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To examine the bidirectional association between physical activity (PA) and polysomnographically (PSG)-assessed sleep parameters characterized by total sleep time (TST), sleep onset latency (SOL), wake time after sleep onset (WASO), sleep efficiency and percentage of TST in N1, N2, and N3 stages and rapid eye movement (REM) sleep in middle-aged and older adults. Longitudinal study based on a subsample of the Wisconsin Sleep Cohort. Self-reported PA information was used to estimate the metabolic equivalents of task (MET-minutes/week) activity and in-laboratory PSG exams provided information on sleep parameters at baseline and after 3-11 years of follow-up between 2004 and 2015. Poisson and linear regression models controlling for confounders estimated associations of sleep outcomes with changes in PA. A total of 424 participants (45.8% female; mean ± SD age 60.1 ± 7.5 years) were followed over an average of 5.0 ± 1.6 years. Compared to baseline PA of <500 MET-minutes/week (reference category), 500 to 1500 MET-minutes/week of PA was associated with lower incidences of TST <6 hours (relative risk, RR: 0.49; 95% confidence interval, CI: 0.27; 0.88), WASO >60 minutes (RR: 0.58; 95% CI: 0.41; 0.82) and sleep efficiency <80% (RR: 0.61; 95% CI: 0.39; 0.94), adjusting for sociodemographic, health behaviors and medical conditions. No significant associations were observed between baseline sleep characteristics and changes in PA through the follow-up. In this prospective study, an intermediate level of PA at baseline predicted lower risk of incident short sleep time, higher WASO and lower sleep efficiency measured with PSG.

Background The length of time between symptom onset and reperfusion therapy in patients with ST-segment elevation acute myocardial infarction (STEMI) is a key determinant of mortality. Information on this delay is scarce, particularly for developing countries. The objective of the study is to prospectively evaluate the individual components of reperfusion time (RT) in patients with STEMI treated at a University Hospital in 2012. Methods Medical records were reviewed to determine RT, its main (patient delay time [PDT] and system delay time [SDT]) and secondary components and hospital access variables. Cognitive responses were evaluated using a semi-structured questionnaire. Results A total of 50 patients with a mean age of 59 years (SD = 10.5) were included, 64% of whom were male. The median RT was 430 min, with an interquartile range of 315–750 min. Regarding the composition of RT in the sample, PDT corresponded to 18.9% and SDT to 81.1%. Emergency medical services were used in 23.5% of cases. Patients treated in intermediate care units showed a significant increase in SDT ( p  = 0.008). Regarding cognitive variables, PDT was approximately 40 min longer among those who answered “I didn’t think it was serious” ( p  = 0.024). Conclusions In a Brazilian tertiary public hospital, RT was higher than that recommended by international guidelines, mainly because of long SDT, which was negatively affected by time spent in intermediate care units. Emergency Medical Services underutilization was noted. A patient’s low perception of severity increased PDT.

Obesity-related eating behaviors (OREB) are associated with higher energy intake. Total energy intake can be decomposed into the following constituents: food portion size, food energy density, the number of eating occasions, and the energy intake from energy-rich beverages. To our knowledge this is the first study to examine the association between the OREB and these energy components. Data were taken from a cross-sectional study conducted in 2008-2010 among 11,546 individuals representative of the Spanish population aged ≥ 18 years. Information was obtained on the following 8 self-reported OREB: not planning how much to eat before sitting down, eating precooked/canned food or snacks bought at vending machines or at fast-food restaurants, not choosing low-energy foods, not removing visible fat from meat or skin from chicken, and eating while watching TV. Usual diet was assessed with a validated diet history. Analyses were performed with linear regression with adjustment for main confounders. Compared to individuals with ≤ 1 OREB, those with ≥ 5 OREB had a higher food energy density (β 0.10; 95% CI 0.08, 0.12 kcal/g/day; p-trend<0.001) and a higher consumption of sugary drinks (β 7; 95% CI -7, 20 ml/day; p-trend<0.05) and of alcoholic beverages (β 24; 95% CI 10, 38 ml/day; p-trend<0.001). Specifically, a higher number of OREB was associated with higher intake of dairy products and red meat, and with lower consumption of fresh fruit, oily fish and white meat. No association was found between the number of OREB and food portion size or the number of eating occasions. OREB were associated with higher food energy density and higher consumption of sugary and alcoholic beverages. Avoiding OREB may prove difficult because they are firmly socially rooted, but these results may nevertheless serve to palliate the undesirable effects of OREB by reducing the associated energy intake.

