Open Access
Are 24-hour movement recommendations associated with obesity-related indicators in the young population? A meta-analysis
(Wiley, 2023) López Gil, José Francisco; Tapia-Serrano, Miguel Ángel; Sevil-Serrano, Javier; Sánchez-Miguel, Pedro Antonio; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Objective: This study aimed to determine the relationship between meeting all three 24-hour movement recommendations (i.e., physical activity, sleep duration, and screen time) and obesity-related indicators among young people. Methods: Four databases were systematically searched (PubMed, Scopus, Web of Science, and Cochrane Library). Results: Meeting the 24-hour movement recommendations was cross-sectionally associated with lower overall obesity-related indicators (r = −0.09, 95% CI: −0.11 to −0.06), but no longitudinal association was found. Regarding each obesity-related indicator separately, meeting all three recommendations was related to lower odds of overweight/obesity (odds ratio = 0.65, 95% CI: 0.56 to 0.76) and obesity alone (odds ratio = 0.28, 95% CI: 0.16 to 0.50). An inverse relationship between meeting 24-hour movement recommendations and BMI, BMI z score, waist circumference, and body fat was also found. Regarding subgroup analysis, the association between 24-hour movement recommendations and overall obesity-related indicators was similar regardless of sex, comparison used (meeting all three vs. not meeting [i.e., those who met zero to two of the movement behaviors] or meeting all three vs. none), and type of measure to assess 24-hour movement recommendations (i.e., self-reported or accelerometer-based measures). Conclusions: Meeting all 24-hour movement recommendations may be a crucial factor in maintaining a healthy weight status in the young population.
Open Access
Combined aerobic and muscle-strengthening activity guidelines and their association with obesity in US adolescents
(Wiley, 2023) García Hermoso, Antonio; Izquierdo Redín, Mikel; López Gil, José Francisco; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Most of the evidence on physical activity for maintaining a healthy weight in adolescents is based solely on aerobic physical activity alone, with little attention given to the muscle strength component. This study aimed to investigate the associations between aerobic activities and muscle-strengthening activities (MSA) and overweight/obesity among a representative sample of adolescents. Data from the United States-based Youth Risk Behavior Surveillance System for the 2011–2019 cycle were used in this cross-sectional study. Adolescents self-reported their adherence to aerobic and MSA guidelines, as well as their height and weight. Overweight and obesity were defined using the age- and sex-specific criteria of the Centers for Disease Control and Prevention, with a body mass index (BMI) ≥85th and ≥95th percentiles, respectively. We examined the associations between adherence to physical activity guidelines (reference: not meeting either of the physical activity guidelines) and overweight/obesity or obesity using binary logistic regressions. These analyses were adjusted for race/ethnicity, sex, age, screen time, sleep duration, tobacco, alcohol, fruit, vegetables, and soda consumption. A total of 42 829 adolescents (48.98% girls) were included in the study. Of these, 22.23% met both guidelines for physical activity, 30.47% had overweight/obesity, and 14.51% had obesity. Compared with meeting neither guideline, meeting both aerobic and MSA guidelines was associated with lower odds of having overweight/obesity (odds ratio [OR] = 0.64, 95% confidence interval [CI], 0.60 to 0.68) and obesity (OR = 0.52, 95% CI 0.48 to 0.56). These results were consistent across years of assessment, sex, and race/ethnicity. In conclusion, our results highlight the importance of MSA, which is often overlooked in physical activity recommendations in many studies, in combating childhood obesity in the United States.
