Association of dietary habits with levels of physical activity and screen time among adolescents living in Saudi Arabia. Energy balance-related behaviours associated with overweight and obesity in preschool children: a systematic review of prospective studies. Physical activity, sedentary behaviors and dietary habits among Saudi adolescents relative to age, gender and region The association between dietary patterns and mental health in early adolescence. Lifestyle correlates of self-reported sleep duration among Saudi adolescents: a multicentre school-based cross-sectional study. Role of dietary patterns, sedentary behaviour and overweight on the longitudinal development of childhood constipation: the Generation R study. A behaviour change intervention to reduce sedentary time in people with chronic obstructive pulmonary disease: protocol for a randomised controlled trial. Western and Mediterranean dietary patterns among Balearic Islands' adolescents: socio-economic and lifestyle determinants. What are the most effective behaviour change techniques to promote physical activity and/or reduce sedentary behaviour in inactive adults? A systematic review protocol Protocol for systematic reviews of determinants/correlates of obesity-related dietary and physical activity behaviors in young children (preschool 0 to 6 years): evidence mapping and syntheses The relationship between physical activity, sedentary behaviour and psychological wellbeing among adolescents Impact of objectively measured sedentary behaviour on changes in insulin resistance and secretion over 3 years in the RISC study: interaction with weight gain. Healthy Eating, Aerobic and Resistance Training in Youth (HEARTY): study rationale, design and methods. Objective vs. Self-Reported Physical Activity and Sedentary Time: Effects of Measurement Method on Relationships with Risk Biomarkers Preventing obesity among Brazilian adolescent girls: Six-month outcomes of the Healthy Habits, Healthy Girls-Brazil school-based randomized controlled trial. Dietary Patterns and Depressive Symptoms over Time: Examining the Relationships with Socioeconomic Position, Health Behaviours and Cardiovascular Risk Behavioural effects of a community-oriented setting-based intervention for prevention of childhood obesity in eight European countries. Main results from the IDEFICS study. A Cross-Cultural Comparison of Health Behaviors between Saudi and British Adolescents Living in Urban Areas: Gender by Country Analyses Low dietary intake of magnesium is associated with increased externalising behaviours in adolescents. Depression scores predict adherence in a dietary weight loss intervention trial. Lifestyle factors associated with overweight and obesity among Saudi adolescents Results of the Sedentary Intervention Trial in Cardiac Rehabilitation (SIT-CR Study): A pilot randomized controlled trial. Dietary intake, physical activity and energy expenditure of Malaysian adolescents.
BACKGROUND Underst and ing the inter-relationships between lifestyle factors in youth is important with respect to the development of effective promotional programmes for healthy eating and active living . The present study aim ed to explore the associations of dietary habits ( DH ) with physical activity ( PA ) and screen time ( ST )  among Saudi adolescents aged between 15 and 19 years of age relative to gender . METHODS Data were obtained from the Arab Teens Lifestyle Study , a school-based multicentre lifestyle study conducted in 2009/2010 in three major cities in Saudi Arabia . A multistage stratified cluster r and om sampling technique was used . The number of participants with complete data for  DH  and  PA  was 2886 and the respective number for DH and ST was 2822 . Assessment included weight , height , body mass index , total daily ST ( television viewing , video/computer games and Internet use ) , PA and DH using self-reported question naires . RESULTS Females were significantly more sedentary and less active than males ( P < 0.001 ) . Two-way analysis of covariance , controlling for age , showed significant ( P < 0.05 ) gender by PA and gender by ST interactions for several DH . Logistic regression analyses revealed significant associations of higher PA with a higher consumption of fruit , vegetables , milk , French fries/potato chips and energy drinks , whereas higher ST was significantly associated with a higher consumption of sugar-sweetened drinks , fast foods , cake/doughnuts and energy drinks . CONCLUSIONS Healthful dietary habits were associated mostly with  PA  , whereas sedentary behaviours , independent of PA , negatively impacted upon eating behaviours . The low PA levels and high sedentary levels of Saudi females represent a great concern . The results reported in the present study have important implication s for both youth public health policies and intervention programmes The current review aim ed to systematic ally identify dietary , physical activity and sedentary behaviours in preschool children ( 4 - 6 years of age ) that are prospect ively related to overweight or obesity later in childhood . Prospect i ve studies published between January 1990 and June 2010 were selected from search es in PubMed , EMBASE , PsycINFO , CINAHL and Cochrane Library . Studies examining the prospect i ve association between at least one relevant behaviour measured during preschool period ( children aged 4 - 6 years at baseline ) in relation to at least one anthropometric measurement at follow-up ( age < 18 years ) were included . Harvest plots were used to summarize the results and draw conclusions from the evidence . Of the 8,718 retrieved papers , 23 papers reporting on 15 different study sample s were included in this review . Strong evidence was found for an inverse association between total physical activity and overweight . Moderate evidence was observed for a positive association between television viewing and overweight . Because of the heterogeneity in the assessed dietary behaviours , insufficient evidence was found for an association between  dietary intake or specific dietary behaviours and overweight . These results suggest that interventions aim ing to prevent overweight among preschool children should focus on promotion of total physical activity and limitation of screen time and that further research is needed to establish whether and which dietary behaviours are important for obesity prevention in this age group . However , despite the lack of evidence for dietary behaviours from the present review , future interventions may already target specific dietary behaviours that are highly prevalent and for which there a clear rationale as well as preliminary evidence that these behaviours are associated with overweight Background Few lifestyle factors have been simultaneously studied and reported for Saudi adolescents . Therefore , the purpose of the present study was to report on the prevalence of physical activity , sedentary behaviors and dietary habits among Saudi adolescents and to examine the interrelationships among these factors using representative sample s drawn from three major cities in Saudi Arabia . Methods This school-based cross-sectional study was conducted during the years 2009 - 2010 in three cities : Al-Khobar , Jeddah and Riyadh . The participants were 2908 secondary -school males ( 1401 ) and females ( 1507 ) aged 14 - 19 years , r and omly selected using a multistage stratified sampling technique . Measurements included weight , height , sedentary behaviors (  TV viewing  , playing video games and computer use ) , physical activity using a vali date d question naire and dietary habits . Results A very high proportion ( 84 % for males and 91.2 % for females ) of Saudi adolescents spent more than 2 hours on screen time daily and almost half of the males and three-quarters of the females did not meet daily physical activity guidelines . The majority of adolescents did not have a daily intake of breakfast , fruit , vegetables and milk . Females were significantly ( p < 0.05 ) more sedentary , much less physically active , especially with vigorous physical activity , and there were fewer days per week when they consumed breakfast , fruit , milk and diary products , sugar-sweetened drinks , fast foods and energy drinks than did males . However , the females ' intake of  French fries and potato chips , cakes and donuts , and c and y and chocolate was significantly ( p < 0.05 ) higher than the males ' . Screen time was significantly ( p < 0.05 ) correlated inversely with the intake of breakfast , vegetables and fruit .  Physical activity had a significant ( p < 0.05 ) positive relationship with fruit and vegetable intake but not with sedentary behaviors . Conclusions The high prevalence of sedentary behaviors , physical inactivity and unhealthy dietary habits among Saudi adolescents is a major public health concern . There is an urgent need for national policy promoting active living and healthy eating and reducing sedentary behaviors among children and adolescents in Saudi Arabia OBJECTIVE To investigate the associations between dietary patterns and mental health in early adolescence . METHOD The Western Australian Pregnancy Cohort ( Raine ) Study is a prospect i ve study of 2900 pregnancies recruited from 1989 - 1992 . At 14 years of age ( 2003 - 2006 ; n=1324 ) , the Child Behaviour Checklist ( CBCL ) was used to assess behaviour ( characterising mental health status ) , with higher scores representing poorer behaviour . Two dietary patterns ( Western and Healthy ) were identified using factor analysis and food group intakes estimated by a 212-item food frequency question naire . Relationships between dietary patterns , food group intakes and behaviour were examined using general linear modelling following adjustment for potential confounding factors at age 14 : total energy intake , body mass index , physical activity , screen use , family structure , income and functioning , gender and maternal education at pregnancy . RESULTS Higher total ( b=2.20 , 95 % CI=1.06 , 3.35 ) , internalizing ( withdrawn/depressed ) ( b=1.25 , 95 % CI=0.15 , 2.35 ) and externalizing ( delinquent/aggressive ) ( b=2.60 , 95 % CI=1.51 , 3.68 ) CBCL scores were significantly associated with the Western dietary pattern , with increased intakes of takeaway foods , confectionary and red meat . Improved behavioural scores were significantly associated with higher intakes of leafy green vegetables and fresh fruit ( components of the Healthy pattern ) . CONCLUSION These findings implicate a Western dietary pattern in poorer behavioural outcomes for adolescents . Better behavioural outcomes were associated with a higher intake of fresh fruit and leafy green vegetables BACKGROUND Lifestyle factors are important determinants of adequate sleep among adolescents . However , findings on sleep duration relative to lifestyle factors are conflicting . Therefore , this study examined the association of self-reported sleep duration with physical activity , sedentary behaviours and dietary habits among Saudi adolescents . METHODS A multicentre school-based cross-sectional study was conducted in three major cities in Saudi Arabia . The sample included 2868 secondary -school students ( 51.9 % girls ) aged 15 - 19 years , r and omly selected using a multistage stratified cluster sampling technique . In addition to  anthropometric measurements , sleep duration , physical activity , sedentary behaviours and dietary habits were assessed using self-reported question naire . RESULTS Several lifestyle factors were associated with sleep duration in adolescents . While controlling for some potential confounders , the findings showed that high screen time [ > 5 h/day ; adjusted odds ratio ( aOR ) = 1.505 , 95 % confidence interval ( CI ) = 1.180 - 1.920 , P = 0.001 ] and low ( aOR = 1.290 , 95 % CI = 1.064 - 1.566 , P = 0.010 ) to medium ( aOR = 1.316 , 95 % CI = 1.075 - 1.611 , P = 0.008 ) physical activity levels were significantly related to daily sleep of 8 h or longer . Furthermore , having low intake of breakfast ( <3 day/week compared with 5 days or more per week ) decreased the odd of having adequate sleep duration by a factor of 0.795 ( 95 % CI = 0.667 - 0.947 , P < 0.010 ) . CONCLUSIONS Short sleep duration ( < 8 h/day ) among Saudi adolescents 15 - 19 year olds was significantly associated with several lifestyle factors . Intervention programs aim ing for improving sleeping habits among adolescents need to consider such potential association of lifestyle variables with sleep duration The influence of childhood nutrition on the development of constipation beyond the period of weaning and breastfeeding is relatively understudied . In addition , eating patterns in childhood can be highly correlated with overweight and sedentary behaviour , which may also have an influence on constipation . The aim of this study was to assess whether common dietary patterns , sedentary behaviour and childhood overweight are associated with  constipation in childhood . The study was embedded in a population -based prospect i ve birth cohort . Information on dietary intake was obtained by a food frequency