ObjectivesSun exposure seems to have an indirect effect on the development of obesity through vit... more ObjectivesSun exposure seems to have an indirect effect on the development of obesity through vitamin D synthesis in the skin, the primary source of this vitamin. The present study aimed to investigate associations among sun exposure time, obesity indicators, and lifestyle habits in children.MethodsA total of 4755 children (3–10 years; 49.86% boys) from the north, center and south‐central Portugal were included in the present study. During 2016/2017 children's sun exposure time, screen time, time devoted to the practice of physical activity and active play were collected through standard questionnaires answered by parents. Statistical analyses were conducted to investigate differences among sun exposure time according to the sex, age, obesity indicators and lifestyle habits.ResultsLinear regression analysis showed that sun exposure time presented a negative association with Body Mass Index (β = −0.09, 95% CI: −0.18; −0.003; p = .042), body fat % (β = −0.31, 95%; CI: −0.54; −0.07; p = .010), computer time (β = −0.08, 95% CI: −0.12; − 0.05; p < .0001) and a positive association with active play time (β = 0.22, 95% CI: 0.17; 0.27; p < .0001) and total time of physical activity practice (β = 10.01, 95% CI: 4.52; 15.20; p < .0001).ConclusionsThe results reinforce the need for future guidance on the ideal sun exposure time, especially in children, who are at risk for vitamin D deficiency. Standardization of criteria for classifying optimal sun exposure time in this age group, considering the parameters that affect vitamin D status, such as age and seasonality, should be considered when planning future guidelines.
OBJECTIVE Sedentary behaviours, even at an early age, are associated with potential health risks ... more OBJECTIVE Sedentary behaviours, even at an early age, are associated with potential health risks such as obesity, some cardio metabolic risk factors, poorer mental health, and lower levels physical fitness. The aim of this study was twofold: i) to compare objectively measured sedentary time and physical activity (PA) levels in its different intensity portions between boys and girls; ii) to analyse associations among the risk of overweight and moderate-to-vigorous physical activity (MVPA) in pre-school children. METHODS The present cross-sectional study comprised a sample of 134 children (70 males) aged 3-5 years. Height and weight were measured, and BMI was calculated. A tri-axial accelerometer was used to obtain seven consecutive days of MVPA, as well as the weekly time being sedentary. The t-test was used to analyse the effect of the sex on body size, sedentary behaviour, and PA levels; furthermore, logistic regression analysis was used to examine the afore-mentioned relationship among the risk of obesity and MVPA, controlling for sex, age, and sedentary behaviour. RESULTS About 16.0% of the sample is overweight or obese (boys 12.2%, girls 20.0%). Boys spent significantly more minutes/day in the moderate-to-vigorous portion of PA than their female counterparts on the week days (boys: 90.9±21.8 min/day; girls: 77.6±21.7 min/day) and in the total measured days (boys: 89.5±20.4 min/day; girls: 77.7±21.6 min/day). MVPA was inversely associated with the risk of being overweight in pre-school children after adjustment for potential confounders; children with higher levels of MVPA have less likely to be classified as overweight and/or obese than less active children (95% CI 0.96 to 0.99, p<0.05). CONCLUSIONS Findings of this study revealed males significantly more active than females. Objectively measured MVPA was independent and inversely associated with increased risk of overweight in pre-school children. Future interventions for improving weight health in paediatrics should enhance MVPA at early ages.
Background: This cross-sectional study aimed to explore how parental perceptions of the social an... more Background: This cross-sectional study aimed to explore how parental perceptions of the social and physical environment of the neighborhood was associated with 3- to 10-year-old children’s use of traditional and modern screen devices. Methods: Participants were recruited under the scope of the project ObesInCrisis, conducted in 2016–2017 in the cities of Porto, Coimbra, and Lisbon (Portugal). Data from 6347 children aged 3–10 years were analyzed (3169 boys [49.9%]). A parental questionnaire was used to collect data on children’s screen time (dependent variable) and parents’ perceived social and physical environment (from the Environmental Module of the International Physical Activity Prevalence Study questionnaire; independent variable), parental education, and urbanization (used as covariates). Results: Neighborhood features were more correlated with girls’ screen time, than with boys’, particularly among younger children. Also, more social than physical characteristics of the neig...
This study investigated the household food insecurity (HFI) among Portuguese children following t... more This study investigated the household food insecurity (HFI) among Portuguese children following the last world financial crisis. A cross-sectional study was conducted on 4737 Portuguese children (3-11 yrs). Socio-demographics, food insecurity, and household geographic location were assessed via questionnaire. Nutritional status was measured. Following the economic crisis, 14.2% of school children and 12.0% of preschool children experienced HFI. Preschool children having parents with low and medium parental education (paternal: OR = 4.4; 95% CI 2.7-7.1 and OR = 2.4; 95% CI 1.5-3.6; maternal: OR = 2.2; 95% CI 1.4-3.5 and OR = 1.6; 95% CI 1.1-2.3), living in the south (OR = 1.4; 95% CI 1.0-2.0) and being overweight/obese (OR = 1.1; 95% CI 0.7-1.3) were more likely to experience HFI than food secure household peers. Higher OR of belonging to a food insecure household were observed in school-aged children with low and medium parental education (paternal: OR = 2.9; 95% CI 1.9-4.6 and OR = 1.7; 95% CI 1.1-2.5; maternal: OR = 2.5; 95% CI 1.6-3.9 and OR = 2.3; 95% CI 1.6-3.3), living in Coimbra (OR = 1.7; 95% CI 1.1-2.6) and being overweight/obese (OR = 1.3; 95% CI 0.8-1.5) compared to food secure household peers. Data are instructive and support the need to increase awareness of HFI, reduce its incidence in overweight/obese children from low socio-economic status families and specific geographic areas, and increase food availability based on local ecology.
OBJECTIVES Further evidence on how the Great Recession was associated with childhood obesity is n... more OBJECTIVES Further evidence on how the Great Recession was associated with childhood obesity is needed, particularly when the world is facing a new and severe economic downturn caused by the COVID-19 pandemic. This study explores: (1) the direct association of the 2008's economic crisis with eating patterns and body mass index (BMI), among children, independently of their socioeconomic status (SES), and (2) the indirect association between the crisis and children's BMI, by using eating patterns as mediators. METHODS A sample of children (n = 8472, mean age: 7.17 years old, 50.8% male) was recruited in schools from the cities of Porto, Coimbra and Lisbon, Portugal. Children's height and weight were objectively measured; BMI was calculated. Other data were collected by a parental questionnaire. A structural equation modeling studied the associations between the economic crisis impact, eating patterns, and BMI; model was adjusted for SES. RESULTS Children in families that reported a greater impact of the economic crisis showed higher consumption of unhealthy food items and lower consumption of healthy foods, regardless of SES. Indirectly, children whose parents scored higher in the economic crisis impact had higher BMI mediated by a higher consumption of cakes/chocolates and lower intake of vegetables/salads. CONCLUSIONS The economic crisis was associated with higher BMI and unhealthy eating patterns. Efforts to promote healthy diets and weight are needed at a population level rather than for specific social classes, particularly in the face of a new economic crisis caused by the COVID-19 pandemic.
OBJECTIVES Little is known about the impact of the 2008 global economic recession on childhood ob... more OBJECTIVES Little is known about the impact of the 2008 global economic recession on childhood obesity in Portugal. Thus, this study's goals were to compare weight status of children during and after the economic crisis according to their neighbourhood environment features and to assess changes in specific dietary habits during the economic crisis. STUDY DESIGN Cross-sectional study. METHODS Data including weight, height, residence address to allow its geocoding and dietary habits changes during the crisis from children living in Lisbon municipality were collected in 2009 (N = 929) and in 2016 (N = 1751). A multidimensional environment index, with data of both built and socioeconomic nature collected at the statistical section level (areas comprised 300 dwellers) in the 2011 census, was used to characterize neighbourhoods. RESULTS Overall, the proportion of children who are overweight or obese living in the socioeconomically vulnerable areas decreased in 2016. Families living in the latter areas stopped buying some food items, started to buy cheaper food items, cooked more meals at home and ate less in restaurants. In 2016, the risk for overweight and obesity increased in children who lived in the least advantageous areas. Living in areas with high socioeconomic status or most advantageous areas no longer represented a decreased risk of being overweight or obese in children in 2016 as it did in 2009. CONCLUSIONS This study suggests that the economic crisis enhanced the social inequalities regarding childhood obesity. These results aid the development of evidence-based strategies to lessen the social inequities in health outcomes created by the crisis.
ObjectivesThis study explores the association between socioeconomic position (SEP) and health‐rel... more ObjectivesThis study explores the association between socioeconomic position (SEP) and health‐related quality of life (HRQoL) among Portuguese children according to their weight status.MethodsA total of 1215 primary school‐aged children (mean age 8.78 years) from three Portuguese districts (Lisbon, Porto, Coimbra) were assessed during 2016/2017. Father and mother's education (low, medium, high) and work status (employed, unemployed/retired) were used as SEP indicators. Self‐reported HRQoL was assessed with the KIDSCREEN‐27. Height and weight were objectively measured and body mass index categorized in normal, overweight or obese. Age, sex, and district‐adjusted linear regression models were fitted to estimate associations between SEP indicators and HRQoL dimensions, according to weight status.ResultsWe found that 24.9% of children were categorized as having overweight/obesity. The mean scores of the Physical Well‐Being, and School Environment dimensions of HRQoL were lower among...
Background Children are often exposed to too much screen time but few studies have explored the u... more Background Children are often exposed to too much screen time but few studies have explored the use of old and new digital media among young children. This study assesses screen time, including traditional and mobile devices, in pre-school and elementary school-aged children, according to their gender, age, and socioeconomic position (SEP). Methods A total of 8430 children (3 to 10 years; 50.8% boys) from the north, center and south-central Portugal were included in the present study. Data was collected by a parental questionnaire during 2016/2017. Children’s screen time (by media device, weekdays and at the weekend; calculated by mean minutes per day) were reported by parents. Analysis were carried to compare screen time by children’s age, gender and family SEP (classified using father’s educational degree). Results Daily screen time was high both in children aged 3 to 5 and 6 to 10 years – 154 min/day (95% CI: 149.51–158.91) and 200.79 min/day (95% CI: 197.08–204.50), respectively...
Background Symptoms of depression, anxiety and stress experienced during childhood might have a n... more Background Symptoms of depression, anxiety and stress experienced during childhood might have a negative impact on development. This study explores factors associated with such symptoms among Portuguese primary school-aged children. Methods A sample of children (n = 1022, mean age = 8.77 years old) was recruited in public and private schools from the cities of Coimbra, Lisbon and Porto, Portugal. The children’s version of the Depression, Anxiety and Stress Scale (DASS-C) was self-administered. Multivariate logistic regression models were fitted to measure associations (expressed as Odds Ratio, OR and 95% Confidence Intervals, CI) between each DASS-C subscale, dichotomized by its 4th vs. 3rd or less quartiles (symptoms increase with scores), and covariates: child sex, age, socioeconomic status (SES), sports activity beyond school, children self-assessed health status, child and mother’s body mass index and mother’s DASS scores. Results Age was negatively associated with anxiety sympt...
ObjectivesThe environment is believed to be key in obesity prevention, yet it is unclear how fact... more ObjectivesThe environment is believed to be key in obesity prevention, yet it is unclear how factors in the neighborhood influence weight‐related behaviors. The present study aimed to investigate the influence of parental perceived environment on physical activity (PA), television (TV) time, active play and Body Mass Index (BMI) z score, and the mediating role of these weight‐related behaviors on the relationship between neighborhood characteristics and children's BMI.MethodsData of 8472 Portuguese preschool (aged 3‐6, n = 3819) and school‐aged children (aged 7‐11 years, n = 4653) were collected during 2016/2017. Structural equation modeling was used to estimate the associations between parents perceived neighborhood characteristics (latent variables: unsafety and built/physical environment) and child's BMI z score, PA and TV time.ResultsAmong preschoolers, the latent variables of the perceived environment were not associated with the BMI, TV time, extracurricular PA, and ac...
