PA, especially physical education, improves classroom behaviors and benefits several aspects of academic achievement, especially mathematics-related skills, reading, and composite scores in youth.

IMPORTANCE Studies of trends in excess weight among European children throughout the last few decades have rendered mixed results. Additionally, some studies were outdated, were based on self-reported weight and height, or included only a few European countries.OBJECTIVE To assess prevalence trends in measured overweight and obesity among children across Europe from 1999 to 2016 using a systematic methodology.DATA SOURCES MEDLINE, Embase, CINAHL, and Web of Science were searched from their inception until May 2018. Moreover, searches were conducted on health institutions' websites to identify studies not published in scientific journals. STUDY SELECTIONThe inclusion criteria were: (1) studies reporting the population-based prevalence of excess weight (overweight plus obesity) or obesity according to body mass index cutoffs proposed by the International Obesity Task Force; (2) cross-sectional or follow-up studies; and (3) studies including populations aged 2 to 13 years.DATA EXTRACTION AND SYNTHESIS Literature review and data extraction followed established guidelines. The Mantel-Haenszel method was used to compute the pooled prevalence estimates and their 95% CI whenever there was no evidence of heterogeneity (I 2 < 50%); otherwise, the DerSimonian and Laird random-effects method was used. Subgroup analyses by study year, country, or European region (Atlantic, Iberian, Central, and Mediterranean) were conducted. Prevalence estimates were calculated as an aggregate mean, weighted by the sample size and the number of individuals in each study. RESULTS A total of 103 studies (477 620 children aged 2 to 13 years) with data from 28 countries were included. The combined prevalence of overweight and obesity in the Iberian region tended to decrease from 30.3% (95% CI, 28.3%-32.3%) to 25.6% (95% CI, 19.7%-31.4%) but tended to increase in the Mediterranean region from 22.9% (95% CI, 17.9%-27.9%) to 25.0% (95% CI, 14.5%-35.5%). No substantial changes were observed in Atlantic Europe or Central Europe, where the overweight and obesity prevalence changed from 18.3% (95% CI, 14.0%-23.9%) to 19.3% (95% CI, 17.7%-20.9%) and from 15.8% (95% CI, 13.4%-18.5%) to 15.3% (95% CI, 11.6%-20.3%), respectively. CONCLUSIONS AND RELEVANCEThe prevalence of childhood overweight and obesity is very high, but trends have stabilized in most European countries. There are substantial between-country differences in the current levels and trends of overweight and obesity. The rising prevalence in some Mediterranean countries is worrisome.

The aims of this study were to assess the association of adherence to the Mediterranean diet (MD) with physical fitness and body composition in Spanish university students and to determine the ability to predict the MD adherence of each Mediterranean Diet Adherence Screener (MEDAS) item. A cross-sectional study was performed involving 310 first-year university students. Adherence to the MD was evaluated with MEDAS-14 items. Anthropometric variables, body composition, and physical fitness were assessed. Muscle strength was determined based on handgrip strength and the standing long jump test. Cardiorespiratory fitness (CRF) was measured using the Course–Navette test. Only 24% of the university students had good adherence to the MD. The ANCOVA models showed a significant difference between participants with high adherence to the MD and those with medium and low adherence in CRF (p = 0.017) and dynamometry (p = 0.005). Logistic binary regression showed that consuming >2 vegetables/day (OR = 20.1; CI: 10.1–30.1; p < 0.001), using olive oil (OR = 10.6; CI: 1.4–19.8; p = 0.021), consuming <3 commercial sweets/week (OR = 10.1; IC: 5.1–19.7; p < 0.001), and consuming ≥3 fruits/day (OR = 8.8; CI: 4.9–15.7; p < 0.001) were the items most associated with high adherence to the MD. In conclusion, a high level of adherence to the MD is associated with high-level muscular fitness and CRF in Spanish university students.

The aim of this review was to estimate the prevalence of overweight and obesity among European children aged 2–7 years from 2006 to 2016 and to analyze these estimations by gender, country, and food group consumption. We searched CINAHL, EMBASE, MEDLINE, and Web of Science databases from their inception until 27 February 2019 including cross-sectional studies and baseline measurements of cohort studies with overweight and obesity defined according to the International Obesity Task Force criteria. Both the inverse-variance fixed-effects method and the DerSimonian and Laird random effects method were used to determinate pooled prevalence estimates and their respective 95% confidence intervals (CIs). A total of 32 studies (n = 197,755 children) with data from 27 European countries were included. Overall, the pooled prevalence estimates of overweight/obesity in European children (aged 2–7 years) during the period 2006–2016 was 17.9% (95% CI: 15.8–20.0), and the pooled prevalence estimate of obesity was 5.3% (95% CI: 4.5–6.1). Southern European countries showed the highest prevalence of excess weight. Additional measures to address the obesity epidemic in early life should be established, especially in European countries where the prevalence of excess weight is very high.

