ABSTRACT Objectives. To characterize how physical activity and sedentary behavior have been measured in national health surveys in South American countries. Methods. An extensive search was made for national health surveys from all 12 South American countries through health websites, national statistical offices, and contact with researchers and policy-makers. The following eligibility criteria were used to select surveys: conducted in a South American country; used a nationally representative sample ≥ 18 years; coordinated by the public, private or mixed private–public sector; and assessed physical activity and/or sedentary behavior. Data were extracted on general information about the surveys, specific details about the physical activity and sedentary behavior assessment, and additional questions related to activity behavior. Results. In total, 36 surveys were included, two of which were multicountry surveys; all surveys assessed physical activity and 27 assessed sedentary behavior. Most surveys (23/36; 64%) were based on previously validated international questionnaires, but 13 (57%) of these deviated from the reference tools, introducing changes and adaptations. Sedentary behavior was assessed mostly through questions on screen time and/or daily sitting time in the same physical activity questionnaires. No survey used device-based measures to generate data on these behaviors. Conclusions. Differences between instruments used and modifications limit the comparability of data across countries. This highlights the importance of standardizing assessment within South America for physical activity and sedentary behavior sections in national surveys, with the broader aim of contributing to establishing a standardized strategy for the surveillance of physical activity and sedentary behavior in South America.

RESUMO Objetivos. Caracterizar como a atividade física e o comportamento sedentário têm sido medidos em pesquisas nacionais de saúde em países sul-americanos. Métodos. Foi realizada uma busca extensa de pesquisas nacionais de saúde de todos os 12 países sul-americanos em sites de saúde e órgãos nacionais de estatística, e pelo contato com pesquisadores e formuladores de políticas. Foram usados os seguintes critérios de elegibilidade para selecionar as pesquisas: conduzida em um país sul-americano; que tenha usado uma amostra nacionalmente representativa ≥ 18 anos; coordenada pelo setor público, privado ou público-privado; e que tenha avaliado a atividade física e/ou o comportamento sedentário. Os dados extraídos eram sobre informações gerais das pesquisas, detalhes específicos sobre a avaliação da atividade física e do comportamento sedentário e questões adicionais relacionadas ao comportamento na atividade. Resultados. Ao todo, 36 pesquisas foram incluídas, duas das quais foram conduzidas em vários países. Todas as pesquisas avaliaram a atividade física e 27 avaliaram o comportamento sedentário. A maioria das pesquisas (23/36; 64%) baseou-se em questionários internacionais previamente validados e 13 (57%) delas se desviaram das ferramentas de referência, introduzindo mudanças e adaptações. O comportamento sedentário foi avaliado principalmente por meio de perguntas sobre tempo de tela e/ou tempo diário sentado nos mesmos questionários sobre atividade física. Nenhuma pesquisa utilizou medições realizadas por dispositivos para gerar dados sobre esses comportamentos. Conclusões. As diferenças entre os instrumentos usados e as modificações limitam a comparabilidade dos dados entre os países, o que destaca a importância de padronizar a avaliação na América do Sul para as seções de atividade física e comportamento sedentário em pesquisas nacionais, com o objetivo mais amplo de contribuir para o estabelecimento de uma estratégia padronizada para a vigilância da atividade física e do comportamento sedentário na América do Sul.

RESUMEN Objetivos. Describir cómo se han medido la actividad física y el sedentarismo en las encuestas nacionales de salud en los países de América del Sur. Métodos. Se llevó a cabo una extensa búsqueda de encuestas nacionales de salud de los doce países sudamericanos en sitios web de salud, oficinas nacionales de estadística y mediante el contacto con investigadores y responsables de formular políticas. Para escoger las encuestas se emplearon los siguientes criterios de selección: realizada en un país sudamericano; muestra representativa a nivel nacional de ≥ 18 años; coordinada por el sector público, el sector privado o mixto público-privado; y evaluación de la actividad física o el sedentarismo. Se extrajeron datos como información general de las encuestas, detalles específicos de la evaluación de la actividad física y el sedentarismo, y otras preguntas relacionadas con la actividad física. Resultados. En total, se incluyeron 36 encuestas, dos de las cuales se realizaron en varios países. Todas las encuestas evaluaron la actividad física; 27, el sedentarismo. La mayoría de las encuestas (23/36; 64%) se basaron en cuestionarios internacionales anteriormente validados, de los cuales 13 (57%) se desviaron de las herramientas de referencia al tener cambios y adaptaciones. El sedentarismo se evaluó principalmente en los mismos cuestionarios de actividad física mediante preguntas sobre el tiempo invertido delante de pantallas o el tiempo diario sentado. Ninguna encuesta aplicó medidas basadas en dispositivos para obtener datos sobre estos comportamientos. Conclusiones. Las diferencias entre los instrumentos empleados y las modificaciones limitan la comparabilidad de los datos en todos los países. Esto pone de relieve la importancia de estandarizar la evaluación en América del Sur de las secciones dedicadas a la actividad física y al sedentarismo en las encuestas nacionales, con el objetivo general de contribuir a la creación de una estrategia estandarizada para la vigilancia de la actividad física y el sedentarismo en América del Sur.

Resumo: O estudo teve como objetivo verificar se a densidade residencial e a conectividade entre ruas são mediadores da associação entre fatores ambientais percebidos e deslocamento ativo casa-escola (DAE) em adolescentes brasileiros. Foi um estudo transversal com uma amostra randomizada de 1.130 adolescentes (52,7% do sexo feminino) entre 14 e 20 anos de idade, de Porto Alegre, Rio Grande do Sul, Brasil. Os adolescentes informaram seu modo de deslocamento casa-escola (ida e volta) através de um questionário, além dos atributos ambientais percebidos, de acordo com a Neighborhood Environment Walkability Scale for Youth (NEWS-Y). A densidade residencial e a conectividade entre ruas foram medidas por sistemas de informação geográfica (SIG), dentro de um raio de 1km da rede viária em torno do endereço residencial do participante. Foram ajustados modelos de regressão de acordo com os procedimentos para análises de mediação. Os resultados mostraram que a densidade residencial é um mediador da associação entre os fatores ambientais percebidos e o DAE, inclusive a diversidade do uso do solo (EI = 0,114; IC95%: 0,130, 0,311; 32% de mediação), infraestrutura para atividades de lazer na vizinhança (EI = 0,064; IC95%: 0,034, 0,105; 15% de mediação) e acesso a serviços (EI = 0,045; IC95%: 0,006, 0,104; 14% de mediação). A conectividade entre ruas não mostrou correlação com DAE, portanto não foi testado no modelo de mediação. Conclui-se que a densidade residencial é um mediador da relação entre fatores ambientais percebidos e DAE.

Abstract: The objective of this study was to verify whether residential density and connectivity between streets are mediators on the association between perceived environmental factors and active commuting to school (ACS) in Brazilian adolescents. This is a cross-sectional study with a random sample of 1,130 adolescents (52.7% girls) aged between 14 to 20 years, from Porto Alegre, Rio Grande do Sul State, Brazil. Adolescents’ self-reported their usual mode of commuting to and from school using a questionnaire and the perceived environmental attributes by Neighborhood Environment Walkability Scale for Youth (NEWS-Y). Residential density and connectivity between streets were measured by gographic information systems (GIS), within 1km road network buffers around the participant’s residential address. Regression models were fitted according to mediation analyses procedures. The results showed that residential density is a mediator on the association between ACS and perceived environmental factors, including land-use mix diversity (IE = 0.114; 95%CI: 0.130, 0.311; 32% mediation), neighborhood recreation facilities (IE = 0.064; 95%CI: 0.034, 0.105; 15% mediation), and access to services (IE = 0.045; 95%CI: 0.006, 0.104; 14% mediation). Connectivity between streets did not correlate with ACS, thus it was not tested in the mediation model. In conclusion, residential density is a mediator on the relationship between perceived environmental factors and ACS.

Resumen: El objetivo fue verificar si la densidad poblacional y la conectividad entre calles son mediadores en la asociación entre los factores ambientales percibidos y el desplazamiento activo a la escuela (DAE) en adolescentes brasileños. Se trata de un estudio transversal, con una muestra aleatoria de 1.130 adolescentes (52,7% chicas), con una edad comprendida entre los 14 y los 20 años de edad, de Porto Alegre, Río Grande do Sul, Brasil. Los adolescentes autoinformaron su modo habitual de desplazamiento “a” y “desde” la escuela, usando un cuestionario y las características ambientales percibidas mediante el Neighborhood Environment Walkability Scale for Youth (NEWS-Y). La densidad poblacional y conectividad entre las calles se midieron mediante los sistemas de información geográfica (GIS), dentro de una red vial delimitada por un radio de 1km alrededor de la dirección residencial del participante. Los modelos de regresión se ajustaron según los procedimientos para el análisis de mediación. Los resultados mostraron que la densidad poblacional es un a mediador en la asociación entre los factores ambientales percibidos y la DAE, incluyendo el uso del suelo para diversos fines (EI = 0,114; IC95%: 0,130, 0,311; 32% mediación), instalaciones recreativas en el barrio (EI = 0,064; IC95%: 0,034, 0,105; 15% mediación), y acceso a los servicios (EI = 0,045; IC95%: 0,006, 0,104; 14% mediación). Conectividad entre calles que no mostraron correlación con DAE, por consiguiente, no fue probado en el modelo de mediación. En conclusión, la densidad poblacional es un mediador en la relación entre los factores ambientales percibidos con DAE.

Resumo: O estudo teve como objetivo verificar se a densidade residencial e a conectividade entre ruas são mediadores da associação entre fatores ambientais percebidos e deslocamento ativo casa-escola (DAE) em adolescentes brasileiros. Foi um estudo transversal com uma amostra randomizada de 1.130 adolescentes (52,7% do sexo feminino) entre 14 e 20 anos de idade, de Porto Alegre, Rio Grande do Sul, Brasil. Os adolescentes informaram seu modo de deslocamento casa-escola (ida e volta) através de um questionário, além dos atributos ambientais percebidos, de acordo com a Neighborhood Environment Walkability Scale for Youth (NEWS-Y). A densidade residencial e a conectividade entre ruas foram medidas por sistemas de informação geográfica (SIG), dentro de um raio de 1km da rede viária em torno do endereço residencial do participante. Foram ajustados modelos de regressão de acordo com os procedimentos para análises de mediação. Os resultados mostraram que a densidade residencial é um mediador da associação entre os fatores ambientais percebidos e o DAE, inclusive a diversidade do uso do solo (EI = 0,114; IC95%: 0,130, 0,311; 32% de mediação), infraestrutura para atividades de lazer na vizinhança (EI = 0,064; IC95%: 0,034, 0,105; 15% de mediação) e acesso a serviços (EI = 0,045; IC95%: 0,006, 0,104; 14% de mediação). A conectividade entre ruas não mostrou correlação com DAE, portanto não foi testado no modelo de mediação. Conclui-se que a densidade residencial é um mediador da relação entre fatores ambientais percebidos e DAE.

Abstract: The objective of this study was to verify whether residential density and connectivity between streets are mediators on the association between perceived environmental factors and active commuting to school (ACS) in Brazilian adolescents. This is a cross-sectional study with a random sample of 1,130 adolescents (52.7% girls) aged between 14 to 20 years, from Porto Alegre, Rio Grande do Sul State, Brazil. Adolescents’ self-reported their usual mode of commuting to and from school using a questionnaire and the perceived environmental attributes by Neighborhood Environment Walkability Scale for Youth (NEWS-Y). Residential density and connectivity between streets were measured by gographic information systems (GIS), within 1km road network buffers around the participant’s residential address. Regression models were fitted according to mediation analyses procedures. The results showed that residential density is a mediator on the association between ACS and perceived environmental factors, including land-use mix diversity (IE = 0.114; 95%CI: 0.130, 0.311; 32% mediation), neighborhood recreation facilities (IE = 0.064; 95%CI: 0.034, 0.105; 15% mediation), and access to services (IE = 0.045; 95%CI: 0.006, 0.104; 14% mediation). Connectivity between streets did not correlate with ACS, thus it was not tested in the mediation model. In conclusion, residential density is a mediator on the relationship between perceived environmental factors and ACS.

Resumen: El objetivo fue verificar si la densidad poblacional y la conectividad entre calles son mediadores en la asociación entre los factores ambientales percibidos y el desplazamiento activo a la escuela (DAE) en adolescentes brasileños. Se trata de un estudio transversal, con una muestra aleatoria de 1.130 adolescentes (52,7% chicas), con una edad comprendida entre los 14 y los 20 años de edad, de Porto Alegre, Río Grande do Sul, Brasil. Los adolescentes autoinformaron su modo habitual de desplazamiento “a” y “desde” la escuela, usando un cuestionario y las características ambientales percibidas mediante el Neighborhood Environment Walkability Scale for Youth (NEWS-Y). La densidad poblacional y conectividad entre las calles se midieron mediante los sistemas de información geográfica (GIS), dentro de una red vial delimitada por un radio de 1km alrededor de la dirección residencial del participante. Los modelos de regresión se ajustaron según los procedimientos para el análisis de mediación. Los resultados mostraron que la densidad poblacional es un a mediador en la asociación entre los factores ambientales percibidos y la DAE, incluyendo el uso del suelo para diversos fines (EI = 0,114; IC95%: 0,130, 0,311; 32% mediación), instalaciones recreativas en el barrio (EI = 0,064; IC95%: 0,034, 0,105; 15% mediación), y acceso a los servicios (EI = 0,045; IC95%: 0,006, 0,104; 14% mediación). Conectividad entre calles que no mostraron correlación con DAE, por consiguiente, no fue probado en el modelo de mediación. En conclusión, la densidad poblacional es un mediador en la relación entre los factores ambientales percibidos con DAE.

Resumo Objetivo: Investigar a relação entre a aptidão física relacionada à saúde e o status do peso em adolescentes latinos de 13 a 15 anos. Método: A amostra final consistiu em 73.561 adolescentes entre 13 e 15 anos (35.175 meninas) do Chile (n = 48.771) e da Colômbia (n = 24.790). As aptidões cardiorrespiratória e musculoesquelética foram medidas com a corrida vaivém de 20 m (consumo máximo de oxigênio relativo - VO2máx.) e o teste de impulso horizontal (menor força explosiva do corpo), respectivamente. A definição Força-Tarefa Internacional de Obesidade foi usada para definir o status do peso (ou seja, abaixo do peso, peso normal, sobrepeso e obeso). Resultados: O presente estudo encontrou uma relação na forma de J invertido entre o índice de massa corporal, a aptidão cardiorrespiratória e a aptidão musculoesquelética em ambos os sexos e em todas as faixas etárias (p < 0,01). Os resultados também sugerem que os adolescentes abaixo do peso e não somente os adolescentes acima do peso e obesos têm menor chance de ter um perfil de aptidão cardiorrespiratória saudável (com base em novos padrões internacionais referenciados a critério) em comparação com os pares com peso normal, exceto em meninas de 14 (p = 0,268) e 15 anos (p = 0,280). Conclusões: Nossos resultados mostram baixos níveis de aptidão cardiorrespiratória e aptidão musculoesquelética em adolescentes abaixo do peso, acima do peso e obesos em comparação com os pares com peso normal. Os achados parecem sugerir que os programas de exercícios devam ser voltados para reduzir a massa gorda em adolescentes com sobrepeso/obesos e aumentar a massa muscular em adolescentes abaixo do peso.

Abstract Objective: The aim of this study was to investigate the relation between health-related physical fitness and weight status in 13- to 15-year-old Latino adolescents. Method: The final sample consisted of 73,561 adolescents aged 13 -15 years (35,175 girls) from Chile (n = 48,771) and Colombia (n = 24,790). Cardiorespiratory and musculoskeletal fitness were measured using 20-m shuttle run (relative peak oxygen uptake - VO2peak) and standing broad jump test (lower body explosive strength), respectively. The International Obesity Task Force definition was used to define weight status (i.e., underweight, normal weight, overweight, and obese). Results: The present study found an inverted J-shape relationship between body mass index, cardiorespiratory fitness, and musculoskeletal fitness in both genders and all age groups (p < 0.01). Results also suggest that underweight adolescents, and not just overweight and obese adolescents, have lower odds of having a healthy cardiorespiratory fitness (based on new international criterion-referenced standards) profile when compared with their normal weight peers, except in girls aged 14 (p = 0.268) and 15 years (p = 0.280). Conclusions: The present results indicate low cardiorespiratory fitness and musculoskeletal fitness levels in underweight, overweight, and obese adolescents when compared with their normal weight peers. The findings appear to suggest that exercise programs should to decrease fat mass in overweight/obese adolescents and increase muscle mass in underweight adolescents.

Abstract Introduction: beverage consumption constitutes a source of children's daily energy intake. Some authors have suggested that consumption of caloric beverages is higher in children with a low socioeconomic position because families limit their spending on healthy food in order to save money. Objective: the aim of this study was to explore the relationship between socioeconomic status and Spanish children's beverage consumption. Methods: a cross-sectional study was conducted in a sub-sample of 182 children (74 girls) aged 9-11 from the province of Cuenca (Spain). Beverage consumption was assessed using the YANA-C assessment tool, validated for HELENA study. Data for parental socioeconomic status were gathered by using self-reported occupation and education questions answered by parents and classified according to the scale proposed by the Spanish Society of Epidemiology. Results: beverage intake was higher in children belonging to a middle-status family than in those of upper socioeconomic status (p = 0.037). The energy from beverages was similar in most water intake categories, except for water from beverages (p = 0.046). Regarding other beverages categories, middle-status children had higher consumption levels. In contrast, lower status children drank more fruit juices and skimmed milk. All of these do not show statistically significant differences. Conclusions: our study did not find significant associations between beverages consumption and socioeconomic status in children. In fact, intake for most beverage categories was higher in middle-status children than in both other socioeconomic groups. Future research is needed in order to identify this complex relation between socioeconomic inequality and beverage intake behavior.