ObjectivesSun exposure seems to have an indirect effect on the development of obesity through vit... more ObjectivesSun exposure seems to have an indirect effect on the development of obesity through vitamin D synthesis in the skin, the primary source of this vitamin. The present study aimed to investigate associations among sun exposure time, obesity indicators, and lifestyle habits in children.MethodsA total of 4755 children (3–10 years; 49.86% boys) from the north, center and south‐central Portugal were included in the present study. During 2016/2017 children's sun exposure time, screen time, time devoted to the practice of physical activity and active play were collected through standard questionnaires answered by parents. Statistical analyses were conducted to investigate differences among sun exposure time according to the sex, age, obesity indicators and lifestyle habits.ResultsLinear regression analysis showed that sun exposure time presented a negative association with Body Mass Index (β = −0.09, 95% CI: −0.18; −0.003; p = .042), body fat % (β = −0.31, 95%; CI: −0.54; −0.07; p = .010), computer time (β = −0.08, 95% CI: −0.12; − 0.05; p &lt; .0001) and a positive association with active play time (β = 0.22, 95% CI: 0.17; 0.27; p &lt; .0001) and total time of physical activity practice (β = 10.01, 95% CI: 4.52; 15.20; p &lt; .0001).ConclusionsThe results reinforce the need for future guidance on the ideal sun exposure time, especially in children, who are at risk for vitamin D deficiency. Standardization of criteria for classifying optimal sun exposure time in this age group, considering the parameters that affect vitamin D status, such as age and seasonality, should be considered when planning future guidelines.
OBJECTIVE Sedentary behaviours, even at an early age, are associated with potential health risks ... more OBJECTIVE Sedentary behaviours, even at an early age, are associated with potential health risks such as obesity, some cardio metabolic risk factors, poorer mental health, and lower levels physical fitness. The aim of this study was twofold: i) to compare objectively measured sedentary time and physical activity (PA) levels in its different intensity portions between boys and girls; ii) to analyse associations among the risk of overweight and moderate-to-vigorous physical activity (MVPA) in pre-school children. METHODS The present cross-sectional study comprised a sample of 134 children (70 males) aged 3-5 years. Height and weight were measured, and BMI was calculated. A tri-axial accelerometer was used to obtain seven consecutive days of MVPA, as well as the weekly time being sedentary. The t-test was used to analyse the effect of the sex on body size, sedentary behaviour, and PA levels; furthermore, logistic regression analysis was used to examine the afore-mentioned relationship among the risk of obesity and MVPA, controlling for sex, age, and sedentary behaviour. RESULTS About 16.0% of the sample is overweight or obese (boys 12.2%, girls 20.0%). Boys spent significantly more minutes/day in the moderate-to-vigorous portion of PA than their female counterparts on the week days (boys: 90.9±21.8 min/day; girls: 77.6±21.7 min/day) and in the total measured days (boys: 89.5±20.4 min/day; girls: 77.7±21.6 min/day). MVPA was inversely associated with the risk of being overweight in pre-school children after adjustment for potential confounders; children with higher levels of MVPA have less likely to be classified as overweight and/or obese than less active children (95% CI 0.96 to 0.99, p<0.05). CONCLUSIONS Findings of this study revealed males significantly more active than females. Objectively measured MVPA was independent and inversely associated with increased risk of overweight in pre-school children. Future interventions for improving weight health in paediatrics should enhance MVPA at early ages.
Background: This cross-sectional study aimed to explore how parental perceptions of the social an... more Background: This cross-sectional study aimed to explore how parental perceptions of the social and physical environment of the neighborhood was associated with 3- to 10-year-old children’s use of traditional and modern screen devices. Methods: Participants were recruited under the scope of the project ObesInCrisis, conducted in 2016–2017 in the cities of Porto, Coimbra, and Lisbon (Portugal). Data from 6347 children aged 3–10 years were analyzed (3169 boys [49.9%]). A parental questionnaire was used to collect data on children’s screen time (dependent variable) and parents’ perceived social and physical environment (from the Environmental Module of the International Physical Activity Prevalence Study questionnaire; independent variable), parental education, and urbanization (used as covariates). Results: Neighborhood features were more correlated with girls’ screen time, than with boys’, particularly among younger children. Also, more social than physical characteristics of the neig...