question naire  at the child 's age of 14 months ( n = 2420 ) . The adherence scores on a ' Health conscious ' and ' Western-like ' diet were extracted from principal component analysis . At the age of 24 , 36 and 48 months , information on constipation and sedentary behaviour , and weight and height was obtained by parental-derived question naires and from the child health centres , respectively . Adherence to a ' Western-like ' dietary pattern was associated with a higher prevalence of constipation up to 48 months [ adjusted odds ratio ( aOR ) ; 95 % confidence interval ( CI ) : 1.39 ; 1.02 - 1.87 ] , which was not mediated by overweight or sedentary behaviour . Adherence to a ' Health Conscious ' dietary pattern was only associated at short term , with a lower prevalence of constipation at 24 months ( aOR ; 95%CI : 0.65 ; 0.44 - 0.96 ) . No association was found between overweight , sedentary behaviour and constipation . Our results suggest that specific dietary patterns in early childhood could be associated with higher or lower risks for constipation , but these effects are time-dependent . Overweight and sedentary behaviour seem to not have a major role on constipation in childhood INTRODUCTION Replacing sedentary behaviour with light intensity physical activity ( ie , activities classified as less than three metabolic equivalents , such as slow-paced walking ) may be a more realistic strategy for reducing cardiometabolic risk in people with chronic obstructive pulmonary disease than only aim ing to increase levels of moderate-vigorous intensity physical activity . Behaviour change interventions to reduce sedentary behaviour in people with chronic obstructive pulmonary disease have not yet been developed or tested . RESEARCH QUESTIONS Is a 6-week behaviour change intervention effective and feasible in reducing sedentary time in people with chronic obstructive pulmonary disease ? DESIGN This study will be a multi-centre , r and omised , controlled trial with concealed allocation , assessor blinding , and intention-to-treat analysis , comparing a 6-week behaviour change intervention aim ed at reducing sedentary time with a sham intervention in people with chronic obstructive pulmonary disease . PARTICIPANTS AND SETTING Seventy participants will be recruited from the waiting lists for pulmonary rehabilitation programs at Royal Prince Alfred Hospital and Prince of Wales Hospital , Sydney , Australia . INTERVENTION The behaviour change intervention aims to reduce sedentary time through a process of guided goal setting with participants to achieve two target behaviours : ( 1 ) replace sitting and lying down with light-intensity physical activity where possible , and ( 2 ) st and up and move for 2minutes after 30minutes of continuous sedentary time . Three face-to-face sessions and three phone sessions will be held with a physiotherapist over the 6-week intervention period . The ' capability ' , ' opportunity ' , ' motivation ' and ' behaviour ' ( COM-B ) model will be applied to each participant to determine which components of behaviour ( capability , opportunity or motivation ) need to change in order to reduce sedentary time . Based on this ' behavioural diagnosis ' , the Behaviour Change Wheel will be used to systematic ally select appropriate behaviour change techniques to assist participants in achieving their weekly goals . Behaviour change techniques will include providing information about the health consequences of sedentary behaviour , self-monitoring and review of weekly goals , problem-solving of barriers to achieving weekly goals , and providing feedback on sedentary time using the Jawbone UP3 activity monitor . CONTROL The sham intervention will consist of weekly phone calls for 6 weeks , to enquire whether the participants ' health status has changed over the intervention period ( eg , hospitalised for an acute exacerbation ) . No instructions regarding physical activity or exercise will be given . MEASUREMENTS Outcomes will be assessed at baseline , at the end of the 6-week intervention period , and at the 3-month follow-up . Primary outcome measures will be : ( 1 ) total sedentary time , including the pattern of accumulation of sedentary time , assessed by the activPAL3 activity monitor , and ( 2 ) feasibility of the intervention assessed by uptake and retention of participants , participant compliance , self-reported achievement of weekly goals , and adverse events . Secondary outcome measures will include functional exercise capacity , health-related quality of life , domain-specific and behaviour-specific sedentary time , patient activation , and anxiety and depression .  Semi-structured interviews will be conducted with participants who receive the behaviour change intervention to explore acceptability and satisfaction with the different components of the intervention . ANALYSIS Analysis of covariance ( ANCOVA ) will be used to calculate between-group comparisons of total sedentary time and the number of bouts of sedentary time>30minutes after adjusting baseline values . Uncertainty about the size of the mean between-group differences will be quantified with 95 % CI . Within-group comparisons will be examined using paired t-tests and described as mean differences with 95 % CIs . Secondary outcome measures will be analysed similarly . The feasibility measures will be analysed descriptively . Semi-structured interviews will be conducted until data saturation is achieved and there are no new emerging themes . De-identified interview transcripts will be coded independently by two research ers and analysed alongside data collection using the COM-B model as a thematic framework . DISCUSSION / SIGNIFICANCE If behaviour change interventions are found to be an effective and feasible method for reducing sedentary time , such interventions may be used to reduce cardiometabolic risk in people with chronic obstructive pulmonary disease . An approach that emphasises participation in light-intensity physical activity may increase the confidence and willingness of people with chronic obstructive pulmonary disease to engage in more intense physical activity , and may serve as an intermediate goal to increase uptake of pulmonary rehabilitation OBJECTIVE To assess prevailing food patterns among Balearic Isl and s ' adolescents , and socio-economic and lifestyle determinants . DESIGN Cross-sectional nutritional survey carried out ( 2007 - 2008 ) in the Balearic Isl and s , a Mediterranean region . Dietary assessment was based on a 145-item semi-quantitative FFQ and two non-consecutive 24 h recalls .  