Resumen Introducción: el consumo de bebidas supone una elevada carga energética en la dieta y algunos autores han sugerido que el consumo de bebidas azucaradas es mayor en niños con un estatus socioeconómico menor, debido a que las familias limitan su gasto en alimentación saludable para ahorrar dinero. Objetivo: el objetivo de este estudio fue analizar la relación entre el estatus socioeconómico y el consumo de bebidas en niños. Material y métodos: estudio transversal en el que se analizó una muestra de 182 niños (74 niñas) de 9-11 años de la provincia de Cuenca (España). El consumo de bebidas se obtuvo mediante el software YANA-C, validado para el estudio HELENA. Los datos de estatus socioeconómico de los padres se obtuvieron mediante un cuestionario autoadministrado de preguntas sobre ocupación y educación, clasificado según la Sociedad Española de Epidemiología. Resultados: el consumo de bebidas fue mayor en niños de estatus socioeconómico medio (p = 0,037) con respecto a los niños de estatus socioeconómico alto. Los mismos datos se obtuvieron para la energía proveniente de las bebidas y en la mayoría de las categorías de agua analizadas, aunque solo fue significativo para el agua proveniente de bebidas (p = 0,046). En cuanto a otras categorías, los niños de estatus socioeconómico medio tienen mayores consumos. En cambio, los niños de estatus socioeconómico bajo reportan mayores ingestas de zumos de frutas y leches desnatadas, sin significación estadística. Conclusiones: nuestro estudio no ha encontrado relaciones significativas entre el consumo de bebidas y el estatus socioeconómico en niños. Los mayores consumos de bebidas se dan en niños con un estatus socioeconómico medio con respecto a los otros dos grupos. Son necesarios más estudios para explorar las complejas relaciones entre el estatus socioeconómico y el consumo de fluidos.

Abstract Aims: To analyze the association between the percentage of body fat and cardiorespiratory fitness (CRF) with cardiovascular risk factors in children, and; to examine whether percentage of body fat acts as a mediator on the association between CRF and cardiovascular risk factor. Methods: This cross-sectional study included 128 children aged 7-11 years (Mean 8.54, SD: 1.42). The following variables were evaluated: the percentage of body fat, CRF, diastolic and systolic blood pressure, glucose, triglycerides (TG) and total cholesterol. For statistical analysis were performed Partial correlation and mediation analysis. All analysis was adjusted for sex, age and height. Results: CRF, the percentage of body fat, mean arterial pressure (MAP) and TG showed a correlation between each other. Percentage of body fat mediated the association between CRF and MAP (Indirect Effect= -0.008; IC: -0.0159 -0.0030), explaining 29% of this association. However, it was found that the percentage of body fat was not a mediator of the association between CRF and TG. Conclusion: The percentage of body fat mediates the association between CRF and MAP. Our findings show that the importance of a healthy body composition for the prevention of high blood pressure levels in childhood as well as the relevance of physical activity on these parameters.

Resumen Se plantea como objetivo describir las técnicas de necropsia de campo, las condiciones de envío de muestras a los distintos laboratorios y su valor agregado en la medicina veterinaria rural. La necropsia debe ser ordenada, sistemática y completa, para así extraer la mayor cantidad de información posible del cadáver, de tal forma que permita determinar la causa de la muerte o la participación de una patología concreta. Una necropsia realizada de forma correcta, además, va a permitir una toma de muestras adecuada. En relación con el costo por necropsia, en servicios oficiales y privados oscila entre 80-150 dólares, con el envío del animal o cadáver a la sala de necropsia del centro de diagnóstico. En caso de considerarse necropsias con connotaciones médico-legales, incluyendo los animales asegurados, los precios oscilan entre 500-2500 dólares. Estos precios pueden tener un incremento de un 15 a un 20 % en campo, teniendo en cuenta el desplazamiento a la explotación/granja (distancia-kilometraje), aunque también puede tener variaciones de acuerdo con el número de animales fallecidos, lo cual representa un servicio agregado para el veterinario de campo/veterinario rural, que de alguna manera incrementa las ganancias económicas netas anuales de la empresa veterinaria rural. En conclusión, se describen las técnicas de necropsia de campo, las condiciones de envío de muestras a los distintos laboratorios y su valor agregado en la medicina veterinaria rural.

Abstract This paper aims to describe field necropsy techniques, the conditions of sending samples to different laboratories, and their added value in rural veterinary medicine. Necropsy must be ordered, systematic, and complete, in order to extract as much information as possible from the corpse, so as to determine the cause of death or the presence of a particular pathology. In addition, correctly performed necropsy will allow for an adequate sampling. In relation to necropsy costs, official and private services oscillate between 80 and 150 dollars, with the animal or corpse sent to the necropsy room of a diagnostic center. In case of necropsies with medico-legal connotations, including insured animals, prices range between 500 and 2500 dollars. These prices may have a 15 to 20% increase in the field, taking into account travel to the examination site/ranch (distance-mileage), and it may also vary according to the number of dead animals, which represents an added service for the field veterinarian/rural veterinarian, which somewhat increases the annual net economic gains for rural veterinary business.

Resumo Propõe-se como objetivo descrever as técnicas de necropsia de campo, as condições de envio de amostras aos distintos laboratórios e seu valor agregado na medicina veterinária rural. A necropsia deve ser ordenada, sistemática e completa, para deste modo extrair a maior quantidade de informação possível do cadáver, de tal forma que permita determinar a causa da morte ou a participação de uma patologia concreta. Uma necropsia realizada de forma correta, além de tudo, vai permitir uma adequada tomada de amostras. Em relação com o custo por necropsia, em serviços oficiais e privados oscila entre 80 e 150 dólares, com o envio do animal ou cadáver para a sala de necropsia do centro de diagnóstico. Em caso de considerar-se necropsias com conotações médico-legais, incluindo os animais assegurados, os preços oscilam entre 500 e 2500 dólares. Estes preços podem ter um aumento de 15 a 20 % em campo, levando em conta o deslocamento à exploração/granja (distância-quilometragem), embora também possa apresentar variações de acordo com o número de animais falecidos, o que representa um serviço adicional para o veterinário de campo/veterinário rural, que de algum modo aumenta os lucros econômicos líquido anuais da empresa veterinária rural. Em conclusão, se descrevem as técnicas de necropsia de campo, as condições de envio de amostras aos diferentes laboratórios e seu valor agregado na medicina veterinária rural.

Introduction: Milk is a changing fluid composed of lipids, proteins, minerals and immune molecules. The exclusive breastfeeding (BF) rates are below the targets set by the World Health Organization (WHO) who states that mothers should breastfeed exclusively for 6 months and supplement it with other foods during the first two years. If these recommendations are carried out, they would benefit mothers and their babies. Breast milk changes its composition depending on the baby's age, the time of day, the mother's diet or the degree of fullness of the breast. Recent studies suggest that there is a dynamic relationship between the health of children and the composition of breast milk because it increases the production of antibodies against an active infection of the infant. Objective: Perform a systematic review of the scientific literature, grouping current knowledge gathering related to the immunological properties of breast-feeding and its effects on the health of the mother and child. Methods: We conducted a systematic search and 21 specific articles on the subject are selected, following the PRISMA guidelines. Results: The studies analyzed concluded that breast milk has a lot of immune components which increase according to the baby's needs. It also has physical and psychological benefits for mother and child and it also assumed a cost savings by reducing hospital admissions of infants, because it reduces morbidity. Conclusions: Breast-fed babies have less gastrointestinal, respiratory, allergic diseases or asthma and human milk prevents childhood obesity. In addition, the BF has beneficial effects for the mother; it decreases the risk of breast cancer, cardiovascular disease and metabolic syndrome. Mothers should increase rates of exclusive breastfeeding until at least 6 months.

Introducción: la leche es un fluido cambiante formado por lípidos, proteínas, minerales y moléculas inmunes. Las tasas de lactancia materna (LM) exclusiva se encuentran por debajo de los objetivos fijados por la Organización Mundial de la Salud (OMS), que establece que las madres deben dar el pecho de forma exclusiva durante 6 meses y suplementarla con otros alimentos durante los dos primeros años. Si se llevan a cabo esas recomendaciones, las madres y sus bebés se verían beneficiados. La leche materna modifica su composición en función de la edad del bebé, el momento del día, la dieta materna o el grado de plenitud de la glándula mamaria. Estudios recientes apuntan que existe una relación dinámica entre el estado de salud del niño y la composición de la leche de la madre, ya que, incluso, aumenta la producción de anticuerpos ante una infección activa del lactante. Objetivo: efectuar una revisión sistemática de la literatura científica a base de reunir los conocimientos actuales relacionados con las propiedades inmunológicas de la lactancia materna y de sus efectos en la salud de la madre y el niño. Métodos: se lleva a cabo una búsqueda sistemática y se seleccionan 21 artículos específicos sobre el tema, siguiendo las directrices PRISMA. Resultados: los estudios analizados muestran que la leche materna tiene gran cantidad de componentes inmunológicos que aumentan ante las necesidades del bebé. También ofrece beneficios físicos y psicológicos para la madre y el niño y supone, igualmente, un ahorro económico al disminuir los ingresos hospitalarios de los bebés, puesto que disminuye su morbilidad. Conclusiones: los bebés alimentados con leche materna tienen menos probabilidades de padecer enfermedades gastrointestinales, respiratorias, alérgicas o asma, y también previene la obesidad infantil. Además, la LM tiene efectos beneficiosos para la madre, pues disminuye el riesgo de padecer cáncer de mama, enfermedades cardiovasculares y el síndrome metabólico. Se deben aumentar las tasas de lactancia materna exclusiva, al menos hasta los 6 meses de vida.

Introduction: Beverage consumption and its possible association with current obesity epidemic and metabolic syndrome is under investigation in recent years, however water intake is probably the most underestimated of all beverages and could play an important role. Objective: The aim of this study was to examine the association between water intake, body composition and cardiometabolic factors in a sample of Spanish children. Methods: A cross-sectional study was conducted in 366 schoolchildren (53.5% girls) aged 9-11 years from the province of Cuenca in Spain. Data of anthropometrics, body composition, cardiometabolic risk factors and cardiorespiratory fitness variables were collected. Beverage consumption was assessed using two non-consecutive 24 h dietary recalls. Results: We found an inverse association between the consumption of water (ml)/kg per weight with BMI, body fat, fat-free mass, waist circumference, insulin levels, HOMA-IR (p < 0.001), and with arterial pressure parameters, systolic (p < 0.010) and diastolic blood pressure (p < 0.028), and mean arterial pressure (p < 0.012), as well as direct associations with HDL cholesterol (p < 0.001). In ANCOVA analyses, children who drank less water (ml)/kg per weight, had higher levels of LDL cholesterol (p < 0.050) and lower levels of HDL cholesterol (p < 0.042), and overweight-obesity subjects drank less water (ml)/kg per weight than normal peers (p < 0.011). Besides, children with lower levels of HDL cholesterol and higher levels of triglycerides and blood pressure had less water intake as a beverage. Finally, children who drank less water from beverages had high levels of LDL cholesterol. Conclusions: Higher consumption of water (ml)/kg per weight was negatively associated with BMI, body fat, fat-free mass, waist circumference, insulin levels, HOMA-IR, and positively with HDL cholesterol in children independently of age, sex and cardiorespiratory fitness. In addition, overweight-obese children drank less water (ml)/kg per weight than normoweight ones. Therefore, water consumption is associated with numerous health benefits and its adequate intake could contribute to prevent obesity and metabolic syndrome in childhood.