Aim. To assess the incidence trends in type 1 diabetes among children and adolescents across Europe during the period from 1994 to 2022 using a systematic methodology. Materials and Methods. Cross-sectional or follow-up studies reporting population-based incidence rates (IRs) of European children and adolescents diagnosed aged <15 years with type 1 diabetes were included. The Mantel‒Haenszel or DerSimonian and Laird random-effects method was used to compute the pooled IR estimates and their 95% confidence intervals (CIs). Subgroup analyses were conducted by study year, biological sex, age group (0–4, 5−9, and 10–14 years), country, and European regions. Results. A total of 75 studies (219,331 children and adolescents aged 0–14 years) with data from 32 countries were included. Generally, a high overall rate of increase in type 1 diabetes incidence has been shown in most European countries from 1994 to 2022 in both sexes, with an overall increase from 10.85 (95% CI, 9.62–12.07) per 100,000 person-years from 1994 to 2003 to 20.96 (95% CI, 19.26–22.66) per 100,000 person-years from 2013 to 2022. Conclusions. There are substantial between-country differences in the current levels and trends of IR in type 1 diabetes in European children and adolescents. Our data suggest a worrying upward trend in most European countries.

Background/objectives: recent studies have suggested that components typical of the Mediterranean diet (MedDiet) are associated with depression and anxiety prevention. In this sense, the main objective of this study was to analyse the associations between adherence to the MedDiet and depression and anxiety symptoms and to examine whether this relationship is mediated by lean mass and the muscle strength index (MSI). Methods: a cross-sectional study (based on data obtained from the Nuts4Brain-Z study) was conducted from 2023–2024, involving 428 university students, aged 18–30 years, from a Spanish public university. Depression was assessed using the Beck Depression Inventory (BDI-II), and anxiety was assessed via the General Anxiety Disorder-7 (GAD-7) tool. Adherence to the MedDiet was assessed using the MEDAS questionnaire. Lean mass was assessed via bioimpedance, and MSI was measured via a dynamometer. ANCOVA models were used to test the mean differences in depression and anxiety scores using MEDAS categories (low adherence < 9 points vs high adherence ≥ 9 points). Serial multiple mediation models, adjusted for the main confounders, were used to explore the role of lean mass and MSI in the relationships between adherence to the MedDiet and depression and anxiety symptoms. Results: university students with high adherence to the MedDiet exhibited lower scores for depression and anxiety symptoms (p < 0.05) than did students with low adherence to the MedDiet. The mediation analysis preliminarily revealed that both lean mass and MSI acted as mediators of the relationships between adherence to the MedDiet and depression and anxiety. Conclusion:adherence to the MedDiet in university students per se does not appear to have a direct effect on depression and anxiety symptoms because these associations are partially (for depression) or entirely (for anxiety) explained by lean mass and MSI.

The network meta-analysis and systematic review conducted aim to comparatively assess the effects of tree nuts and peanuts on body weight (BW), body mass index (BMI), waist circumference (WC), and body fat percentage (BF%). A systematic search up to 31 December 2020 was performed. A random-effects network meta-analysis was conducted following the PRISMA-NMA statement. A total of 105 randomized controlled trials (RCTs) with measures of BW (n = 6768 participants), BMI (n = 2918), WC (n = 5045), and BF% (n = 1226) were included. The transitivity assumption was met based on baseline characteristics. In the comparisons of nut consumption versus a control diet, there was no significant increase observed in any of the adiposity-related measures examined except for hazelnut-enriched diets, which raised WC. Moreover, almond-enriched diets significantly reduced WC compared to the control diet and to the pistachio-, mixed nuts-, and hazelnut-enriched diets. In subgroup analyses with only RCTs, designed to assess whether nut consumption affected weight loss, almonds were associated with reduced BMI and walnuts with reduced %BF. The evidence supports that: (1) tree nut and peanut consumption do not influence adiposity, and (2) compared to a control diet, the consumption of almond-enriched diets was associated with a reduced waist circumference.

Cortisol levels are implicated in emotional and cognitive development in children. However, it is not clear whether daytime napping influences cortisol levels in early childhood. This systematic review and meta-analysis aimed to synthesize the available evidence regarding the association between daytime napping and salivary cortisol in early childhood. The Medline, Embase, Web of Science, PsycINFO, and Cochrane Collaboration databases were searched for observational and experimental studies reporting data about napping behavior and salivary cortisol in children 0–5 years of age. Salivary cortisol levels were analyzed in three situations: CAR, cortisol awakening response from nap awakening; PRE-POST, before and after a daytime nap; and DIURNAL, from morning awakening to bedtime. Five studies showed a significant CAR after napping (mean difference, MD: 0.11μg/mL; 95% confidence interval, CI: 0.04, 0.18). In the PRE-POST analysis, a small decrease was observed for at-home naps (MD: -0.05 μg/mL; 95% CI: − 0.09, − 0.02) but not for at-childcare naps (MD: 0.04 μg/mL; 95% CI: − 0.01, 0.09). A similar pattern of DIURNAL salivary cortisol decrease was observed when children took a nap (MD: − 0.34 μg/mL; 95% CI: − 0.41, − 0.28) and when they did not sleep during the day (MD: − 0.28 μg/mL; 95% CI: − 0.38, − 0.19).Conclusions: Daytime napping plays a minor role in the fluctuation of salivary cortisol levels during the day. The conditions of the home or the childcare environment under which napping occurs might have a greater influence on cortisol levels than daytime napping itself in early childhood. PROSPERO Identifier: CRD42020212249. What is Known:• The regulation of sleep involves circadian rhythmicity of cortisol secretion via activation of the HPA axis and a subsequent release of cortisol upon morning awakening followed by a decline throughout the day. What is New:• The available evidence supports the occurrence of a cortisol awakening response after a daytime nap.• A small decrease in cortisol after napping was observed when the nap occurred at home but not at childcare.• The conditions of the home or childcare environment under which the nap occurs and the activities before and after napping may have a greater influence on cortisol levels than napping itself.