Anthropometric measurements and questions related to socio-economic , lifestyle , physical activity and body image were assessed . SETTING Data obtained from a representative sample of all inhabitants living in the Balearic Isl and s aged 12 - 17 years . SUBJECTS A r and om sample ( n 1231 ) of the adolescent population ( 12 - 17 years old ) was interviewed . RESULTS Factor analysis identified two major dietary food patterns : ' Western ' and ' Mediterranean ' . The ' Western ' dietary pattern was higher among boys than girls , associated with spending ≥4 h/d on media screen time , but less prevalent among those adolescents who desired a thinner body and those girls who desired to remain the same weight . The ' Mediterranean ' dietary pattern was mainly followed by girls , and also boys who spent < 2 h/d on media screen time and girls with high parental socio-economic status . CONCLUSIONS The present study shows the existence of two major dietary patterns among Balearic Isl and s ' adolescents : ' Western ' and ' Mediterranean ' , but girls are more ' Mediterranean ' than boys . This evidence supports that the food pattern of Balearic Isl and s ' adolescents is in a transitional state characterised by the loss of the traditional Mediterranean dietary pattern towards a Western dietary pattern . Low parental socio-economic status , much leisure-time on sedentary behaviours such as media screen time and body image are factors associated with the ' Western ' dietary pattern Introduction Large proportions of the population are not meeting recommended levels of physical activity and have increasingly sedentary lifestyles . Low levels of physical activity are predictive of poor health outcomes and time spent sedentary is related to a host of risk factors independently of physical activity levels . Building an evidence base of the best approaches to intervene in the lifestyles of inactive individuals is crucial in preventing long-term disease , disability and higher mortality rates . Methods and analysis Systematic search es will be conducted on all relevant data bases ( eg , PubMed , Scopus , CINAHL , PsycINFO ) . Studies will be included if they assess interventions aim ed at changing physical activity or sedentary behaviour levels in adults ( over 18 ) who are inactive and do not suffer from chronic conditions . Studies must also be r and omised controlled trials ( RCTs ) , have a primary outcome of physical activity or sedentary behaviour , and measure outcomes at least 6 months after intervention completion . Studies will be coded using the Behaviour Change Technique ( BCT ) taxonomy v1 and Template for Intervention Description and Replication ( TIDieR ) guidelines . 2 review ers will independently screen full-text articles and extract data on study characteristics , participants , BCTs , intervention features and outcome measures . Study quality will also be assessed independently by 2 review ers using the Cochrane risk of bias tool . A meta- analysis will be considered if there is sufficient homogeneity across outcomes . GRADE criteria will be used to assess quality of evidence . Dissemination This will be the first review to systematic ally appraise interventions aim ed at changing the physical activity or sedentary behaviour of inactive individuals using RCT design s with a 6-month follow-up post-intervention . This review will better inform intervention design ers targeting inactive population s and inform the design of a future complex intervention . Review registration number This protocol was registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) on 17 October 2014 ( registration number : CRD42014014321 ) Background The aim of these review s is to inform the design and content of interventions to reduce obesity in young children . The behaviors that are associated with obesity/overweight have been studied extensively ; however , the factors associated with these behaviors in young children ( 0 to 6 years ) have not been systematic ally review ed . Over the past few years the focus of obesity prevention has shifted to preschool children because of the high prevalence of obesity at school entry and recognition that habits formed in early life could track into adulthood . In order to develop effective interventions and change behavior , it is important to underst and the factors that are associated with those behaviors . For example , we need to underst and whether it would be more important to target the family , childcare setting s or the wider environment and identify the most effective way of changing these energy balance related behaviors . Methods / Design Quantitative ( intervention and observational ) and qualitative literature on determinants/correlates of fruit and vegetable intake , sugar sweetened beverage and other unhealthy diet intake , and physical activity and sedentary behaviors in young children will be systematic ally identified , mapped and review ed . A common search strategy ( no language or period restrictions ) will be used to identify papers from eight electronic data bases and this will be supplemented by h and - search ing . Next , studies in developed countries that examine the factors associated with these behaviors in children aged 0 to 6 years ( at baseline ) will be screened and mapped descriptively followed by in-depth data extraction , quality assessment and synthesis . Data from quantitative studies will be summarized using either forest plots or harvest plots and narrative synthesis , and qualitative studies using thematic analysis . Qualitative evidence will be integrated with the quantitative evidence , using a parallel synthesis approach , to provide a deeper underst and ing of effective strategies to influence these energy balance related behaviors . Discussion In addition to updating and mapping current research , these review s will be the first to comprehensively synthesize and integrate both the quantitative and qualitative evidence pertaining to determinants/correlates/barriers/facilitators of obesity related behaviors in this young age group ( 0 to 6 years ) with the aim of informing future interventions . Systematic review registration International Prospect i ve Register for Systematic Review s ( PROSPERO ) Registration number : Background Previous studies examining the relationship between physical activity levels and broad-based measures of psychological wellbeing in adolescents have been limited by not controlling for potentially confounding variables . The present study examined the relationship between adolescents ’ self-reported physical activity level , sedentary behaviour and psychological wellbeing ; while controlling for a broad range of sociodemographic , health and developmental factors . Methods The study entailed a  cross-sectional school-based survey in ten British towns . Two thous and six hundred and twenty three adolescents ( aged 13–16 years ) reported physical activity levels , patterns of sedentary behaviour  ( TV/computer/video usage )  and completed the strengths and difficulties question naire ( SDQ ) .  