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Despite the benefits of engaging in physical activity during their leisure time, children do not meet the recommendations on physical activity. Following the socio-ecological model as a theoretical framework, the aim of this study was to determine the barriers and facilitators that influence physical activity participation in children’s leisure time. Data collection was conducted through focus groups and individual drawings in a sample of 98 eight- to eleven-year-olds from six schools in Cuenca (Spain). Following the socio-ecological model, individual characteristics (age and sex), as well as the microsystem (parents and friends), mesosystem (timing and out-of-school schedule) and exosystem (safety and weather) influence physical activity participation. The relationships between these levels of the socio-ecological model reveal that opportunities for leisure physical activity are determined by children’s schedules. This schedule is negotiated by the family and is influenced by parents’ worries and necessities. This is the main barrier to physical activity participation due to the creation of more restrictive, sedentary schedules, especially for girls. Our results show the elements required to develop successful strategies to increase physical activity opportunities, namely, focusing on giving children the opportunity to choose activities, raising parents’ awareness of the importance of physical activity and improving the perceived safety of parks, taking into consideration the gender perspective.

BackgroundPeripheral arterial disease (PAD) is an indicator of widespread atherosclerosis. However, most individuals with PAD, in spite of being at high cardiovascular risk, are asymptomatic. This fact, together with the limitations of the Doppler ankle-brachial index (ABI), contributes to PAD underdiagnose. The aim of this study was to compare oscillometric ABI and Doppler ABI to diagnose peripheral arterial disease, and also to examine the influence of oscillometric errors and calcified legs on the PAD diagnoses.Methods and FindingsWe measured the ankle-brachial indexes of 90 volunteers (n = 180 legs, age 70 ± 14 years, 43% diabetics) using both oscillometer OMRON-M3 and Doppler. For concordance analyses we used the Bland and Altman method, and also estimated the intraclass correlation coefficient. Receiver Operating Characteristic Curves were used to examine the diagnostic performance of both methods. The ABI means were 1.06 ± 0.14 and 1.04 ± 0.16 (p = 0.034) measured by oscillometer and Doppler ABIs respectively, with limits of agreement of ± 0.20 and intraclass correlation coefficient = 0.769. Oscillometer yielded 23 “error” measurements, and also overestimated the measurements in low ankle pressures. Using Doppler as gold standard, oscillometer performance for diagnosis of PAD showed an Area Under Curve = 0.944 (sensitivity: 66.7%, specificity: 96.8%). Moreover, when considered calcified legs and oscillometric “error” readings as arteriopathy equivalents, sensitivity rose to 78.2%, maintaining specificity in 96%. The best oscillometer cut-off point was 0.96 (sensitivity: 87%, specificity: 91%, positive likelihood ratio: 9.66 and negative likelihood ratio: 0.14).ConclusionDespite its limitations, oscillometric ABI could be a useful tool for the diagnosis of PAD, particularly when considering calcified legs and oscillometric “errors” readings as peripheral arterial disease equivalents.

Background Previous studies have reported a high prevalence of excessive gestational weight gain (GWG) in women with prepregnancy BMI classified as overweight and obese. However, the joint evidence regarding GWG and prepregnancy BMI in the worldwide population has not been synthesized. Thus, this systematic review and meta-analysis aimed to estimate global and regional mean GWG and the prevalence of GWG above, within and below 2009 Institute of Medicine (IOM) guidelines. Second, we aimed to estimate global and regional prepregnancy BMI and the prevalence of BMI categories according to World Health Organization (WHO) classification. Methods We searched Medline, Embase, the Cochrane Library and Web of Science to identify observational studies until 9 May 2018. We included studies published from 2009 that used 2009 IOM guidelines, reporting data from women in general population with singleton pregnancies. The 2009 IOM categories for GWG and the WHO categories for prepregnancy BMI were used. DerSimonian and Laird random effects methods were used to estimate the pooled and their respective 95% confidence intervals (95% CIs) of the mean and by category rates of GWG and prepregnancy BMI, calculated by global and regions. Results Sixty-three published studies from 29 countries with a total sample size of 1,416,915 women were included. The global prevalence of GWG above and below the 2009 IOM guidelines, was 27.8% (95% CI; 26.5, 29.1) and 39.4% (95% CI; 37.1, 41.7), respectively. Furthermore, meta-regression analyses showed that the mean GWG and the prevalence of GWG above guidelines have increased. The global prevalence of overweight and obesity, was 23.0% (95% CI; 22.3, 23.7) and 16.3% (95% CI; 15.4, 17.4), respectively. The highest mean GWG and prepregnancy BMI were in North America and the lowest were in Asia. Conclusions Considering the high prevalence of GWG above the 2009 IOM guidelines and women with overweight/obesity and their continuously increasing trend in most regions, clinicians should recommend lifestyle interventions to improve women’s weight during reproductive age. Due to regional variability, these interventions should be adapted to each cultural context. Trial registration Prospectively registered with PROSPERO (CRD42018093562).