This study investigated the household food insecurity (HFI) among Portuguese children following t... more This study investigated the household food insecurity (HFI) among Portuguese children following the last world financial crisis. A cross-sectional study was conducted on 4737 Portuguese children (3-11 yrs). Socio-demographics, food insecurity, and household geographic location were assessed via questionnaire. Nutritional status was measured. Following the economic crisis, 14.2% of school children and 12.0% of preschool children experienced HFI. Preschool children having parents with low and medium parental education (paternal: OR = 4.4; 95% CI 2.7-7.1 and OR = 2.4; 95% CI 1.5-3.6; maternal: OR = 2.2; 95% CI 1.4-3.5 and OR = 1.6; 95% CI 1.1-2.3), living in the south (OR = 1.4; 95% CI 1.0-2.0) and being overweight/obese (OR = 1.1; 95% CI 0.7-1.3) were more likely to experience HFI than food secure household peers. Higher OR of belonging to a food insecure household were observed in school-aged children with low and medium parental education (paternal: OR = 2.9; 95% CI 1.9-4.6 and OR = 1.7; 95% CI 1.1-2.5; maternal: OR = 2.5; 95% CI 1.6-3.9 and OR = 2.3; 95% CI 1.6-3.3), living in Coimbra (OR = 1.7; 95% CI 1.1-2.6) and being overweight/obese (OR = 1.3; 95% CI 0.8-1.5) compared to food secure household peers. Data are instructive and support the need to increase awareness of HFI, reduce its incidence in overweight/obese children from low socio-economic status families and specific geographic areas, and increase food availability based on local ecology.
OBJECTIVES Further evidence on how the Great Recession was associated with childhood obesity is n... more OBJECTIVES Further evidence on how the Great Recession was associated with childhood obesity is needed, particularly when the world is facing a new and severe economic downturn caused by the COVID-19 pandemic. This study explores: (1) the direct association of the 2008's economic crisis with eating patterns and body mass index (BMI), among children, independently of their socioeconomic status (SES), and (2) the indirect association between the crisis and children's BMI, by using eating patterns as mediators. METHODS A sample of children (n = 8472, mean age: 7.17 years old, 50.8% male) was recruited in schools from the cities of Porto, Coimbra and Lisbon, Portugal. Children's height and weight were objectively measured; BMI was calculated. Other data were collected by a parental questionnaire. A structural equation modeling studied the associations between the economic crisis impact, eating patterns, and BMI; model was adjusted for SES. RESULTS Children in families that reported a greater impact of the economic crisis showed higher consumption of unhealthy food items and lower consumption of healthy foods, regardless of SES. Indirectly, children whose parents scored higher in the economic crisis impact had higher BMI mediated by a higher consumption of cakes/chocolates and lower intake of vegetables/salads. CONCLUSIONS The economic crisis was associated with higher BMI and unhealthy eating patterns. Efforts to promote healthy diets and weight are needed at a population level rather than for specific social classes, particularly in the face of a new economic crisis caused by the COVID-19 pandemic.
OBJECTIVES Little is known about the impact of the 2008 global economic recession on childhood ob... more OBJECTIVES Little is known about the impact of the 2008 global economic recession on childhood obesity in Portugal. Thus, this study's goals were to compare weight status of children during and after the economic crisis according to their neighbourhood environment features and to assess changes in specific dietary habits during the economic crisis. STUDY DESIGN Cross-sectional study. METHODS Data including weight, height, residence address to allow its geocoding and dietary habits changes during the crisis from children living in Lisbon municipality were collected in 2009 (N = 929) and in 2016 (N = 1751). A multidimensional environment index, with data of both built and socioeconomic nature collected at the statistical section level (areas comprised 300 dwellers) in the 2011 census, was used to characterize neighbourhoods. RESULTS Overall, the proportion of children who are overweight or obese living in the socioeconomically vulnerable areas decreased in 2016. Families living in the latter areas stopped buying some food items, started to buy cheaper food items, cooked more meals at home and ate less in restaurants. In 2016, the risk for overweight and obesity increased in children who lived in the least advantageous areas. Living in areas with high socioeconomic status or most advantageous areas no longer represented a decreased risk of being overweight or obese in children in 2016 as it did in 2009. CONCLUSIONS This study suggests that the economic crisis enhanced the social inequalities regarding childhood obesity. These results aid the development of evidence-based strategies to lessen the social inequities in health outcomes created by the crisis.