Results Lower levels of self-reported physical activity and higher levels of sedentary behaviour showed grade d associations with higher SDQ total difficulties scores , both for boys ( P < 0.001 ) and girls ( P < 0.02 ) after adjustment for age and town . Additional adjustment for social class , number of parents , predicted school examination results , body mass index , ethnicity , alcohol intake and smoking status had little effect on these findings . Conclusions Low levels of self-reported physical activity are independently associated with diminished psychological wellbeing  among adolescents . Longitudinal studies may provide further insights into the relationship between wellbeing and activity levels in this population . Ultimately , r and omised controlled trials are needed to evaluate the effects of increasing physical activity on psychological wellbeing among adolescents AIMS The importance of reducing sedentary time is increasingly being recognized in the prevention of diabetes and cardiovascular disease . Despite this , the prospect i ve association between sedentary time and physical activity with insulin sensitivity and cardiometabolic risk factors has been little studied . METHODS In an analysis of data from the European RISC study , sedentary time and time spent in activity of moderate or vigorous intensity were assessed by accelerometry at baseline in 313 men and 414 women , aged 30 - 60 years , with insulin sensitivity as measured by euglycaemic-hyperinsulinaemic clamp . Three years later , cardiometabolic risk factors ( anthropometry , glucose , insulin , lipids ) were available for 549 participants . RESULTS In cross-sectional analyses using baseline data , after adjusting for age , gender , recruitment centre and time spent in activity of moderate or vigorous intensity , significant unfavourable associations were observed between higher sedentary time with body weight , HDL cholesterol , triglycerides , clamp-measured insulin sensitivity and insulin secretion ( all P(trend)<0.002 ) .  Sedentary time  remained significantly associated with insulin secretion after adjusting for insulin sensitivity ( P(trend)=0.02 ) . In longitudinal analyses , higher baseline sedentary time  was associated with 3-year increases in fasting glucose , fasting insulin and the HOMA insulin-resistance index score for the 50 % of the study population who increased their BMI by at least 0.3 kg/m(2 ) ( all P(trend)<0.01 ) ; these relationships remained significant after adjusting for time spent in activity of moderate or vigorous intensity . The 3-year increase in insulin secretion was lower in those spending more time doing activity of moderate or vigorous intensity ( P(trend)=0.03 ) . CONCLUSION These prospect i ve data suggest that less sedentary behaviour may partly counteract some of the negative effects of increasing body weight on glucose-insulin homoeostasis PURPOSE The objective of the Healthy Eating Aerobic and Resistance Training in Youth ( HEARTY ) trial ( Clinical Trials . Gov # NCT00195858 ) was to examine the effects of resistance training , with and without aerobic training , on percent body fat in sedentary , post-pubertal overweight or obese adolescents aged 14 - 18 years . This paper describes the HEARTY study rationale , design and methods . METHODS After a 4-week supervised low-intensity exercise run-in period , 304 overweight or obese adolescents with a body mass index≥85th percentile for age and sex were r and omized to 4 groups for 22 weeks ( 5 months ) : diet+aerobic exercise , diet+resistance exercise , diet+combined aerobic and resistance exercise , or a diet only waiting-list control . All participants received dietary counseling design ed to promote healthy eating with a maximum daily energy deficit of -250 kcal . OUTCOMES The primary outcome is percent body fat measured by Magnetic Resonance Imaging . Secondary outcomes include changes in anthropometry , regional body composition , resting energy expenditure , cardiorespiratory fitness , musculoskeletal fitness , cardiometabolic risk markers , and psychological health . SUMMARY To our knowledge , HEARTY is the largest clinical trial examining effects of aerobic training , resistance training , and combined aerobic and resistance training on changes in adiposity and cardiometabolic risk markers in overweight and obese adolescents . The findings will have important clinical implication s regarding the role that resistance training should play in the management of adolescent obesity and its co-morbidities Purpose Imprecise measurement of physical activity variables might attenuate estimates of the beneficial effects of activity on health-related outcomes . We aim ed to compare the cardiometabolic risk factor dose-response relationships for physical activity and sedentary behaviour between accelerometer- and question naire-based activity measures . Methods  Physical activity and sedentary behaviour  were assessed in 317 adults by 7-day accelerometry and International Physical Activity Question naire ( IPAQ ) . Fasting blood was taken to determine insulin , glucose , triglyceride and total , LDL and HDL cholesterol concentrations and homeostasis model-estimated insulin resistance ( HOMAIR ) . Waist circumference , BMI , body fat percentage and blood pressure were also measured . Results For both accelerometer-derived sedentary time ( < 100 counts.min−1 ) and IPAQ-reported sitting time significant positive ( negative for HDL cholesterol ) relationships were observed with all measured risk factors – i.e. increased sedentary behaviour was associated with increased risk ( all p≤0.01 ) . However , for HOMAIR and insulin the regression coefficients were > 50 % lower for the IPAQ-reported compared to the accelerometer-derived measure ( p<0.0001 for both interactions ) . The relationships for moderate-to-vigorous physical activity ( MVPA ) and risk factors were less strong than those observed for sedentary behaviours , but significant negative relationships were observed for both accelerometer and IPAQ MVPA measures with glucose , and insulin and