Abstract Objective: to assess the evolution of adherence to Mediterranean diet and level of physical activity of university students of Health Sciences in Castilla-La Mancha during the COVID-19 lockdown and one year afterwards. Methods: a cross-sectional observational study using questionnaires on adherence to the Mediterranean diet and level of physical activity. A total of 893 students enrolled in Health Sciences degrees at the University of Castilla la Mancha participated, 575 in the first survey (during the lockdown) and 318 in the second (one year later). By sex, 672 women and 221 men (in the first survey 77.7 % were women and 22.3 % men while in the second survey these were 70.8 % and 29.2 %, respectively). Adherence to the Mediterranean diet was assessed with the Mediterranean Diet Adherence Screener (MEDAS) questionnaire and the modified Prevention with Mediterranean Diet (PREDIMED) questionnaire. The level of physical activity was assessed with the Rapid Assessment of Physical Activity Scale (RAPA). Results: one year after the COVID-19 confinement, consumption of olive oil has almost tripled. Daily fruit consumption has also doubled. Similarly, the consumption of wine and alcoholic beverages has doubled. Conversely, there was a reduction in the consumption of butter and margarine, as well as of carbonated drinks and sweetened beverages. Likewise, the percentage of university students with high adherence to the Mediterranean diet increased significantly (from 26 % to 34.3 %). Regarding physical activity level, there was a significant increase in the percentage of university students who engaged in light, moderate and even intense physical activity on an irregular basis. This increase was not found in the case of muscular strength and flexibility training activities. Conclusion: the results of the study indicate that, although the levels of adherence to the Mediterranean diet and physical activity have improved after the COVID-19 confinement, adherence to Mediterranean diet and physical activity level among the university population analyzed is still low. It is necessary to implement strategies for the achievement or maintenance of a healthy lifestyle in this population.

Resumen Objetivo: valorar la evolución de la adherencia a la dieta mediterránea y el nivel de actividad física de los estudiantes universitarios de Ciencias de la Salud de Castilla-La Mancha durante la pandemia de COVID-19 y un año después de la misma. Método: estudio observacional transversal mediante cuestionarios sobre la adherencia a la dieta mediterránea y el nivel de actividad física. Participaron 893 alumnos matriculados en grados de Ciencias de la Salud de la Universidad de Castilla-La Mancha, 575 en la primera encuesta (durante la pandemia) y 318 en la segunda (un año después). Por sexos, 672 mujeres y 221 hombres (en la primera encuesta, el 77,7 % eran mujeres y el 22,3 % hombres, mientras que en la segunda lo eran el 70,8 % y 29,2 %, respectivamente). La adherencia a la dieta mediterránea se valoró con el cuestionario Mediterranean Diet Adherence Screener (MEDAS) y el cuestionario de Prevención con Dieta Mediterránea (PREDIMED), modificado. El nivel de actividad física se valoró con el cuestionario Rapid Assessment of Physical Activity Scale (RAPA). Resultados: tras un año desde el confinamiento por la COVID-19, el consumo de aceite de oliva casi se ha triplicado. Se ha duplicado también el consumo de frutas diario. De igual modo, se ha duplicado el consumo de vino y bebidas alcohólicas. Por el contrario, se encontró una reducción del consumo de mantequilla y margarina, al igual que de bebidas carbonatadas y azucaradas. Asimismo, aumentó significativamente el porcentaje de estudiantes universitarios con adherencia alta a la dieta mediterránea (del 26 % al 34,3 %). En cuanto al nivel de actividad física, ha aumentado significativamente el porcentaje de estudiantes universitarios que realizan actividad fisica ligera, moderada e incluso intensa de forma irregular. Este aumento no se ha encontrado en el caso de las actividades de fuerza muscular y flexibilidad. Conclusión: los resultados del estudio nos indican que, aunque los niveles de adherencia a la dieta mediterránea y de actividad física han mejorado tras el confinamiento por la COVID-19, la adherencia a la dieta mediterránea y el nivel de actividad física de la población universitaria analizada siguen siendo bajos. Es necesario aplicar estrategias para la consecución o mantenimiento de un estilo de vida saludable en dicha población.