ObjectivesThis study explores the association between socioeconomic position (SEP) and health‐rel... more ObjectivesThis study explores the association between socioeconomic position (SEP) and health‐related quality of life (HRQoL) among Portuguese children according to their weight status.MethodsA total of 1215 primary school‐aged children (mean age 8.78 years) from three Portuguese districts (Lisbon, Porto, Coimbra) were assessed during 2016/2017. Father and mother's education (low, medium, high) and work status (employed, unemployed/retired) were used as SEP indicators. Self‐reported HRQoL was assessed with the KIDSCREEN‐27. Height and weight were objectively measured and body mass index categorized in normal, overweight or obese. Age, sex, and district‐adjusted linear regression models were fitted to estimate associations between SEP indicators and HRQoL dimensions, according to weight status.ResultsWe found that 24.9% of children were categorized as having overweight/obesity. The mean scores of the Physical Well‐Being, and School Environment dimensions of HRQoL were lower among...
Background Children are often exposed to too much screen time but few studies have explored the u... more Background Children are often exposed to too much screen time but few studies have explored the use of old and new digital media among young children. This study assesses screen time, including traditional and mobile devices, in pre-school and elementary school-aged children, according to their gender, age, and socioeconomic position (SEP). Methods A total of 8430 children (3 to 10 years; 50.8% boys) from the north, center and south-central Portugal were included in the present study. Data was collected by a parental questionnaire during 2016/2017. Children’s screen time (by media device, weekdays and at the weekend; calculated by mean minutes per day) were reported by parents. Analysis were carried to compare screen time by children’s age, gender and family SEP (classified using father’s educational degree). Results Daily screen time was high both in children aged 3 to 5 and 6 to 10 years – 154 min/day (95% CI: 149.51–158.91) and 200.79 min/day (95% CI: 197.08–204.50), respectively...
Background Symptoms of depression, anxiety and stress experienced during childhood might have a n... more Background Symptoms of depression, anxiety and stress experienced during childhood might have a negative impact on development. This study explores factors associated with such symptoms among Portuguese primary school-aged children. Methods A sample of children (n = 1022, mean age = 8.77 years old) was recruited in public and private schools from the cities of Coimbra, Lisbon and Porto, Portugal. The children’s version of the Depression, Anxiety and Stress Scale (DASS-C) was self-administered. Multivariate logistic regression models were fitted to measure associations (expressed as Odds Ratio, OR and 95% Confidence Intervals, CI) between each DASS-C subscale, dichotomized by its 4th vs. 3rd or less quartiles (symptoms increase with scores), and covariates: child sex, age, socioeconomic status (SES), sports activity beyond school, children self-assessed health status, child and mother’s body mass index and mother’s DASS scores. Results Age was negatively associated with anxiety sympt...
ObjectivesThe environment is believed to be key in obesity prevention, yet it is unclear how fact... more ObjectivesThe environment is believed to be key in obesity prevention, yet it is unclear how factors in the neighborhood influence weight‐related behaviors. The present study aimed to investigate the influence of parental perceived environment on physical activity (PA), television (TV) time, active play and Body Mass Index (BMI) z score, and the mediating role of these weight‐related behaviors on the relationship between neighborhood characteristics and children's BMI.MethodsData of 8472 Portuguese preschool (aged 3‐6, n = 3819) and school‐aged children (aged 7‐11 years, n = 4653) were collected during 2016/2017. Structural equation modeling was used to estimate the associations between parents perceived neighborhood characteristics (latent variables: unsafety and built/physical environment) and child's BMI z score, PA and TV time.ResultsAmong preschoolers, the latent variables of the perceived environment were not associated with the BMI, TV time, extracurricular PA, and ac...
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