HOMAIR values ( all p<0.05 ) . For accelerometer-derived MVPA only , additional negative relationships were seen with triglyceride , total cholesterol and LDL cholesterol concentrations , BMI , waist circumference and percentage body fat , and a positive relationship was evident with HDL cholesterol ( p = 0.0002 ) . Regression coefficients for HOMAIR , insulin and triglyceride were 43–50 % lower for the IPAQ-reported compared to the accelerometer-derived MVPA measure ( all p≤0.01 ) . Conclusion Using the IPAQ to determine sitting time and MVPA reveals some , but not all , relationships between these activity measures and metabolic and vascular disease risk factors . Using this self-report method to quantify activity can therefore underestimate the strength of some relationships with risk factors BACKGROUND School-based trials to prevent and reduce prevalence of pediatric obesity in low-income countries are necessary . In Brazil , addressing adolescent obesity is a public health priority . OBJECTIVE To evaluate the impact of a group r and omized controlled trial involving a 6-month multicomponent school-based obesity prevention program  targeting adolescent girls . METHODS The  Healthy Habits , Healthy Girls-Brazil program recruited participants ( n=253 ; 16.05±0.05 years ) from ten eligible public technical schools in São Paulo , Brazil . The program was adapted from an Australian intervention study , which is based on the Social Cognitive Theory . The primary outcome measure was body mass index ( BMI ) , and secondary outcomes included BMI z score , waist circumference , and various sedentary and dietary health-related behaviours . RESULTS Although changes in BMI were not statistically significant , differences favored the intervention group ( adjusted mean difference , -0.26kg/m(2),se SE=0.018 , p=0.076 ) . Statistically significant intervention effects were found for waist circumference ( -2.28 cm ; p= , p=0.01 ) , computer screen time on the weekends ( 0.63h/day , p ; p=0.02 ) , total sedentary activities on the weekends ( -0.92h/day , p<0.01 ) , and vegetable intake ( 1.16servings/day , p=0.01 ) . CONCLUSION These findings provide some evidence for the benefit of a school-based intervention to prevent unhealthy weight gain in adolescent girls living in low-income communities Introduction Recent research suggests that diet quality influences  depression  risk ; however , a lack of experimental evidence leaves open the possibility that residual confounding explains the observed relationships . The aim of this study was to document the cross-sectional and longitudinal associations between  dietary patterns  and symptoms of depression and to undertake a detailed examination of potential explanatory factors , particularly socioeconomic circumstances , in the diet-depression relationship . Methods Data were drawn from the Personality and Total Health ( PATH ) Through Life Study , a longitudinal community study following three age cohorts ( 20 + ; 40 + ; 60+yrs ) from south-eastern Australia over three assessment periods ( n = 3663 ) .  Regression analyses evaluated the cross-sectional and longitudinal relationships between dietary patterns , depressive symptoms , age , detailed measures of socioeconomic circumstances , other health behaviours , and cardiovascular risk factors . Results The lowest tertile of prudent ( healthy ) dietary pattern and the highest tertile of western ( unhealthy ) dietary pattern were associated with an increased likelihood of depressive symptoms . However , these contemporaneous associations were explained by adjustment for detailed measures of socioeconomic circumstances and physical activity . In prospect i ve analyses , lower scores on the  healthy dietary pattern  and higher scores on the unhealthy  dietary pattern  independently predicted increased depressive symptoms across time , before and after adjustment for potential confounders and baseline depressive symptoms , but only for those in the oldest cohort . Dietary patterns did not explain the relationship between socioeconomic position and depressive symptoms . Conclusion The results of this study confirm that the relationship between habitual dietary intake and depressive symptoms is somewhat explained by socioeconomic circumstances and other health behaviours , but suggest that long term exposure to unhealthy dietary habits independently predisposes to depression over the lifecourse OBJECTIVE The objective of this paper is to evaluate the behavioural effects , as reported by the parents of the participating boys and girls , of the IDEFICS ( Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS ) intervention . METHODS The effectiveness of the IDEFICS intervention was evaluated through a cluster-controlled trial in eight European countries ( control and intervention communities in each country ) including more than 16,000 children . The 2- to 9.9-year-old children in the intervention group were exposed to a culturally adapted intervention that aim ed to prevent childhood obesity through the community , schools/kindergartens and family . Parents completed question naires to measure  water , soft drink and fruit juice intake ; fruit and vegetable intake ; daily TV viewing and other sedentary behaviours ; daily physical activity levels and strengthening of the parent-child relationships at baseline and follow-up ( 2 years later ) . Mixed models with an additional r and om effect for country were used to account for the clustered study design , and results were stratified by sex . RESULTS The pan-European analysis revealed no significant time by condition interaction effects , neither for boys nor girls , i.e. the analysis revealed no intervention effects on the behaviours of the IDEFICS children as reported by their parents ( F = 0.0 to 3.3 , all p > 0.05 ) . Also very few significance s were found in the country-specific analyses . Positive intervention effects were only found for sport club participation in Swedish boys , for screen time in weekends for Spanish boys and for TV viewing in Belgian girls . CONCLUSION Although no expected intervention effects as reported by the parents on diet , physical activity and sedentary behaviours could be shown for the overall IDEFICS cohort , a few favourable intervention effects were found on specific behaviours in some individual countries . More in-depth analyses of the process evaluation data are needed to obtain more insight into the relationship between the level of exposure to the intervention and its effect This study investigated the cross-cultural differences and