Introduction: the relationship between changes in energy intake (EI) over the last few decades and the trends towards of excess weight in children is still debated. Objective: to examine the relationship between energy and macronutrient intakes with adipostity in children, controlling for cardiorespiratory fitness (CRF) as a surrogate measure of physical activity. Method: we conducted a cross-sectional study of 320 schoolchildren aged 9-11 years (54.5% girls). We collected data on socio-demographic variables, and measured weight, height, waist circumference (WC), and fat mass percentage by bioimpedance analysis. Fat mass index (FMI) was calculated as fat mass (kg) divided by height (m) squared, to adjust for body size. Energy (kcal) and macronutrient intake (percentages) were measured by two non-consecutive 24-h recalls (weekday and weekend day), using the Young Adolescents' Nutrition Assessment on Computer (YANA-C) software program; CRF was measured by the 20-m shuttle run test. Results: boys in the 4th quartile of the WC distribution had lower fat intake (34.9%) than boys in the 1st (42.4%; p = 0.019) and 2nd quartiles (41.6%; p = 0.022). Children in the 1st quartile of the FMI distribution had higher daily EIs than children in the 4th quartile (1762.3 kcal vs. 1496.8 kcal; p = 0.023). All macronutrient intakes relative to weight were lower in children in the more adipose categories for weight status, WC and FMI (p < 0.001). Conclusion: adiposity was inversely related to energy and fat intakes. Excessive EI and high EI from fats not appears to be directly associated with the current obesity epidemic among schoolchildren living in Cuenca (Spain).

Introducción: la relación entre los cambios en la ingesta energética en las últimas décadas y el incremento en las cifras de obesidad en niños está aún en debate. Objetivo: examinar la asociación entre la ingesta energética y de macronutrientes con diferentes medidas de adiposidad en niños, controlando por resistencia cardiorrespiratoria como una medida sustituta de la actividad física. Método: se realizó un estudio observacional sobre 320 escolares de entre 9 y 11 años (54,5% niñas). Se tomó información sobre variables sociodemográficas y se midió peso, altura, perímetro de cintura y porcentaje de masa grasa a través de bioimpedancia. El índice de masa grasa fue calculado dividiendo la masa grasa (en kg) entre la altura al cuadrado (en m), para ajustar por el tamaño corporal. La ingesta energética y el porcentaje de macronutrientes fueron medidos con dos recordatorios de 24-h en días no consecutivos (entre semana y fin de semana), empleando el software Young Adolescents' Nutrition Assessment on Computer (YANA-C); el fitness cardiorrespiratorio fue medido a través del test de 20 metros de ida y vuelta. Resultados: los niños en el cuarto cuartil de perímetro de cintura tienen una ingesta de grasas menor (34,9%) que los chicos en el primer (42,4%; p = 0,019) y segundo cuartil (41,6%; p = 0,022). Los escolares en el primer cuartil de índice de masa grasa tienen mayor ingesta energética total que los escolares del cuarto cuartil (1762,3 kcal vs. 1496,8 kcal; p = 0,023). Las ingestas de macronutrientes relativas al peso son menores en los sujetos de las categorías más altas de estatus ponderal, perímetro de cintura e índice de masa corporal (p < 0,001). Conclusión: la adiposidad está inversamente asociada con las ingestas energética y de grasas. Una excesiva ingesta energética y de grasas no parece estar directamente asociada con la actual epidemia de obesidad de los escolares de Cuenca (España).

OBJETIVO: Analisar a relação entre a forma física e o sucesso acadêmico e determinar a influência do tempo de tela sobre a relação entre a forma física e o sucesso acadêmico.MÉTODO: Estudo transversal que incluiu 395 crianças em idade escolar de sete escolas da região de Maule, Chile (com idade média de 12,1 anos; 50,4% de meninos), foi feito no outono de 2014 (março a junho). A atividade física e o tempo de tela autorrelatados foram avaliados. Mensuramos o desempenho escolar (média das notas obtidas em diversas matérias principais), a forma física (aptidão cardiorrespiratória e força muscular), o peso, a estatura, a escolaridade dos pais e a condição socioeconômica. A análise de regressão linear foi usada para avaliar as relações entre a forma física e o sucesso acadêmico após o ajuste pelas possíveis variáveis de confusão por sexo. A análise de variância foi usada para avaliar as diferenças no sucesso escolar de acordo com as categorias de forma física e tempo de tela (< 2 horas/dia e ≥ 2 horas/dia).RESULTADOS: Em ambos os sexos, os bons níveis de aptidão cardiorrespiratória foram associados às maiores notas em línguas (ß = 0,272-0,153) e à média de sucesso acadêmico (ß = 0,192-0,156); contudo, após ajustar o tempo de tela e outras possíveis variáveis de confusão, essas associações desaparecem. Da mesma forma, não foi observada relação após analisar as crianças com mais horas de tempo de tela (≥ 2 horas/dia).CONCLUSÕES: O sucesso acadêmico está associado a maiores níveis de aptidão cardiorrespiratória; contudo, foi pouco prejudicado pelo tempo de tela. Esses achados parecem sugerir que os pais e órgãos reguladores devem minimizar os efeitos negativos do tempo de tela sobre as vidas das crianças para maximizar o efeito benéfico de hábitos saudáveis sobre o sucesso acadêmico.

OBJECTIVE: The purpose of this study was twofold: to analyze the association between physical fitness and academic attainment, and to determine the influence of screen time on the association between physical fitness and academic attainment.METHODS: A cross-sectional study including 395 schoolchildren from seven schools of the Maule Region, Chile (mean age 12.1 years; 50.4% boys) participated in the autumn of 2014 (March to June). Self-reported physical activity and screen time were evaluated. The study measured academic achievement (mean of the grades obtained in several core subjects), physical fitness (cardiorespiratory fitness and muscular strength), weight, height, parental education, and socioeconomic status. Linear regression analysis was used to analyze the relationships between physical fitness and academic attainment after adjusting for potential confounders by gender. Analysis of variance was used to analyze the differences in academic attainment according to fitness and screen time categories (< 2 hours/day and ≥ 2 hours/day).RESULTS: In both genders good cardiorespiratory fitness levels were associated with high language (ß = 0.272-0.153) and mean academic attainment (ß = 0.192-0.156) grades; however, after adjusting for screen time and other potential confounders, these associations disappear. Similarly, no relationship was observed after analyzing those children who spend more hours of screen time (≥ 2 hours/day).CONCLUSIONS: Academic attainment is associated with higher cardiorespiratory fitness levels; however, it was weakly impaired by screen time. These findings seem to suggest that parents and policymakers should minimize the negative effects of screen time on children's lives to maximize the beneficial effect of healthy habits on academic attainment.