Abstract Objective: this study analyzed the association between adherence to the Mediterranean diet and proxy-reported physical fitness among Spanish and Brazilian youths during the COVID-19 lockdown according to several inequality indicators. Methods: we conducted a cross-sectional study with parents and guardians of children and adolescents from Spain and Brazil. The evaluation process was through the use of online questionnaires. Adherence to the Mediterranean diet was assessed using the Mediterranean Diet Quality Index in Children and Adolescents. Proxy-reported physical fitness was determined using the International Fitness Scale. Inequality indicators (gender, nationality, socioeconomic status, and parents/guardians' education level) were evaluated with a survey completed by the participants' parents/guardians. Binary logistic regression models estimated the association between adherence to the Mediterranean diet and proxy-reported physical fitness, with stratification according to inequality variables. A total sample of 1099 Spanish and Brazilian individuals (47.6% girls, aged 3 to 17 years) were included in the analysis. Results: compared to the "improvement needed to Mediterranean diet" category, the "optimal Mediterranean diet" group was significantly associated with "very good" physical fitness in boys (OR = 1.5; 95 % CI: 1.0-2.1) and in participants with parents/legal guardians' education level without university studies (OR = 1.5; 95 % CI: 1.0-2.4). Conclusions: gender and parents/guardians' education level plays a significant role in the association between the "optimal Mediterranean Diet" and "very good" physical fitness level in Spanish and Brazilian children and adolescents. Future prospective studies are needed to investigate the role of inequality indicators in this relationship.

Resumen Objetivo: este estudio analizó la asociación entre la adherencia a la dieta mediterránea y la aptitud física autoinformada entre jóvenes españoles y brasileños durante el confinamiento de COVID-19 según varios indicadores de desigualdad. Métodos: se realizó un estudio transversal con padres y tutores de niños y adolescentes de España y Brasil. El proceso de evaluación fue a través del uso de cuestionarios online. La adherencia a la dieta mediterránea se evaluó mediante el Índice de Calidad de la Dieta Mediterránea en Niños y Adolescentes. La aptitud física declarada por los padres se determinó mediante la Escala Internacional de Aptitud Física. Los indicadores de desigualdad (género, nacionalidad, estatus socioeconómico y nivel educativo de los padres/tutores) se evaluaron con una encuesta completada por los padres/tutores de los participantes. Los modelos de regresión logística binaria estimaron la asociación entre la adherencia a la dieta mediterránea y la aptitud física informada por los progenitores, estratificando según las variables de desigualdad. Se incluyó en el análisis una muestra total de 1099 individuos españoles y brasileños (47,6 % niñas, de 3 a 17 años). Resultados: en comparación con la categoría de "necesidad de mejorar la dieta mediterránea", la de "dieta mediterránea óptima" se asoció significativamente con una aptitud física "muy buena" en los chicos (OR = 1,5; IC del 95 %: 1,0-2,1) y en los participantes con nivel educativo de los padres/tutores sin estudios universitarios (OR = 1,5; IC del 95 %: 1,0-2,4). Conclusiones: el género y el nivel educativo de los padres/tutores legales desempeñan un papel significativo en la asociación entre la "dieta mediterránea óptima" y el nivel de condición física "muy bueno" en niños y adolescentes españoles y brasileños. Se necesitan futuros estudios prospectivos para investigar el papel de los indicadores de desigualdad en esta relación.

ABSTRACT OBJECTIVE To verify whether parental physical activity and social support are associated with adolescents meeting physical activity recommendations. METHODS This is a cross-sectional study that selected 1,390 adolescents (59.6% girls) from Curitiba, Paraná, Brazil. The IPAQ (International Physical Activity Questionnaire), QAFA (Physical Activity Questionnaire for Adolescents), and ASAFA (Social Support for Physical Activity Practice in Adolescents) questionnaires were applied. Binary logistic regression was used to test the relationship among the study variables. RESULTS For boys, having parents who “always attend” (OR = 1.96; 95%CI: 1.16–3.32) and having parents or legal guardians who meet the PA recommendations (OR = 2.78; 95%CI: 1.76–4.38) were associated with meeting the PA recommendations. Odds were greater after adjusting for socioeconomic status (OR = 3.47; 95%CI: 1.73–6.96) and schooling level (OR = 4.20; 95%CI: 1.96–9.02). For girls, those with parents or legal guardians who “sometimes encourage them” (OR = 0.61; 95%CI: 0.37–0.98) had lower odds of meeting PA recommendations. These odds were higher after adjusting for socioeconomic status (OR = 2.11; 95%CI: 1.36–3.29) and schooling level (OR = 4.30; 95%CI: 2.41–7.69). CONCLUSIONS Boys and girls were more likely to meet PA recommendations daily by having parents who meet PA recommendations than by receiving parental social support. These results could help establish future interventions aimed at modifying behaviors related to PA in adolescents.