similarity in health behaviors between Saudi and British adolescents . A school-based cross-sectional study was conducted at four cities in Saudi Arabia ( Riyadh and Al-Khobar ; N = 1,648 ) and Britain ( Birmingham and Coventry ; N = 1,158 ) . The participants ( 14–18 year-olds ) were r and omly selected using a  multistage stratified cluster sampling technique . Measurements included anthropometric , screen time , vali date d physical activity ( PA ) question naire and dietary habits . The overweight/obesity prevalence among Saudi adolescents ( 38.3 % ) was significantly ( p < 0.001 ) higher than that found among British adolescents ( 24.1 % ) . The British adolescents demonstrated higher total PA energy expenditure than Saudi adolescents ( means ± SE = 3,804.8 ± 81.5 vs. 2,219.9 ± 65.5 METs-min/week ) . Inactivity prevalence was significantly ( p < 0.001 ) higher among Saudi adolescents ( 64 % ) compared with that of British adolescents ( 25.5 % ) . The proportions of adolescents exceeding 2 h of daily screen time were high ( 88.0 % and 90.8 % among Saudis and British , respectively ) . The majority of Saudi and British adolescents did not have daily intakes of breakfast , fruit , vegetables and milk . MANCOVA showed significant ( p < 0.05 ) gender by country interactions in several lifestyle factors . There was a significant ( p < 0.001 ) gender differences in the ratio of physical activity to sedentary behaviors . In conclusion , Saudi and British adolescents demonstrated some similarities and differences in their PA levels , sedentary behaviors and dietary habits . Unhealthy lifestyle behaviors among adolescents appear to be a cross-cultural phenomenon OBJECTIVE Adequate Zn and Mg intakes may be beneficial for the prevention and treatment of mental health problems , such as depression , anxiety and attention-deficit hyperactivity disorder . We aim ed to investigate the prospect i ve association between dietary intakes of Zn and Mg and internalising and externalising behaviour problems in a population -based cohort of adolescents . DESIGN Prospect i ve analysis ( general linear mixed models ) of dietary intakes of Zn and Mg assessed using a vali date d FFQ and mental health symptoms assessed using the Youth Self-Report ( YSR ) , adjusting for sex , physical activity , family income , supplement status , dietary misreporting , BMI , family functioning and energy intake . SETTING Western Australian Pregnancy Cohort ( Raine ) Study . SUBJECTS Adolescents ( n 684 ) at the 14- and 17-year follow-ups . RESULTS Higher dietary intake of Mg ( per SD increase ) was significantly associated with reduced externalising behaviours ( β = -1.45 ; 95 % CI -2.40 , -0.50 ; P = 0.003 ) . There was a trend towards reduced externalising behaviours with higher Zn intake ( per SD increase ; β = -0.73 ; 95 % CI -1.57 , 0.10 ; P = 0.085 ) . CONCLUSIONS The study shows an association between higher dietary Mg intake and reduced externalising behaviour problems in adolescents . We observed a similar trend , although not statistically significant , for Zn intake . R and omised controlled trials are necessary to determine any benefit of micronutrient supplementation in the prevention and treatment of mental health problems in adolescents BACKGROUND & AIMS Depression has a complex association with cardiometabolic risk , both directly as an independent factor and indirectly through mediating effects on other risk factors such as BMI , diet , physical activity , and smoking . Since changes to many cardiometabolic risk factors involve behaviour change , the rise in depression prevalence as a major global health issue may present further challenges to long-term behaviour change to reduce such risk . This study investigated associations between depression scores and participation in a community-based weight management intervention trial . METHODS A group of 64 overweight ( BMI > 27 ) , otherwise healthy adults , were recruited and r and omised to follow either their usual diet , or an isocaloric diet in which saturated fat was replaced with monounsaturated fat ( MUFA ) , to a target of 50 % total fat , by adding macadamia nuts to the diet . Subjects were assessed for depressive symptoms at baseline and at ten weeks using the Beck Depression Inventory ( BDI-II ) . Both control and intervention groups received advice on National Guidelines for Physical Activity and adhered to the same protocol for food diary completion and trial consultations . Anthropometric and clinical measurements ( cholesterol , inflammatory mediators ) also were taken at baseline and 10 weeks . RESULTS During the recruitment phase , pre-existing diagnosed major depression was one of a range of reasons for initial exclusion of volunteers from the trial . Amongst enrolled participants , there was a significant correlation ( R = -0.38 , p < 0.05 ) between BDI-II scores at baseline and duration of participation in the trial . Subjects with a baseline BDI ≥10 ( moderate to severe depression symptoms ) were more likely to dropout of the trial before week 10 ( p < 0.001 ) . BDI-II scores in the intervention ( MUFA ) diet group decreased , but increased in the control group over the 10-week period . Univariate analysis of variance confirmed these observations ( adjusted R(2 ) = 0.257 , p = 0.01 ) . Body weight remained static over the 10-week period in the intervention group , corresponding to a relative increase in the control group ( adjusted R(2 ) = 0.097 , p = 0.064 ) . CONCLUSIONS Depression symptoms have the potential to affect enrolment in and adherence to dietbased risk reduction interventions , and may consequently influence the generalisability of such trials . Depression scores may therefore be useful for characterising , screening and allocating subjects to appropriate treatment pathways Background A better underst and ing of the relationships between obesity and lifestyle factors is necessary for effective prevention and management of obesity in youth . Therefore , the objective of this study was to evaluate the associations between obesity measures and several lifestyle factors , including  physical activity , sedentary behaviors  and dietary habits among Saudi adolescents aged 14–19 years . Methods This was a school-based cross-sectional study that was conducted in three cities in Saudi Arabia ( Al-Khobar , Jeddah and Riyadh ) . The participants were 2906 secondary school males ( 1400 ) and females ( 1506 ) aged 14–19 years , who were r and omly selected using a multistage stratified cluster sampling technique . Measurements included weight , height , body mass index ( BMI ) , waist circumference , waist/height ratio ( WHtR ) , screen time ( television viewing , video games and computer use ) , physical activity ( determined using a vali date d question naire ) , and dietary habits ( intake frequency per week ) . Logistic regression was used to examine the associations between obesity and lifestyle factors . Results Compared with non-obese , obese males and females were significantly less active , especially in terms of vigorous activity , had less favorable dietary habits ( e.g. , lower intake of breakfast , fruits and milk ) , but had lower intake of sugar-sweetened drinks and sweets/chocolates . Logistic regression analysis showed that overweight/obesity ( based on BMI categories ) or abdominal obesity ( based on WHtR categories ) were significantly and inversely associated with vigorous physical activity levels ( aOR for high level = 0.69 , 95 % CI 0.41–0.92 for BMI and 0.63 , 95 % CI 0.45–0.89 for WHtR ) and frequency of breakfast ( aOR for < 3 days/week = 1.44 ; 95 % CI 1.20–1.71 for BMI and 1.47 ; 95 % CI 1.22–1.76 for WHtR ) and vegetable ( aOR for < 3 days/week = 1.29 ; 95 % CI 1.03–1.59 for WHtR ) intakes , and consumption of sugar-sweetened beverages ( aOR for < 3 days/week = 1.32 ; 95 % CI 1.08–1.62 for BMI and 1.42 ; 95 % CI 1.16–1.75 for WHtR ) . Conclusions The present study identified several lifestyle factors associated with obesity that may represent valid targets for the prevention and management of obesity among Saudi adolescents . Primary prevention of obesity by promoting active lifestyles and healthy diets should be a national public health priority BACKGROUND Sedentary time ( ST ) is negatively associated with cardiometabolic health and fitness . Traditional cardiac rehabilitation ( CR ) programming may not significantly reduce ST . The objectives of the study were to assess the feasibility and practicality of activPAL devices for measuring ST in CR , and whether prompting cues to interrupt sedentary behaviour can decrease ST and improve clinical outcomes . METHODS An 8-week , two-arm pilot r and omized controlled trial allocated coronary artery disease patients to either a control ( usual care CR ) or intervention ( CR + sedentary prompts from an activPAL3-VT ) group . Primary outcomes included : recruitment ; acceptability ; completion ; and , adherence rates . Secondary outcomes included changes in : ST ; physical activity ( PA ) ; cardiometabolic health ; psychosocial health ; and , fitness . RESULTS Forty participants ( 16 females ; 19 intervention ; 62 ± 10 years ) were r and omized . Outcome data were available for 95 % of participants . All but one participant completed the full intervention . Most ( 73 % ) intervention participants felt the prompts had somewhat changed their sedentary behaviour . At baseline , participants spent 47 % of their day sedentary . No significant group differences in changes for any of the ST , PA or fitness outcomes were observed . The mean group difference for post-intervention ST ( controlling for baseline ) was 30.3 min/day ( 95 % CI : -51.7 , 112.2 ) in favour of the intervention . The intervention group reported significantly better physical health and had a lower ratio of total cholesterol-to-high density lipoprotein when compared to controls . CONCLUSIONS It is feasible to use activPAL devices to measure ST in a CR setting . Further studies are needed to assess the effectiveness of multi-component sedentary behaviour interventions INTRODUCTION Paediatric obesity is a public health concern worldwide as it can track into adulthood and increase the risk of adult morbidity and mortality . While the aetiology of obesity is multi-factorial , the roles of diet and physical activity are controversial . Thus , the purpose of this study was to report on the differences in  energy intake , diet composition , time spent doing physical activity and energy expenditure  among underweight ( UW ) , normal weight ( NW ) and at-risk of overweight ( OW ) Malaysian adolescents ( 317 females and 301 males ) aged 11 - 15 years . METHODS This was a cross-sectional study with 6,555 adolescents measured for weights and heights for body mass index ( BMI ) categorisation . A total of 618 subjects were r and omly selected from each BMI category according to gender . The subjects '  dietary intake and physical activity  were assessed using self-reported three-day food and activity records , respectively . Dietary intake components included total energy and macronutrient intakes .  Energy expenditure was calculated as a sum of energy expended for basal metabolic rate and physical activity . Time spent ( in minutes ) in low , medium and high intensity activities was also calculated . RESULTS The OW adolescents had the highest crude energy intake and energy expenditure . However , after adjusting for body weight , the OW subjects had the lowest energy intake and energy expenditure ( p-value is less than 0.001 ) . The study groups did not differ significantly in time spent for low , medium and high intensity activities . Macronutrient intakes differed significantly only among the girls where the OW group had the highest intakes compared to UW and NW groups ( p-value is less than 0.05 ) . All study groups had greater than 30 percent and less than 55 percent of energy intake from fat and carbohydrate , respectively . CONCLUSION The data suggested that a combination of low energy expenditure adjusted for body weight and high dietary fat intake may be associated with overweight and obesity among adolescents . To prevent overweight and obesity among children and adolescents , strategies that address eating behaviours and physical activity are required . Various segments of the society must be involved in efforts to promote healthful dietary intakes and active lifestyle in children and adolescents
No significant associations between screen time with blood pressure and cholesterol were reported .
Sedentary behaviour appears to be associated with  adiposity in adolescents , irrespective of dietary intake .
Screen time , but not overall sedentary behaviour , is consistently related to cardiometabolic health in adolescents .
Because of the associations screen time has with dietary intake , diet may be an important factor in the screen time and health relationship ; however , evidence has not previously been synthesized .
Thus , the aim of this systematic review was to explore whether the associations between various sedentary behaviours and cardiometabolic risk markers are independent of dietary intake in adolescents .