Introduction: introduction: Some of the diseases that can appear in pregnancy (gestational diabetes, hypertension and preeclampsia) are being associated with an increased risk of heart throughout life diseases. This should be present in future assessments of the health of women. One of the most important biomarkers in cardiovascular diseases is the triglyceride level, and that undergoes a significant change during pregnancy. Objective: the objective of this review is to analyze the studies that have investigated triglyceride levels during pregnancy as a risk factor for cardiovascular disease in the last weeks of pregnancy and childbirth. Methods: a systematic search was made and 14 specific articles on the subject were selected following the PRISMA guidelines. Results: in normal pregnancy decreased the level of lipids in the first weeks, followed by a gradual increase. Especially high from the 12th week of gestation. This increase in plasma levels of circulating lipids occurs linearly, reaching a peak a few days before delivery. This increase results because of the increased estrogen levels and insulin resistance. It has also been associated with prolactin levels. Conclusions: through this review, it has been able to demonstrate the relationship of elevated triglycerides some pathologies or more frequent changes in risk pregnancies, in which a significantly higher elevation occurs compared to normal pregnancies. It is in this context that the biological modeling may be particularly important, facilitating the creation of models and percentile curves applicable to the population, and allow monitoring of changes in triglycerides, which end up pointing situations passing be predictors of a potentially pathological situation. Thus, appropriate interventions would be carried rafter more briefly, and see so favored adequate primary prevention.

Introducción: algunas de las patologías que se pueden presentar en el embarazo (diabetes gestacional, hipertensión y preeclampsia) se están relacionando con un aumento del riesgo de padecer enfermedades cardiovasculares a lo largo de la vida. Esto se debe tener en cuenta en las futuras valoraciones de la salud de las mujeres. Uno de los biomarcadores más importantes en las enfermedades cardiovasculares es el nivel de triglicéridos, que experimenta un importante cambio durante la gestación. Objetivo: el objetivo de esta revisión es analizar los estudios que han investigado los niveles de triglicéridos durante el embarazo como factor de riesgo cardiovascular en las últimas semanas de gestación y en el parto. Métodos: se ha efectuado una búsqueda sistemática y se seleccionaron 14 artículos específicos sobre el tema, siguiendo las directrices PRISMA. Resultados: en el embarazo normal tiene lugar un descenso del nivel de lípidos en las primeras semanas, seguido de un aumento progresivo, especialmente notable a partir de la semana 12 de gestación. Este incremento de las concentraciones plasmáticas de lípidos circulantes se produce de forma lineal, hasta alcanzar un pico máximo unos días antes del parto. Esta subida se debe al aumento de los niveles de estrógenos y a la resistencia a la insulina. También se ha relacionado con los niveles de prolactina. Conclusiones: a través de la presente revisión se ha podido constatar la relación del aumento de los triglicéridos en algunas de las patologías o alteraciones más frecuentes en los embarazos de riesgo, en las que se produce una elevación significativamente mayor que en los embarazos normales. Es en este contexto en el que el modelado biológico puede cobrar una relevancia especial, facilitando la creación de modelos y curvas de percentiles aplicables a la población, y que permitan un seguimiento de los cambios en la trigliceridemia, que acaben señalando aquellas situaciones que pasan a ser predictores de una situación potencialmente patológica. De este modo, las oportunas intervenciones serían llevadas a cabo con mayor brevedad, viéndose así favorecida una adecuada prevención primaria.

Introduction. Detraining is the loss of improvements obtained through the participation in physical exercise/training after training cessation, an aspect that has been poorly studied in obese child population. Therefore, the purpose of this study was to assess the effects of detraining on the lipid profile (HDL, LDL, total cholesterol and triglycerides) of obese children. Population and Methods. Studies were collected through a search across sevendatabases. The search was limited to physical exercise programs that lasted, at least, eight weeks and the corresponding detraining, with an assessment of obese children lipid profile. Effect size (ES), 95% confidence intervals and study heterogeneity were estimated using Cochran's Q test (random effects model). Results. Five studies complied with the inclusion criteria and were selected for review (n= 330). In general, intra-group results (posttest versus detraining) indicated that, following detraining, blood levels of HDL cholesterol (ES= 0.12) and total cholesterol (ES= 1.41) were increased. Likewise, inter-group results (experimental group versus control group) confirmed the increase of HDL cholesterol following detraining (ES= 0.49). Conclusions. The results of this systematic review suggest that detraining after a physical exercise program does not lead to a significant loss of the benefits gained in relation to the lipid profile of obese children. However, given the number of analyzed studies and the heterogeneity observed in the analyses and the period defined as detraining (12 to 48 weeks), a higher number of well designed studies is required to obtain more conclusive results.

Introducción. El desentrenamiento es la pérdida de las mejoras obtenidas por el ejercicio físico/ entrenamiento tras su cese, aspecto poco estudiado en población infantil obesa. Así, el propósito del presente estudio fue evaluar los efectos del desentrenamiento sobre el perfil lipídico (HDL, LDL, colesterol total y triglicéridos) en niños obesos. Población y métodos. Los estudios fueron recuperados mediante la búsqueda en siete bases de datos. Dicha búsqueda se limitó a programas de ejercicio físico de, al menos, ocho semanas de duración y su desentrenamiento, y se evaluó el perfil lipídico de niños obesos. Se calculó el tamaño del efecto (TE), sus intervalos de confianza del 95% y la heterogeneidad de los estudios a través de la Q de Cochrane (modelo de efectos aleatorios). Resultados. Cinco estudios cumplieron los criterios de inclusión y fueron seleccionados para su revisión (n= 330). En general, los resultados intragrupo (postest vs. desentrenamiento) mostraron que, tras el desentrenamiento, el nivel en sangre del colesterol HDL (TE= 0,12) y el colesterol total aumentaron (TE= 1,41). Del mismo modo, los resultados intergrupo (grupo experimental vs. grupo control) confirmaron el aumento del colesterol HDL tras el desentrenamiento (TE= 0,49). Conclusiones. Los resultados de esta revisión sistemática sugieren que el desentrenamiento tras un programa de ejercicio físico no genera una pérdida significativa de los beneficios obtenidos sobre el perfil lipídico de los niños obesos. No obstante, debido al número de estudios analizados y a la heterogeneidad observada en los análisis y en el tiempo considerado como desentrenamiento (de 12 a 48 semanas), se requiere un mayor número de estudios de calidad para obtener resultados más concluyentes.