ABSTRACT OBJECTIVE To verify whether parental physical activity and social support are associated with adolescents meeting physical activity recommendations. METHODS This is a cross-sectional study that selected 1,390 adolescents (59.6% girls) from Curitiba, Paraná, Brazil. The IPAQ (International Physical Activity Questionnaire), QAFA (Physical Activity Questionnaire for Adolescents), and ASAFA (Social Support for Physical Activity Practice in Adolescents) questionnaires were applied. Binary logistic regression was used to test the relationship among the study variables. RESULTS For boys, having parents who “always attend” (OR = 1.96; 95%CI: 1.16–3.32) and having parents or legal guardians who meet the PA recommendations (OR = 2.78; 95%CI: 1.76–4.38) were associated with meeting the PA recommendations. Odds were greater after adjusting for socioeconomic status (OR = 3.47; 95%CI: 1.73–6.96) and schooling level (OR = 4.20; 95%CI: 1.96–9.02). For girls, those with parents or legal guardians who “sometimes encourage them” (OR = 0.61; 95%CI: 0.37–0.98) had lower odds of meeting PA recommendations. These odds were higher after adjusting for socioeconomic status (OR = 2.11; 95%CI: 1.36–3.29) and schooling level (OR = 4.30; 95%CI: 2.41–7.69). CONCLUSIONS Boys and girls were more likely to meet PA recommendations daily by having parents who meet PA recommendations than by receiving parental social support. These results could help establish future interventions aimed at modifying behaviors related to PA in adolescents.

Resumen Objetivo: el objetivo del presente estudio fue evaluar el nivel de actividad física y su asociación con la dieta mediterránea en estudiantes universitarios de ciencias de la salud de la Universidad de Castilla-La Mancha (España). Método:: se realizó un estudio transversal a través de una encuesta online. La muestra final estuvo formada por 555 estudiantes universitarios (78,2 % mujeres). La adherencia a la dieta mediterránea se evaluó mediante el evaluador de adherencia a la dieta mediterránea de 14 ítems (MEDAS). Para medir la actividad física se utilizó el cuestionario Rapid Assessment of Physical Activity Scale (RAPA). Resultados: de acuerdo con la actividad física, el 2,5 % de los participantes se consideraron activos y el 35,1 % realizaban actividades tanto de fuerza como de flexibilidad. Se observó una mayor asociación entre la ingesta de frutas (OR = 1,95; IC 95 %, 1,25-3,04), legumbres (OR = 1,51; IC 95 %, 1,00-3,20) y frutos secos (OR = 1,99; IC 95 %, 1,33-2,99) en aquellos considerados suficientemente activos. Asimismo, encontramos una relación significativa entre la ingesta de frutas (OR = 2,28; IC 95 %, 1,49-3,47), legumbres (OR = 1,41; IC 95 %, 1,00-2,08), frutos secos (OR = 1,96; IC 95 %, 1,34-2,86) y pescado/marisco (OR = 1,67; IC 95 %, 1,15-2,43), en aquellos que participaron en actividades de fuerza y flexibilidad. Conclusión: este estudio sugiere que el consumo de determinados alimentos mediterráneos se asocia con mayores niveles de actividad física en la muestra de universitarios españoles analizada.

Abstract Objective: the aim of the present study was to assess the level of physical activity and its association with Mediterranean dietary patterns in university students of health sciences at Universidad de Castilla-La Mancha (Spain). Method: a cross-sectional study was performed through an online survey. The final sample consisted of 555 university students (78.2 % females). Adherence to Mediterranean diet was assessed using the 14-item Mediterranean Diet Adherence Screener (MEDAS). To measure physical activity, the Rapid Assessment of Physical Activity Scale (RAPA) questionnaire was used. Results: according to physical activity, 2.5 % of the participants were considered active and 35.1 % did both strength and flexibility activities. A greater association was seen between intake of fruits (OR = 1.95; 95 % CI, 1.25-3.04), pulses (OR = 1.51; 95 % CI, 1.00-3.20), and nuts (OR = 1.99; 95 % CI, 1.33-2.99) in those considered sufficiently active. Similarly, we found a significant relationship between the intake of fruits (OR = 2.28; 95 % CI, 1.49-3.47), pulses (OR = 1.41; 95 % CI, 1.00-2.08), nuts (OR = 1.96; 95 % CI, 1.34-2.86), and fish/seafood (OR = 1.67; 95 % CI, 1.15-2.43) in those who engaged in both strength and flexibility activities. Conclusion: this study suggests that consumption of certain Mediterranean foods was associated with higher levels of physical activity in a sample of Spanish university students.

