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Childhood Obesity
Determinants of Adherence to the Mediterranean Diet in Spanish Children and Adolescents: The PASOS Study
By Maria del Mar Bibiloni, Laura Gallardo-Alfaro, Santiago F Gómez, Julia Wärnberg, Maddi Osés-Recalde, Marcela González-Gross, Narcís Gusi, Susana Aznar, Elena Marín-Cascales, Miguel A González-Valeiro, Lluís Serra-Majem, Nicolás Terrados, Marta Segu, Camille Lassale, Clara Homs, Juan Carlos Benavente-Marín, Idoia Labayen, Augusto G Zapico, Jesús Sánchez-Gómez, Fabio Jiménez-Zazo, Pedro E Alcaraz, Marta Sevilla-Sánchez, Estefanía Herrera-Ramos, Susana Pulgar, Clara Sistac, Helmut Schröder, Cristina Bouzas y Josep A Tur

A progressive shift away from traditional healthy dietary patterns, such as the Mediterranean diet (MedDiet), has been observed in recent decades. The aim of this study was to assess determinants of optimal adherence to the MedDiet in Spanish children and adolescents. A cross-sectional analysis was included in the PASOS nationwide representative study in Spain. Participants were 3607 children and adolescents; 8–16 years old. Primary and secondary outcome measures of weight and height were measured. Adherence to the MedDiet, physical activity, and sedentary behavior in children and adolescents, as well as parental physical activity and dietary habits, were assessed. Optimal adherence to the MedDiet was observed in 45.5% of primary school students and 34.8% of secondary school students (OR: 0.65; 95%CI: 0.56–0.75). Optimal adherence to the MedDiet was higher in children/adolescents meeting daily recommended moderate and vigorous physical activity (OR: 2.39, 95%CI: 1.97–2.89) and in those meeting daily recommended screen time on weekdays (OR: 2.05, 95%CI: 1.77–2.38) and weekends (OR: 1.76, 95%CI: 1.48–2.10). Participants with optimal adherence to the MedDiet were more likely to have mothers with a high-level education and high-tercile of SDQS, mothers who never smoked or were former smokers, and mothers who met the recommended physical activity and screen time. It can be concluded that a low prevalence of optimal adherence to the MedDiet was found among current Spanish children and adolescents. Optimal adherence to the MedDiet was associated with reaching the recommendations on physical activity and screen time, with the highest maternal educational level, and healthier maternal lifestyles

Childhood Obesity
Combined Body Mass Index and Waist-to-Height Ratio and Its Association with Lifestyle and Health Factors among Spanish Children: The PASOS Study
By Maria del Mar Bibiloni, Laura Gallardo-Alfaro, Santiago F Gómez, Julia Wärnberg, Maddi Osés-Recalde, Marcela González-Gross, Narcís Gusi, Susana Aznar, Elena Marín-Cascales, Miguel González-Valeiro, Lluís Serra-Majem, Nicolás Terrados, Marta Segu, Camille Lassale, Clara Homs, Juan Carlos Benavente-Marín, Idoia Labayen, Augusto G Zapico, Jesús Sánchez-Gómez, Fabio Jiménez-Zazo, Pedro E Alcaraz, Marta Sevilla-Sánchez, Estefanía Herrera-Ramos, Susana Pulgar, Clara Sistac, Helmut Schröder, Cristina Bouzas y Josep A Tur

Background and Aims: The World Health Organization recommended simultaneous measurement of body mass index (BMI) and waist circumference (WC) and suggested joint use to predict disease risks. The aim of this study was to assess the prevalence of BMI and waist-to-height ratio (WHtR) categories among Spanish children and adolescents, as well as their associations with several lifestyle factors. Methods: Cross-sectional analysis of 8–16-year-old children and adolescents (n = 3772) were included in the PASOS nationwide representative study. Children/adolescents and their mothers/female caregivers answered a questionnaire on lifestyle and health factors. Child/adolescent anthropometrics were measured. Four combined BMI-WHtR disease risk categories were built. Results: A third of participants showed combined BMI-WHtR categories with high disease risk (12.3% ‘increased risk’, 9.7% ‘high risk’, 14.3% ‘very high risk’). Participants in the ‘very high risk’ group were less likely to be females (odds ratio 0.63; 95% CI: 0.52–0.76) and adolescents (0.60; 95% CI: 0.49–0.72), to practice ≥60 min/day of moderate-vigorous physical activity (MVPA) (0.73; 95% CI: 0.57–0.93), and to watch <120 min/day of total screen time on weekdays (0.61; 95% CI: 0.49–0.76). Mothers of participants in the ‘very high risk’ group were less likely to have a high educational level, be in the overweight or normal range, have never smoked or were former smokers, and watch <120 min/day of total screen time on weekends. Participants in the ‘increased’ and ‘high risk’ categories had mothers with normal weight and ≥60 min/day of MVPA. Participants in the ’high risk’ group did not achieve ≥60 min/day of MVPA and showed lower adherence to the Mediterranean diet. Conclusions: Adherence to a healthy lifestyle in children and adolescents, but also in their mothers/female caregivers during offspring’s childhood and adolescence, is associated with low BMI-WHtR disease risk.

Childhood Obesity
Prospective Association of Maternal Educational Level with Child’s Physical Activity, Screen Time, and Diet Quality
By Gabriela Cárdenas-Fuentes, Clara Homs, Catalina Ramírez-Contreras, Charlotte Juton, Rafael Casas-Esteve, Maria Grau, Isabel Aguilar-Palacio, Montserrat Fitó, Santiago F Gomez y Helmut Schröder

Evidence has identified unhealthy lifestyle behaviors as the main contributors to obesity in children, so it is essential to identify factors that could influence children’s lifestyles. The objective of the present study was to analyze the association of baseline maternal educational level with child’s physical activity, screen time, and dietary habits at follow-up. This community-based cohort study was carried out between 2012 and 2014 and included 1405 children aged 8 to 10 years old. Maternal educational level was used as an indicator of child’s socioeconomic status. Physical activity, screen time, and dietary habits were assessed by validated questionnaires. The odds of having commercially baked goods for breakfast [OR 1.47 (95% CI 1.03 to 2.10)], going more than once a week to a fast-food restaurant [OR 1.64 (95% CI 1.20 to 2.26)], and taking sweets and candys several times a day [OR 3.23 (95% CI 2.14 to 4.87) were significantly higher among children whose mothers had a lower educational level compared to their peers whose mothers had a higher level. These associations held for taking sweets and candy several times a day after additional adjustment for the corresponding dietary behavior at baseline. Maternal educational level was inversely associated (p < 0.001) with child’s screen time at follow up and being in the lowest maternal educational category was associated with an increased odds of surpassing the maximum recommended time of screen time of 120 min per day (OR (95% CI) 1.43 (1.07 to 1.90), p = 0.016). Maternal education is a predictor for unhealthy dietary habits and high screen time in children.