Introduction: Beverage consumption is becoming more important in current research regarding its possible association with the childhood obesity epidemic. The influence of physical activity on fluid intake has been poorly studied, and cardiorespiratory fitness (CRF) may be a reliable marker for this type of assessment. The present study analysed beverage intake related to weight, adjusted by CRF, in children aged 9 to 11 years. Methods: A cross-sectional, school-based study was conducted on 373 children, aged 9 to 11 years, from the Cuenca province in Spain. To obtain beverage consumption we averaged two 24-h recalls, collected using the YANA-C assessment tool, validated for HELENA study. CRF was assessed by the 20-m shuttle run test. Results: Fluid intake was 1483.39 mL/day, and energy ascribed to fluids was 16% of total energy intake. Beverages were 40% of total sugar intake from diet. The largest amount of fluid consumed among thinness boys came from fruit juices and milk drinks. Thinner girls consumed more diet drinks and whole milk than their normal and overweight counterparts, after adjusting for age and CRF. Conclusions: Overweight-obese boys consumed less fruit juices and milk drinks and girls ingested less diet drinks and whole milk than their normal-weight counterparts. These results suggest the importance of investigating the hydration habits of children to draw reliable conclusions about the best way to hydrate in different situations to avoid adiposity increases.

Introducción: El consumo de bebidas está cobrando mayor importancia en las investigaciones actuales en relación a una posible asociación con la epidemia de obesidad infantil. La influencia de la actividad física en este consumo de fluidos ha sido escasamente estudiada y la resistencia cardiorespiratoria (RCR) puede resultar un marcador fiable para su valoración. Nuestro estudio analiza la ingesta de fluidos y su relación con el estatus ponderal ajustado por RCR en niños de 9-11 años. Métodos: Estudio transversal en el que participaron 373 niños de 9-11 años de colegios de la provincia de Cuenca (España). Para obtener la ingesta de bebidas, se realizó la media de dos recordatorios de 24 horas obtenidos mediante el programa YANA-C, validado para el estudio HELENA. La condición física cardiorrespiratoria fue evaluada a través del test de 20 metros ida y vuelta. Resultados: La ingesta media de líquidos fue de 1483,39 ml/día, y la energía proveniente de fluidos supone un 16% del aporte energético diario. Las bebidas suponen el 40% del aporte de azúcares ingeridos en la dieta. Las bebidas más consumidas en niños son los zumos naturales y las bebidas lácteas. Las niñas delgadas consumen más leches enteras y bebidas refrescantes "light" que sus homólogas con peso normal y sobrepeso-obesidad. Conclusiones: Los niños con exceso de peso consumen menos zumos naturales y bebidas lácteas, y las niñas consumen menos leches enteras y bebidas refrescantes "light" que sus compañeras en normopeso. Es de gran importancia revisar los hábitos de hidratación de los escolares para establecer conclusiones fiables sobre cuál es la mejor forma de hidratarse en diferentes situaciones para evitar ganancias ponderales.

Introduction: There have been just a few studies examining the influence of detraining on obese boys. They conclude that any gains regress to the untrained control values during the detraining period. Objective: The objective of the present study was thus to evaluate the effects of detraining (6 months) on metabolic syndrome after two types of intervention (both 31 months), one of an exercise program alone and the other of a diet-plus-exercise program, in obese boys. Methods: The participants were 18 sedentary boys (811 years old) with a body mass index equal or greater than the 97th percentile for the age and sex (male) of the subject, without any dysfunction or metabolic problem. The participants were divided into two groups - the E group (physical exercise program) and the E+D group (physical exercise program plus a low calorie diet). Metabolic parameters were evaluated (TC, HDL, LDL, TG, glucose, insulin, Systolic Blood Pressure, and Diastolic Blood Pressure), allowing the metabolic syndrome index to be calculated. Results: Changes were observed in LDL-C (effect sizes = -3.19 and -2.28) and in the LDL-C/HDL-C ratio (effect sizes = -3.02 and -1.16) in the E and E+D groups, respectively. The prevalence of metabolic syndrome and obesity was completely removed only in the E group (100% norisk and non-obese subjects - < 90th percentile). Conclusions: Detraining from a long-term exercise program (with or without diet) seems not to negatively affect the cardiovascular profile, suggesting that the program provides benefits and fosters healthy habits that can be maintained over time, preventing the development of metabolic syndrome.

Introducción: Existen pocos estudios que examinen la influencia del desentrenamiento en niños obesos. Estos estudios concluyen que tras el desentrenamiento se regresa a los valores iniciales antes de la intervención. Objetivo: El objetivo del presente estudio fue examinar los efectos del desentrenamiento (6 meses) sobre e l síndrome metabólico después de dos tipos de intervención (31 meses), una de las intervenciones consistió en un programa de ejercicio físico aislado y la otra además del ejercicio físico incluyó la dieta. Métodos: Participaron 18 niños sedentarios (8-11 años) con un índice de masa corporal igual o superior al percentil 97 en función de la edad y sexo (varones) sin ninguna disfunción o problema metabólico. Los participantes fueron divididos en dos grupos: Grupo E (realizó el programa de ejercicio físico) y grupo E+D (realizó el programa de ejercicio físico más una dieta hipocalórica). Se evaluaron los parámetros metabólicos (CT, HDL-C, LDL-C, TG, glucosa, insulina y presión sistólica y diastólica) que permitieron calcular el síndrome metabólico. Resultados: Se observaron cambios en el LDL-C (TE = -3.19 y -2.28) y el índice LDL-C/HDL-C (TE = -3.02 y -1.16) en el grupo E y E+D respectivamente. La prevalencia del síndrome metabólico y obesidad fue eliminada por completo en el grupo E (100% sin riesgo en niños no obesos - < percentil 90). Conclusiones: El desentrenamiento tras un programa de ejercicio a largo plazo (con y sin dieta) parece no tener efectos negativos en el perfil cardiovascular, sugiriendo que el programa aporta beneficio sobre la salud (síndrome metabólico) que se mantienen en el tiempo.