Abstract Objective: to assess the degree of adherence to the Mediterranean diet and the practice of physical activity in university Health Sciences students in Castile-La Mancha. Methods: this was a cross-sectional, observational study by means of a dietary and physical activity survey. The sample consisted of 575 university students (77.7 % women). An initial data collection survey was developed using the Google Forms platform (https://www.google.com/forms/about/). Adherence to the Mediterranean diet was assessed with the Mediterranean Diet Adherence Screener (MEDAS) questionnaire and the modified Prevention with Mediterranean Diet (PREDIMED) questionnaire. The Rapid Assessment of Physical Activity Scale (RAPA) questionnaire was used to measure physical activity. Results: we found a 58.3 % adherence to Mediterranean diet among Health Sciences students, with 38.6 % of average adherence, and 5.0 % of poor adherence, with a low consumption of fruits with no gender differences, and a high consumption of red or processed meat and butter or cream with significant differences between women and men. There is also a high consumption of carbonated beverages (more frequent in women). Likewise, a high percentage of students (22.5 %) do practically no physical activity. As for physical exercise, it is always higher in men, with significant differences (p > 0.05). Conclusion: this study suggests that the sample of university Health Sciences students in Castile-La Mancha shows an acceptable adherence to the Mediterranean diet and insufficient levels of physical activity.

Resumen Objetivo: valorar el grado de adherencia a la dieta mediterránea y la práctica de actividad física en estudiantes universitarios de Ciencias de la Salud de Castilla-La Mancha. Método: estudio observacional transversal mediante encuesta alimentaria y de actividad física. La muestra contó con 575 estudiantes universitarios (77,7 % de mujeres). Se desarrolló una encuesta de recogida de datos inicial mediante la plataforma Google Forms (https://www.google.com/forms/about/). La adherencia a la dieta mediterránea se valoró con el cuestionario Mediterranean Diet Adherence Screener (MEDAS) y el cuestionario PREvención con DIeta MEDiterránea (PREDIMED), modificado. Para medir la actividad física se utilizó el cuestionario Rapid Assessment of Physical Activity Scale (RAPA), que valora la actividad física desempeñada. Resultados: se encontró en los estudiantes de Ciencias de la Salud una adherencia a la dieta mediterránea del 58,3 %, siendo la adherencia media del 38,6 % y la mala adherencia del 5,0 %, observándose un bajo consumo de frutas sin diferencias de sexo, un alto consumo de carne roja o procesada y de mantequillas o natas, con diferencias significativas entre mujeres y hombres. También hay un consumo alto de bebidas carbonatadas (más frecuente en mujeres). Asimismo, un porcentaje alto de estudiantes (22,5 % del total) no hace prácticamente ninguna actividad física. En cuanto al ejercicio físico, siempre es mayor entre los hombres, con diferencias significativas (p > 0,05). Conclusión: este estudio sugiere que la muestra de estudiantes universitarios de Ciencias de la Salud de Castilla-La Mancha presenta una aceptable adherencia a la dieta mediterránea y unos niveles de actividad física insuficientes.

Abstract Objective: the aim of this research was to explore the relationship between dietary pattern habits and compliance with screen-time guidelines in Spanish schoolchildren. Material and methods: a cross-sectional and associative study was performed in a total of 370 schoolchildren (44.9 % girls) aged 6-13 (8.7 ± 1.8) years. Results: for boys, those who did not meet these guidelines presented lower chances of eating vegetables regularly (OR = 0.50; 95 % CI = 0.28-0.89) or more than once a day (OR = 0.43; 95 % CI = 0.22-0.85). In girls, it was observed that those who did not meet the guidelines presented a lower probability of eating one piece of fruit (OR = 0.43; 95 % CI = 0.19-0.99) as well as a second piece (OR = 0.22; 95 % CI = 0.22-0.81), vegetables more than once a day (OR = 0.39; 95 % CI = 0.19-0.80), fish (at least 2-3 times/week) (OR = 0.40; 95 % CI = 0.20-0.78) and nuts (at least 2 or 3 times per week) (OR = 0.46; 95 % = 0.24-0.87). Conclusion: some healthy eating patterns, such as the consumption of fruits and vegetables, appeared to be more prevalent in those children who met the international screen-time guidelines.