Open Access
Overall proportion of orthorexia nervosa symptoms: a systematic review and meta-analysis including 30 476 individuals from 18 countries
(International Society of Global Health, 2023) López Gil, José Francisco; Tárraga López, Pedro J.; Hershey, María Soledad; López-Bueno, Rubén; Gutiérrez Espinoza, Héctor; Soler-Marín, Antonio; Fernández-Montero, Alejandro; Victoria-Montesinos, Desirée; Ciencias de la Salud; Osasun Zientziak
Background. To date, no previous meta-analysis has determined the overall proportion of orthorexia nervosa symptoms on a global scale. The aim of the present study was 2-fold: first, to establish the overall proportion of orthorexia nervosa symptoms on a global scale, assessed with the ORTO-15 questionnaire; and second, to determine the role of sex, type of population, mean age, body mass index, and the temporal trend in relation to orthorexia nervosa symptoms. Methods. Four databases were searched (PubMed, Scopus, Web of Science, and Cochrane Database of Systematic Reviews) with date limits from January 2005 to June 2023. Studies assessing the proportion of orthorexia nervosa assessed using the ORTO-15 questionnaire with a cutoff of <35 or <40 points were included in this review. Results. The overall proportion of orthorexia nervosa symptoms (using the cutoff <35 points) was 27.5% (95% confidence interval (CI) = 23.5-31.6, I2 = 97.0%). In addition, no significant differences were observed between females (34.6%, 95% CI = 29.5-39.8, I2 = 96.1%) and males (32.1%, 95% CI = 26.5-38.1, I2 = 93.1%). According to the type of population, the highest overall proportion was found in people focused on sports performance or body composition (34.5%, 95% CI = 23.1-47.0, I2 = 98.0%). Notwithstanding, caution should be exercised in interpreting this result, as reverse causality could be a potential pitfall in this relationship. Conclusions. We found that approximately three out of 10 study participants showed orthorexia nervosa symptoms according to the ORTO-15 tool. This overall proportion was higher in those participants who were athletes or fitness practitioners. Over the years, the proportion of orthorexia nervosa symptoms seems to be increasing. These high percentages and their increase are worrisome from a public health perspective and highlight the need to develop psychometric instruments to aid in clinical diagnosis and treatment efficacy.
Open Access
Twenty-four-hour movement guidelines during middle adolescence and their association with glucose outcomes and type 2 diabetes mellitus in adulthood
(Elsevier, 2022) García Hermoso, Antonio; López Gil, José Francisco; Ezzatvar, Yasmin; Ramírez Vélez, Robinson; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak
Background: The aim of the present study was to determine the association between adherence to the 24-h movement guidelines during middle adolescence and glucose outcomes (glycated hemoglobin and fasting glucose) and type 2 diabetes mellitus (T2DM) in adulthood, 14 and 22 years later. Methods: We analyzed data from apparently healthy adolescents aged 12-18 years who participated in Waves I and II (1994-1996, n = 14,738), Wave IV (2008-2009, n = 8913), and Wave V (2016-2018, n = 3457) of the National Longitudinal Study of Adolescent to Adult Health (Add Health) in the United States. Physical activity, screen time, and sleep duration were measured using questionnaires, and the 24-h guidelines were defined as: 5 or more times moderate-to-vigorous physical activity per week, ≤2 h per day of screen time, and sleeping 8-10 h per day and or night. Capillary and venous whole blood was collected and analyzed to determine glycated hemoglobin and fasting glucose for Waves IV and V, respectively. Results: Only 2.1% of the adolescents met all the 3 guidelines, and 37.8% met none of them. In both waves IV and V, adolescents who met physical activity and screen time guidelines had lower odds of T2DM in adulthood than those who did not meet any of these guidelines (Wave IV; prevalence ratio (PR) = 0.57, 95%CI: 0.21-0.89; Wave V: PR = 0.43, 95%CI: 0.32-0.74). Only for Wave V did adolescents who met all three guidelines have lower odds of T2DM at follow-up compared with those who did not meet any of these guidelines (PR = 0.47, 95%CI: 0.24-0.91). Also, for each increase in meeting one of the 24-h recommendations, the odds of T2DM decreased by 18% (PR = 0.82, 95%CI: 0.61-0.99) and 15% (PR = 0.85, 95%CI: 0.65-0.98) in adulthood for Waves IV and V, respectively. Conclusion: Promoting all 24-h movement guidelines in adolescence, especially physical activity and screen time, is important for lowering the potential risk of T2DM in adulthood.