Background: Children and adolescents with obesity have altered serum copper (Cu) and zinc (Zn) levels, which are associated with oxidative stress, inflammation, and health outcomes. The inclusion of cashew nuts in an adequate diet may provide health benefits and help improve the mineral status of individuals with obesity. Objective: To evaluate the effects of cashew nut consumption on biomarkers of Cu and Zn status in adolescents with obesity. Methods: This was a randomized controlled trial conducted in adolescents. The participants were divided into a control group (CON) and a cashew nut group (CASN). The CASN group received 30 g/day of roasted cashew nuts for 12 weeks, and both groups received nutritional counseling during the study. Anthropometric, dietary, and biochemical parameters (Zn, Cu, and superoxide dismutase (SOD)) were assessed at the baseline and at the end of the study. Association tests, within-group and between-group mean comparisons, and analyses of variation between study periods (Δ T12-T0) were performed. Results: The sample consisted of 81 adolescents who completed the intervention period, resulting in 54 in the CASN group and 27 in the CON group. After the intervention, the CASN group presented a decrease in plasma Cu (p = 0.004) and an increase in SOD (p = 0.030). Both groups showed an increase in plasma Zn (p < 0.050) and a decrease in the Cu/Zn ratio (p < 0.001). CASN had a negative effect on the Cu concentration, which was significantly different from that of CON (p = 0.004). Conclusions: The consumption of cashew nuts for 12 weeks reduced plasma Cu levels in adolescents with obesity. Nutritional counseling may have contributed to the increase in plasma Zn levels in all the study participants.

Depressive and anxiety symptoms are associated with a greater likelihood of disordered eating behaviors (DEBs), but the role of sex in these associations is unclear. Objectives: The aim of this study was to analyze the associations between depression, anxiety, and DEBs in a sample of Spanish university students. Methods: Depression was assessed with the Beck Depression Inventory-II (BDI-II), anxiety with the Generalized Anxiety Disorder (GAD-7) instrument, and DEBs with the Sick, Control, One stone, Fat, Food (SCOFF) questionnaire. Statistical analyses included generalized linear regression models adjusted for sociodemographic, body composition, and lifestyle covariates as the main confounders. Results: Among the 453 students analyzed (71.5% female), the frequencies of mild-to-severe depression, mild-to-severe anxiety, and of DEBs were higher in the females (42.0%, 77.5%, and 32.7%, respectively) than in the males (24.0%, 52.7%, and 20.2%, respectively). The results of the adjusted GLMs were similar for both the sexes, indicating higher estimated marginal means of the SCOFF total score and greater odds of DEBs among those with mild-to-severe depression or anxiety than among those without these conditions. Conclusions: Depression and anxiety symptoms are cross-sectionally associated with DEBs in Spanish university students of both sexes. Future prospective studies are needed to examine the direction of these associations separately for females and males.

Objectives: Eating disorders (EDs) have emerged as a growing public health concern. However, the role of sleep in this context remains underexplored. The aim of this cross-sectional study was to determine the associations between sleep parameters and chronotype with ED risk in a sample of university students in Spain. Methods: ED risk was assessed via the Sick, Control, One stone, Fat, Food Questionnaire, and sleep quality was assessed via the Pittsburgh Sleep Quality Index. Other sleep parameters and chronotypes were self-reported. Sociodemographic, body composition, lifestyle, and depressive symptom data were collected. Logistic and linear regression models adjusted for the main confounders were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the study associations. Results: A total of 403 students (70.2% female) aged 18 to 30 years participated in the study. Those reporting poor sleep quality (OR = 1.85, 95% CI 1.08–3.17, p = 0.025) and ≤6 h of night-time sleep duration (OR = 4.14, 95% CI 2.00–8.57, p < 0.01) were more likely to be at risk of EDs in the adjusted analyses. The association between night-time sleep duration and the risk of ED did not remain significant when we adjusted for sleep quality. In addition, an evening chronotype was associated with an increased risk of EDs (OR = 1.68, 95% CI 1.07–2.66, p = 0.039) only before adjustment for confounders. Conclusions: Among university students, poorer sleep quality was cross-sectionally associated with EDs. Future prospective studies are needed to examine whether promoting sleep quality may serve as an effective strategy for preventing the risk of EDs.