Resumen Objetivo: el objetivo de esta investigación fue explorar la relación entre los hábitos de alimentación y el cumplimiento de las recomendaciones de tiempo de pantalla en escolares españoles. Material y métodos: se realizó un estudio transversal y asociativo con un total de 370 escolares (44,9 % niñas) de 6 a 13 años (8,7 ± 1,8). Resultados: en los niños, aquellos que no cumplían con las recomendaciones presentaron menos probabilidades de comer verduras regularmente (OR = 0,50; IC 95 % = 0,28-0,89) y de ingerirlas más de una vez al día (OR = 0,43; IC 95 % = 0,22-0,85). En las niñas se observó que las que no cumplían las recomendaciones presentaban una menor probabilidad de comer una pieza de fruta (OR = 0,43; IC 95 % = 0,19-0,99) así como una segunda pieza (OR = 0,22; IC 95 % = 0,22-0,81), verduras más de una vez al día (OR = 0,39; IC 95 % = 0,19-0,80), pescado (al menos 2-3 veces por semana) (OR = 0,40; IC 95 % = 0,20-0,78) y frutos secos (al menos 2 o 3 veces por semana) (OR = 0,46; IC 95 % = 0,24-0,87). Conclusión: algunos patrones de alimentación saludable, como el consumo de frutas y verduras, parecen ser más prevalentes en los niños que cumplen con las recomendaciones internacionales de tiempo de pantalla.

Resumo Introdução A falta de atividade física, junto com o consumo inadequado de alimentos, tem sido um dos tópicos mais presentes em investigações sobre mortalidade e doenças crônicas não transmissíveis. Por isso, conhecer o nível de atividade física em escolares ostenta grande importância, posto que é possível empregar ações para diminuir os níveis alarmantes de sedentarismo, especialmente nas aulas de Educação Física. Objetivo Examinar sistematicamente o nível de atividade física auto-informado em crianças em idade escolar não isentos da participação em sessões de Educação Física. Método Revisão sistemática de estudos transversais que determinam o nível de atividade física auto-informado mediante o questionário PAQ-C. Resultados Identificou-se 23 artigos mediante a busca em cinco bases de dados distintas, entre 2014 e 2019. Para seleção dos artigos foi considerado o tipo de estudo e o lugar de realização, faixa etária analisada, assim como os não participantes de Educação Física. Conclusão A maioria dos estudos analisados mostraram níveis insuficientes de atividade física, não obstante, é necessário levar em consideração a realização de novas investigações relacionadas com o nível de atividade física auto-informado, para diagnosticar com maior precisão a realidade de crianças em idade escolar.

Abstract Introduction The lack of physical activity, together with inadequate food consumption, has been one of the most present topics in research on mortality and chronic non-communicable diseases. Therefore, knowing the level of physical activity in schoolchildren is of great importance, since actions could be deployed to reduce the alarming levels of sedentary life, especially from the subject of Physical Education. Objective To systematically examine the level of self-reported physical activity in schoolchildren not exempt from participation in Physical Education sessions. Method A systematic review of cross-sectional studies that determined the level of self-reported PAQ-C questionnaire. Results Twenty-three articles were identified by searching five different databases between 2014 and 2019. For the selection of the articles, it was necessary to consider the type of study and location, the age phase analyzed, as well as the non-participation in the Physical Education sessions. Conclusion Most of the studies analyzed indicate insufficient levels of physical activity; however, it is necessary to carry out more research related to the level of self-reported physical activity, enabling to diagnose with greater precision the reality of school-age children.

Resumen Introducción La falta de actividad física, junto con el consumo inadecuado de alimentos, ha sido uno de los tópicos más presentes en la investigación sobre mortalidad y las enfermedades crónicas no transmisibles. Por ello, conocer el nivel de actividad física en escolares ostenta gran importancia, puesto que podrían desplegarse acciones para disminuir los alarmantes niveles de sedentarismo, especialmente desde la asignatura de Educación Física. Objetivo Examinar sistemáticamente el nivel de actividad física autoinformado en escolares no exentos de la participación en las sesiones de Educación Física. Método Revisión sistemática de estudios transversales que determinaron el nivel de actividad física autoinformado a través del cuestionario PAQ-C. Resultados Se identificaron 23 artículos mediante la búsqueda en cinco bases de datos distintas, entre 2014 y 2019. Para la selección de los artículos, fue preciso considerar el tipo de estudio y lugar de realización, la fase etaria analizada, así como la no participación en las sesiones de Educación Física. Conclusiones La mayoría de estudios analizados señalan unos niveles insuficientes de la misma; no obstante, resulta necesario llevar a cabo más investigaciones relacionadas con el nivel de actividad física autoinformado, para diagnosticar con mayor precisión la realidad de los niños en edad escolar.