 2009 cross-sectional school-based study investigated 517 Portuguese adolescents ages 15-18 years. The study considered the age- and sex-adjusted z-scores for the ratio of total cholesterol/high-density lipoprotein, homeostasis model, triglycerides, and systolic blood pressure, and a metabolic risk score was constructed by summing all the z-scores (≥1 standard deviation was considered high risk). Cardiorespiratory fitness was estimated by the 20 m shuttle-run test and dietary intake by a food frequency questionnaire. The best of parental education was used as a proxy measure of SES. The results showed that adolescents with low SES were more likely to have a high metabolic risk score (odds ratio [OR], 1.96; p < 0.020) regardless of cardiorespiratory fitness, adherence to the Mediterranean diet, or pubertal stage. In conclusion, a lower SES was associated with increased risk for a high metabolic risk score among Azorean adolescents after adjustment for pubertal stage, adherence to the Mediterranean diet, and cardiorespiratory fitness. Future health-promotion strategies among Azorean adolescents should consider the impact of SES on their health.