Open Access
Mediation of obesity-related variables in the association between physical fitness and cardiometabolic risk in children and adolescents: a systematic review and meta-analysis
(BMJ, 2025-04-03) Castro Silveira, João Francisco de; López Gil, José Francisco; Reuter, Cézane Priscila; Sehn, Ana Paula; Borfe, Letícia; Carvas Junior, Nelson; Pfeiffer, Karin Allor; Guerra, Paulo Henrique; Andersen, Lars Bo; García Hermoso, Antonio; Gaya, Anelise; Ciencias de la Salud; Osasun Zientziak
Objective. To examine the mediation of obesity-related variables in the association between physical fitness and cardiometabolic risk in children and adolescents. Design. Systematic review and meta-analysis. Data sources. Studies from electronic databases from inception to 31 December 2023. Eligibility criteria for selecting studies. Included were 123 observational studies (cross-sectional and longitudinal) that assessed risk by constructing a continuous score incorporating cardiometabolic parameters. Studies were considered if they evaluated at least one fitness component as an exposure in children and adolescents (5–19 years). Thirty-one were included in the main meta-analyses. Results. Cross-sectional findings indicate that cardiorespiratory fitness is modestly but beneficially associated with cardiometabolic risk, either indirectly via obesity-related variables (indirect standardized beta coefficient [βIndirect]=−0.17; 95% confidence interval [CI] −0.23; −0.11; inconsistency index [I2]=94.4%) or directly and independently from obesity-related variables (r=−0.11; 95% CI −0.15; −0.07; I2=87.4%), whereas muscular fitness seems to be associated with risk only via obesity-related variables (βIndirect=−0.34; 95% CI −0.47; −0.20; I2=85.1%). There was no cross-sectional difference between biological sexes (p≥0.199). Longitudinal findings indicate no total (r=−0.12; 95% CI −0.24; 0.01; I2=23.1%) and direct (r=−0.03; 95% CI −0.08; 0.03; I2=0%) associations. Conclusion. The association between fitness and risk appears to take place either indirectly through the reduction of obesity-related levels or directly by influencing risk. The latter underscores that the inverse association extends beyond a mere reduction in obesity-related variables, encompassing specific enhancements linked to exercise training, including increased metabolic efficiency, and cardiovascular capacity. PROSPERO registration number. CRD42022354628.
Open Access
Environmental tobacco smoke exposure and 24-h movement guidelines in Spanish young people
(AME Publishing, 2023) López Gil, José Francisco; Pozo Cruz, Jesús del; Pozo Cruz, Borja del; Tárraga López, Pedro J.; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak
Background: No prior research has investigated how exposure to environmental tobacco smoke is related to the combination of 24-h movement behaviors among young populations thus far. The aim of this study was to examine the associations between exposure to secondhand smoke and the 24-h movement guidelines. Methods: This is a cross-sectional study using data from the last available wave of the Spanish National Health Survey [2017], a nationally representative survey of the Spanish children and adult population. The final sample included 4,378 (49.0% girls) Spanish young people aged 2-14 years. Results: A lower likelikood of meeting screen time (ST) and all three 24-h movement guidelines were found in those exposed to environmental tobacco smoke in unadjusted models. After adjusting for several covariates, meeting screen time [odds ratio (OR) =0.76; 95% confidence interval (CI), 0.59-0.97], sleep duration (OR =0.75; 95% CI, 0.58-0.96), and all three 24-h movement guidelines (OR =0.63; 95% CI, 0.44- 0.91) reached significance after adjusting for potential confounders. Conclusions: Given the inverse associations found, environmental tobacco smoke exposure should be a relevant factor to consider when promoting 24-h behaviors in the young population. Avoiding exposure to tobacco smoke in the environment is essential, as it can potentially influence the 24-h movement behaviors of young people, and consequently, the health benefits associated with such behaviors.
Open Access
Long-term impact of adherence to muscle-strengthening guidelines on inflammation markers: a 17-year follow-up study with obesity parameters as mediators
(BMJ Publishing, 2024-12-07) García Hermoso, Antonio; Ezzatvar, Yasmin; Yáñez-Sepúlveda, Rodrigo; Olivares-Arancibia, Jorge; Páez-Herrera, Jacqueline; López Gil, José Francisco; Ciencias de la Salud; Osasun Zientziak
Objective: To evaluate the relationship between adherence to muscle-strengthening guidelines in young adulthood and inflammation markers over a 17-year follow-up period. Additionally, it aims to examine whether body mass index (BMI) and waist circumference (WC) act as mediators in this relationship. Methods: The study analysed data from young adults aged 18–26 years who participated in waves III (2001–2002), IV (2008–2009) and V (2016–2018) of the Add Health Study. Adherence to muscle-strengthening guidelines was self-reported, and participants were classified as adherent if they engaged in strength training ≥2 days per week across all waves. Venous blood samples were collected at participants’ homes to measure highsensitivity C reactive protein (hs-CRP) levels and various cytokine concentrations, including interleukin (IL)−6, IL1beta, IL-8, IL-10 and tumour necrosis factor-alpha (TNFα). A global inflammation score was also calculated using z-scores of these markers. Results: A total of 2320 individuals participated (60.8% females). Participants adhering to muscle-strengthening guidelines exhibited significant reductions in hs-CRP, IL-6 and the inflammation z-score, with mean difference (MD) of −1.556mg/L (95% CI BCa −2.312 to −0.799), −0.324 pg/mL (95% BCa CI −0.586 to −0.062), and −0.400 (95% BCa CI −0.785 to −0.035), respectively. Mediation analysis revealed that BMI and WC levels at wave V significantly mediated the relationship between strength training and inflammation z-score, with significant indirect effects of −0.142 (95% CI −0.231 to −0.055) for BMI and −0.210 (95% CI −0.308 to −0.124) for WC. Conclusion: Adherence to muscle-strengthening guidelines alone may not be sufficient to achieve a notable decrease in inflammation without concurrent reductions in these obesity parameters.
Open Access
Comprehensive management of children and adolescents with type 1 diabetes mellitus through personalized physical exercise and education using an mHealth system: the Diactive-1 study protocol
(Frontiers Media, 2024) Hormazábal Aguayo, Ignacio; Muñoz Pardeza, Jacinto; López Gil, José Francisco; Huerta Uribe, Nidia; Chueca-Guindulain, María J.; Berrade-Zubiri, Sara; Burillo Sánchez, Elisabeth; Izquierdo Redín, Mikel; Ezzatvar, Yasmin; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak
Introduction: The use of new technologies presents an opportunity to promote physical activity, especially among young people with type 1 diabetes (T1DM), who tend to be less active compared to their healthy counterparts. The aim of this study is to investigate the impact of a personalized resistance exercise program, facilitated by the Diactive-1 App, on insulin requirements among children and adolescents diagnosed with T1DM. Methods and analysis: A minimum of 52 children and adolescents aged 8-18 years, who were diagnosed with T1DM at least 6 months ago, will be randomly assigned to either a group engaging in an individualized resistance exercise program at least 3 times per week over a 24-week period or a waiting-list control group. The primary outcome will be the daily insulin dose requirement. The secondary outcomes will include glycemic control, cardiometabolic profile, body composition, vascular function, physical fitness, 24-hour movement behaviors, diet, and psychological parameters. The usability of the app will also be assessed. Ethics and dissemination: Ethical approval to conduct this study has been granted by the University Hospital of Navarra Research Board (PI_2020/140). Parents or legal guardians of minors participating in the study will provide written consent, while children and adolescents will sign an assent form to indicate their voluntary agreement. The trial's main findings will be shared through conference presentations, peer-reviewed publications, and communication directly with participating families. This study aims to offer valuable insights into the holistic management of children and adolescents with T1DM by utilizing personalized exercise interventions through an mHealth system.
Open Access
Handgrip strength as a moderator of the influence of age on olfactory impairment in US adult population ≥ 40 years of age
(Nature Research, 2021) Ramírez Vélez, Robinson; López Gil, José Francisco; López Sáez de Asteasu, Mikel; Izquierdo Redín, Mikel; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
The aim of this study was to determine whether handgrip strength attenuates the negative relationship between age and olfactory function in a representative US population sample 40 years old and over. A cross-sectional study was performed with 2861 adults from the US National Health and Nutrition Examination Survey NHANES (2013–2014). An 8-item odor identification test was applied to determine olfactory function. Muscle strength was determined through a handgrip dynamometer (defined as the sum of the largest handgrip strength reading from right and left hands). Moderation analysis was performed to test whether the association between age and olfactory impairment was moderated by handgrip strength. Moderation analysis highlighted two regions of significance: the first region was found at < 56.6 kg, indicating that the adverse influence of age on olfactory function may be greater for the participants in this area; the second region was found at ≥ 56.6 kg, indicating that the negative impact of age on olfactory function disappeared for adults who were above this estimate point. In conclusion, handgrip strength, a general indicator of muscle strength, moderates the relationship between age and olfactory ability in a US adult population aged 40 years and older. Our findings are clinically relevant, since they emphasize the importance of muscular fitness in adulthood and old age by diminishing the deleterious effect of aging on olfactory performance.
Open Access
Evolución de la dieta y la actividad física de los estudiantes universitarios tras la pandemia de COVID-19
(Arán ediciones, 2023) Tárraga Marcos, Almudena; Carbayo Herencia, Julio A.; Panisello Royo, Josefa María; López Gil, José Francisco; Tárraga Marcos, Loreto; Tárraga López, Pedro J.; Ciencias de la Salud; Osasun Zientziak
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.