Healthy lifestyle: relationship between mediterranean diet, body composition and physical fitness in 13 to 16-years old icelandic students

Childhood and adolescent obesity are currently among the greatest challenges for public health. Physical activity, physical fitness, and adherence to the Mediterranean diet (MD), representing powerful indicators of healthy lifestyles, are shown as determinant factors in the prevention and treatment of obesity. The aim of the present study has been to analyse the relationship between health-related physical fitness components, body composition, and adherence to MD in 387 Icelandic adolescents of 13–16-years old (54% boys). The ALPHA Fitness Test was used to measure physical fitness and body composition. The KIDMED questionnaire was used to assess the adherence to MD among participants. Associations between variables were tested according to gender and age using linear regression models and analysis of variance. Participants with high/medium adherence to MD showed significantly higher endurance scores in both the boys and the girls. Gender differences were found. The boys in high/medium MD categories had significantly lower fat percentages and ran a 4 × 10 m sprint faster than the girls. The girls scored higher than the boys in endurance and speed-agility tests. It can be concluded that a high and medium adherence to MD is associated with high and very high endurance in both the girls and the boys

The perception of the autonomy supportive behaviour as a predictor of perceived effort and physical self-esteem among school students from four nations

Grounded in self-determination theory (SDT), this study tested a model of motivational sequence in which perceived autonomy support from teachers in a physical education (PE) context predicted the perceived effort and physical self-esteem via self-determined motivation in school students. School students aged 12 to 16 years from Estonia (N = 816), Lithuania (N = 706), Hungary (N = 664), and Spain (N = 922) completed measures of perceived autonomy support from PE teachers, need satisfaction for autonomy, competence, relatedness, self-determined motivation, perceived effort and physical self-esteem. The results of the structural equation model (SEM) of each sample indicated that the students’ perceived autonomy support from the teacher was directly related to effort and indirectly via autonomous motivation, whereas physical self-esteem was related indirectly. Confirmatory factor analyses and multi-sample structural equation revealed well-fitting models within each sample with the invariances of the measurement parameters across four nations. The findings support the generalizability of the measures in the motivational sequence model to predict perceived effort and physical self-estee

The Influence of Surgical Mask on Heart Rate, Muscle Saturation of Oxygen, and Hemoglobin during Whole-Body Vibration Exercise

Background: Whole-body vibration (WBV) is a safe and effective exercise system that affects muscle oxygen through several physiological processes, although its effects on different protocols are still unclear. Unfortunately, the COVID-19 pandemic has generated various health problems and controversy or confusion on its possible adverse consequences and impact on performance when wearing a mask during the practice of physical exercise. Aim: To analyze the acute effects of WBV exercise in muscle oxygen variables during different intervention phases with or without a surgical mask and compare protocols that differ in the order of vibration frequencies. Methods: Forty-seven healthy students participated in WBV training. They were randomly assigned to use or not use a mask between the three intervention groups: group A (8, 12.6, and 20 Hz), group B (12.6, 20, and 8 Hz), and group C (20, 8, and 12.6 Hz). Besides the 3 WBV moments, the intervention had a baseline moment, two rest time and a recovery moment. During the whole intervention, the heart rate (HR), muscle oxygen saturation (SatO2), oxyhemoglobin (O2Hb), and deoxyhemoglobin (HHb) were registered. Results: There were no significant differences between the mask use and not use groups. Significant differences were found between the variables during the seven intervention moments and between intervention groups (A, B, or C). Conclusion: HR, SatO2, and Hb were not influenced by the use of a surgical mask, but they reacted differently through the different moments and were sensitive to vibration frequencies and respective order

Health-Related Physical Fitness in Adolescents from Spain, Estonia and Iceland : A Cross-Sectional, Quantitative Study

Funding Information: This work was supported by the fifth Research Program 2013–2016 (PPI2015-IV.5/PP2016- EBRV) of the University of Seville (Seville, Spain), the University of Iceland Research Fund (Reykjavik, Iceland) and project (2014-2021.1.05.20-0004) “Increasing the physical activity of schoolchildren”—funded by Iceland, Liechtenstein and Norway through the EEA Grants and co-financed by the Ministry of Social Affairs, Republic of Estonia and the University of Tartu (Tartu, Estonia). Publisher Copyright: © 2022 by the authors.The benefits of physical fitness (PF) for health are well-known. Low PF significantly contributes to the prevalence of obesity in adolescents, with an increased risk of developing chronic diseases. The objectives of the present study were to explore the health-related PF components and body composition levels in adolescents in three European cities, and their differences. The present study is a cross-sectional, descriptive, and quantitative research effort with 1717 participants aged between 13–16 years (48% girls), enrolled in public and private secondary schools in Seville (Spain), Reykjavik (Iceland) and Tartu (Estonia). The ALPHA fitness battery test was used with the following tests: handgrip strength, standing broad jump, 4 × 10 m speed-agility, 20 m shuttle run, and anthropometric variables. Regarding body composition, differences were detected for city and gender in height (p < 0.001), weight (p < 0.001), body fat percentage (p < 0.001), and waist circumference (p < 0.001); but no differences were reported for BMI for both city (p = 0.150) and gender (p = 0.738). Similarly, concerning PF, it was detected statistically significant differences between cities and gender in handgrip strength (p < 0.001), jump test (p < 0.001), speed-agility test (p < 0.001), and cardiovascular endurance in both variables (p < 0.001). In total, 26.8% of the boys and 27.3% of the girls were categorized as overweight; 18.1% of the boys and 31.2% of the girls had an excessive percentage of fat mass; and 22.7% of the boys and 22.2% of the girls showed an excessive waist circumference. The participants from Seville presented the lowest results in PF tests. In contrast, Reykjavik, with the highest results in the endurance and speed-agility tests, and Tartu, with higher results in the manual grip strength and long jump tests, shared the highest results.Peer reviewe

Rural-urban gradients and all-cause, cardiovascular and cancer mortality in Spain using individual data

The literature reporting on rural-urban health status disparities remains inconclusive. We analyzed data from a longitudinal population-based study using individual observations. Our results show that the risks of all-cause and cancer mortality are greater in large cities than in other municipalities, with no clear urban-rural gradient. Not differences were found among territories in cardiovascular mortality.This work was supported by the Institute of Health Carlos III (ISCIII), Ministry of Science and Innovation [grant number PI19CIII/00021 and FI17CIII/00003].S

Sleep Quality and Duration in European Adolescents (The AdolesHealth Study): A Cross-Sectional, Quantitative Study

Sleep is a vital element of adolescents’ overall health; it influences their body and mind and thus affects their quality of life. Adequate sleep quality and duration are essential for maintaining optimal metabolic health and lowering the risk of developing several medical conditions, such as cardiovascular disease. The current study aimed to assess the perceived sleep quality and duration of 1717 European adolescents from three different European countries (Spain, Iceland and Estonia) aged 13- to 16-years (900 boys, 817 girls) using the Pittsburgh Sleep Quality Index (PSQI). A multivariate analysis of variance (MANOVA) was performed to examine differences between groups and two-factor analysis of variance (ANOVA) was used to analyze city and age differences. The probability of having poor sleep quality and duration was calculated by Odd-Ratio (OR). Our study found poor sleep quality in 44% of the boys and 53% of the girls, whereas 68% and 69%, respectively did not get the recommended hours of sleep (i.e., 8–10 h). No difference was found between adolescents from Estonia, Iceland and Spain regarding sleep duration. In contrast, Spanish and Estonian adolescents reported higher probabilities of having poor sleep quality. Finally, girls had a significantly higher probability of poor sleep quality than boys

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie