Flavonoids are a key class of polyphenols, i.e., phytochemical compounds present in foods and beverages, which have been described as having health benefits in preventing several chronic diseases. Estimating flavonoid intake has already been conducted in several countries but has yet to be performed in Portugal. This study included 5005 participants aged 3-84 years and aimed to estimate dietary flavonoid intake in the Portuguese population, using data from the National Food and Physical Activity Survey 2015-2016, providing information on intake, main food contributors and the socio-demographic factors associated with the intake. Food intake data from the survey was converted to flavonoid intake using a database built to include the most updated USDA databases on flavonoids, isoflavones and proanthocyanidins and the Phenol-Explorer database. The rationale for combining food consumption data and different flavonoid databases using the FoodEx2 classification system was established. Linear regressions assessed the associations between socio-demographic factors and dietary flavonoid intake. The total flavonoid intake of the Portuguese population was estimated to be 107·3 mg/d. Flavanols were the most representative subclass, followed by flavonols, anthocyanidins, flavanones, flavones and isoflavones. Fruits and vegetables were the primary food contributors, providing 31·5 % and 12·4 % of the total flavonoid intake. Adolescents had the lowest total flavonoid intake, and older adults had the highest. This study provides information on the Portuguese population's dietary flavonoids, allowing for international comparisons. It can also streamline forthcoming investigations into the link between flavonoid consumption and its impact on health, contributing to the future establishment of dietary reference values.

Background & aims: Ultra-processed foods (UPF) consumption has been associated with unhealthy outcomes. However, the literature lacks robust longitudinal studies considering its cumulative effect, particularly in young populations. This study aimed to evaluate the relationship between UPF consumption patterns throughout childhood with growth and adiposity trajectories. Methods: Generation XXI population-based birth cohort (Porto, Portugal) participants were included. Food frequency questionnaire items at 4, 7 and 10 years were classified according to the processing degree using NOVA. UPF consumption patterns based on total quantity were identified using a probabilistic Gaussian mixture model using participants with complete data and predicting for the total sample (n = 8647). To assess whether the outcome trajectories from 4 to 13 years [body weight (kg), height (cm), body mass index (BMI) z-score, waist circumference (WC) (cm) and fat mass (FM) (%)] depend on UPF patterns, a mixed-effects model with linear and quadratic terms for age adjusted for confounders was used. Participants with at least 2 measurements at 4, 7,10 or 13 years were included in this study (n range: 5885-6272). Results: Four UPF consumption patterns were identified: constantly lower consumption (15.4%), constantly intermediate consumption (56.4%), transition from low to high consumption (11.2%), and constantly higher consumption (17.1%). Compared to the constantly lower UPF consumption, the constantly higher consumption pattern was associated with greater acceleration in body weight ((3: 0.119; 95%CI: 0.027; 0.212), BMI z-score ((3: 0.014; 95%CI: 0.004; 0.023), WC ((3: 0.232; 95%CI: 0.144; 0.319) and FM% ((3: 0.200; 95%CI: 0.092; 0.308) and with lower acceleration in height ((3: -0.063; 95%CI: -0.111;-0.015). The constantly intermediate UPF consumption pattern was associated with greater acceleration in body weight ((3: 0.123; 95%CI: 0.043; 0.203), WC ((3: 0.120; 95%CI: 0.045; 0.195) and FM% ((3: 0.146; 95%CI: 0.054; 0.238). Conclusion: Constantly higher and constantly intermediate UPF consumption throughout childhood were associated with worse growth and adiposity trajectories until adolescence. (c) 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Abstract Background Although physical activity (PA) is associated with significant health benefits, only a small percentage of adolescents meet recommended PA levels. This systematic review with meta-analysis explored the modifiable determinants of adolescents’ device-based PA and/or sedentary behaviour (SB), evaluated in previous interventions and examined the associations between PA/SB and these determinants in settings. Methods A search was conducted on five electronic databases, including papers published from January 2010 to July 2023. Randomized Controlled Trials (RCTs) or Controlled Trials (CTs) measuring adolescents’ device-based PA/SB and their modifiable determinants at least at two time points: pre- and post-intervention were considered eligible. PA/SB and determinants were the main outcomes. Modifiable determinants were classified after data extraction adopting the social-ecological perspective. Robust Bayesian meta-analyses (RoBMA) were performed per each study setting. Outcomes identified in only one study were presented narratively. The risk of bias for each study and the certainty of the evidence for each meta-analysis were evaluated. The publication bias was also checked. PROSPERO ID: CRD42021282874. Results Fourteen RCTs (eight in school, three in school and family, and one in the family setting) and one CT (in the school setting) were included. Fifty-four modifiable determinants were identified and were combined into 33 broader determinants (21 individual–psychological, four individual–behavioural, seven interpersonal, and one institutional). RoBMAs revealed none or negligible pooled intervention effects on PA/SB or determinants in all settings. The certainty of the evidence of the impact of interventions on outcomes ranged from very low to low. Narratively, intervention effects in favour of the experimental group were detected in school setting for the determinants: knowledge of the environment for practicing PA, d = 1.84, 95%CI (1.48, 2.20), behaviour change techniques, d = 0.90, 95%CI (0.09, 1.70), choice provided, d = 0.70, 95%CI (0.36, 1.03), but no corresponding effects on PA or SB were found. Conclusions Weak to minimal evidence regarding the associations between the identified modifiable determinants and adolescents’ device-based PA/SB in settings were found, probably due to intervention ineffectiveness. Well-designed and well-implemented multicomponent interventions should further explore the variety of modifiable determinants of adolescents’ PA/SB, including policy and environmental variables.

INTRODUCTION: Assessing children's lifestyles is fundamental for developing policies that prevent the onset of non-communicable diseases. OBJECTIVES: To develop a short lifestyle index for school-age children (6 to 9 years old) and assess their lifestyle characterization. METHODOLOGY: The index was developed based on data from the 7-year follow-up of the birth cohort Generation XXI (n=4336 children), grouped into four domains: frequency of food consumption, eating behaviours, physical activity (including sedentary behaviours) and sleep duration. Cronbach alpha coefficient was obtained to assess the index internal consistency. Associations between sociodemographic characteristics, the physical environment of the house, and the index score were evaluated through linear regression models, obtaining beta coefficients and respective 95% confidence interval (95%CI). RESULTS: The final index included only two domains (food consumption and physical activity) with a Cronbach alpha of 0.52 and a mean score of 3.6 ± 2.8 (range: -5 to 10). Maternal age (β=1.066; 95%CI=1.045-1.087), years of education (β=1.216; 95%CI=1.186-1.246), having a house with a garden (β=1.630; 95%CI=1.304-2.037), internet access (β=1.524; 95%CI=1.086-2.139) and having a bicycle (β=1.710; 95%CI=1.086-2.694) were positively associated with a healthier lifestyle of the children. CONCLUSIONS: The index developed is a short instrument that can be used to evaluate school-age children’s overall lifestyle. Better maternal sociodemographic characteristics and a better house physical environment increase the likelihood of children having a healthier lifestyle.

This study aimed to examine diet tracking from childhood to adolescence, using 4 time-points, and the influence of socioeconomic and individual characteristics in this transition. The sample included 6893 children from the Portuguese birth cohort Generation XXI with complete information on Food Frequency Questionnaire in at least one of the considered follow-ups. A Healthy Eating Index (HEI), previously developed to assess adherence to WHO's dietary recommendations, was applied at all ages (4, 7, 10 and 13y). The intraclass correlation coefficient (ICC) was used to analyse the tracking of diet quality. Linear mixed-effect models were performed to estimate the association of the child's socioeconomic and individual characteristics with the HEI score and respective trajectories over time. The overall diet quality decreased from childhood (22.2 +/- 3.6 at 4y) to adolescence (18.2 +/- 3.9 at 13y), with moderate tracking (ICC = 0.53), showing that children who start a healthy diet earlier might have a better diet quality as time goes by. Children of older mothers (8 = 0.079, 95%CI = 0.061-0.097) and with higher education (8 = 0.203, 95%CI = 0.178-0.229) and a higher household monthly income (8 = 0.024,95%CI = 0.007-0.041) had a higher diet quality over time. Besides family characteristics, the child's sedentary activities (8 = -0.009, 95%CI = - 0.014--0.003) negatively influence diet quality throughout life. In contrast, being a girl (8 = -0.094, 95%CI = - 0.132--0.056) and having higher sleep duration (8 = 0.039, 95%CI = 0.015-0.064) are associated with a higher diet quality over time. The presence of dietary tracking from childhood to adolescence implies that promoting healthy eating habits during the first years of life is crucial for a healthier diet quality during late childhood and early adolescence, focusing on maternal and individual child characteristics.

Summary In an obesogenic environment, short sleeping may increase opportunistic eating. The timing of sleep might also influence the drive to eat. This study investigated the prospective association of sleep timing and duration with diet in 5286 children from the Portuguese birth cohort Generation XXI, evaluated at 4 and 7 years of age. At 4 years, sleep duration was categorised into ≤10 and >10 h. Four sleep timing categories were generated based on the median split for sleep‐onset and ‐offset times: ‘Early Sleep‐Early Wake’; ‘Early Sleep‐Late Wake’; ‘Late Sleep‐Early Wake’; ‘Late Sleep‐Late Wake’. At 7 years, diet was obtained by a food frequency questionnaire and three dietary patterns were included: ‘Healthier’, ‘Energy‐Dense Foods (EDF)’ and ‘Snacking’. The Healthy Eating Index was used to evaluate diet quality. Multinomial logistic regression models and generalised linear models were performed. Children who had a late sleep, independently of the time of waking up, had higher odds of following the ‘EDF’ pattern, compared with the ‘Healthier’. Boys who had late sleep and/or late wake had also higher odds of following the ‘Snacking’ pattern and had poorer diet quality. In both sexes, a late sleep or late wake were associated with a lower diet quality, compared to the group ‘Early Sleep‐Early Wake’, and independently of nap behaviour. In boys, shorter sleep duration was associated with a poorer diet. In conclusion, pre‐schoolers with late bedtimes or wake‐up times have worse dietary patterns and poorer diet quality at the age of 7 years, which seems to be independent of sleep duration.

Sleep may influence appetite regulation through physiological and neurocognitive pathways. However, the association between sleep and appetite in childhood has been scarcely reported, particularly using a prospective design. We aimed to test associations between sleep duration at 7 years of age (y) and appetitive traits at both 7 and 10 y. Participants are from the population-based cohort Generation XXI (Porto, Portugal), at 7 (n=2437) and 10 y (n=1938) follow-ups. Data on sleep was gathered at 7 y and, considering bedtime and get-up time, total mean sleep duration was calculated and further categorized according to the 10th and 90th percentiles. Appetitive traits were assessed at 7 and 10 y using the parent-reported Children`s Eating Behaviour Questionnaire. Associations were tested through Generalized Linear Models (co-variates: child`s sex; maternal age, education and pre-pregnancy body mass index at 7 y). At 10 y, associations were further adjusted for the respective appetitive trait at 7 y. Children slept a mean of 10.2 hours/night, and 13% and 9% slept ≤9.5 and ≥11.0 hours/night at 7 y, respectively. For each additional hour in sleep duration, children scored 0.078 (99%CI: -0.145; -0.011) lower on Food Responsiveness, 0.065 (99%CI: -0.129; -0.002) lower on Emotional Undereating and 0.096 (99%CI: -0.161; -0.032) lower on Food Fussiness. Lastly, children sleeping ≤9.5 hours/night scored higher on Food Responsiveness (β=0.145 99%CI: 0.020; 0.271); while those sleeping ≥11.0 hours/night scored lower on Food Fussiness (β=-0.255 99%CI: -0.370; -0.079). No significant prospective associations were found. In conclusion, in 7 y children, sleep duration was cross-sectionally associated with lower scores on food approach (Food Responsiveness) and avoidant traits (Emotional Undereating and Food Fussiness). However, the magnitude of the associations was small and further studies are warranted.

Previous physical activity interventions for children (5-12yrs) have aimed to change determinants associated with self-report physical activity behaviour (PAB) and/or sedentary behaviour (SB), however, the associations between these determinants and PAB/SB in different settings are uncertain. The present study aimed to identify modifiable determinants targeted in previous PAB/SB interventions for children. Intervention effects on the determinants and their associations with self-report PAB/SB were assessed across settings. Search of relevant interventions from pre-defined databases was conducted up to July 2023. Randomized and non-randomized controlled trials with modifiable determinants were included. Data extraction and risk of bias assessments were conducted by two independent researchers. Where data could be pooled, we performed Robust Bayesian meta-analyses. Heterogeneity, publication bias and certainty of evidence were assessed. Fifteen studies were deemed eligible to be included. Thirty-seven unique determinants within four settings were identified-school, family, school with family/home, and community with(out) other settings. Ninety-eight percent of determinants belonged to individual/interpersonal determinant categories. Narratively, intervention effects on student perception of teachers' behaviour (school), self-management, perceived barriers, external motivation, exercise intention, parental modeling on SB (school with family/home) and MVPA expectations (community) were weak to strong, however, corresponding PAB/SB change was not evident. There were negligible effects for all other determinants and the corresponding PAB/SB. Meta-analyses on self-efficacy, attitude, subjective norm and parental practice and PAB/SB in two settings showed weak to strong evidence against intervention effect, while the effect on knowledge could not be determined. Similarly, publication bias and heterogeneity for most analyses could not be ascertained. We found no concrete evidence of association between the modifiable determinants and self-report PAB/SB in any settings. This is presumably due to intervention ineffectiveness. Design of future interventions should consider to follow the systems-based approach and identify determinants unique to the context of a setting, including policy and environmental determinants.

Background Despite the potential effectiveness of bariatric surgery in promoting weight loss, a considerable proportion of patients still face the challenge of achieving optimal post-surgery outcomes. The timing of eating, in addition to the content of what is eaten, as well as chronotype and social jetlag (a marker of circadian misalignment), have been implicated in weight regulation. However, the current understanding of these chrono-related behaviours in individuals undergoing bariatric surgery is still scarce. Thus, this study aims to evaluate the role of chrono-nutrition, chronotype, and circadian misalignment in the weight-loss trajectory among individuals living with severe obesity who underwent bariatric surgery. Methods The ChronoWise project is a prospective single-centre cohort study designed to follow patients experiencing bariatric surgery at the Santo António Local Health Unit (ULSSA), Porto, Portugal. Participants will be recruited and evaluated at pre-surgery and followed-up over 3 and 6 months after surgery. The baseline evaluation will be conducted face-to-face during the hospital stay and by telephone or video call on the subsequent evaluations, following standard procedures. Data collection includes sociodemographics, food intake, chrono-nutrition behaviours, sleep time behaviour, sleep quality, screen time, physical activity and exercise behaviours, anthropometric measurements, and biochemical parameters. The ‘Munich Chronotype Questionnaire’ will be used to assess chronotype and social jet lag. Chrono-nutrition dimensions will be measured by the ‘Chrononutrition Profile - Questionnaire' in all evaluations. Weight and height will be self-reported and retrieved from medical registries. trajectories of weight-loss will be obtained. Discussion This study will add important evidence on the role of chrono-nutrition, chronotype and social jetlag profile in weight-loss outcomes after bariatric surgery. Identifying novel approaches to change the paradigm of post-surgical weight management towards a tailored treatment aligned with circadian rhythm may be useful to strengthen the existing treatments and improve patients’ response to bariatric surgery.

To combat the high prevalence of physical inactivity among children, there is an urgent need to develop and implement real-world interventions and policies that promote physical activity (PA) and reduce sedentary behaviour (SB). To inform policy makers, the current body of evidence for children’s PA/SB interventions needs to be translated. The current systematic review and meta-analysis aimed to identify modifiable determinants of device-measured PA and SB targeted in available intervention studies with randomized controlled trial (RCT) and controlled trial (CT) designs in children and early adolescents (5–12 years) and to quantify the effects of the interventions within their respective settings on the determinants of PA/SB and the outcomes PA and SB. A systematic search was conducted in MEDLINE, PsycINFO, Web of Science, SPORTDiscus and CENTRAL. Studies were considered if they were randomized controlled trials (RCTs) or controlled trials (CTs), included children and/or early adolescents (5–12 years; henceforth termed children), measured PA and/or SB using device-based methods and measured PA and/or SB and determinants of PA/SB at least at two timepoints. Risk of bias was assessed using the Cochrane Risk of Bias Tool for Randomised Trials (RoB2) for RCTs and Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) for CTs. The quality of the generated evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Robust Bayesian meta-analysis was conducted to quantify the effects of the interventions on the determinants of PA/SB, and the outcomes PA and SB, stratifying by study design, duration of PA/SB measurement, intervention setting and duration of follow-up measurement. Study characteristics and interventions were summarized. Thirty-eight studies were included with a total sample size of n = 14,258 (67

Later chronotypes may be associated with lower diet quality and later timing of energy intake in paediatric age. Period of data collection of these variables may affect these parameters and inter-relationship. We aimed to assess the cross-sectional association of chronotype with a diet quality score (HEI) and caloric midpoint (time of achieving 50% of total daily energy intake), considering summer holidays, using data from the National Food, Nutrition and Physical Activity Survey 2015-2016 for 578 participants (6-14 years of age). Chronotype was estimated by the midpoint of sleep and categorized as Early, Intermediate and Late, using physical activity diaries, while outcomes using two food diaries/24 h recalls. Associations of chronotype with outcomes were assessed by linear regressions adjusted for sex, age, parental education (model 1), BMI, sports practice (model 2), and summer holidays (no/yes) (model 3). In model 2, a Late vs. Early chronotype was negatively associated with HEI ($\widehat {{\rm{\beta }}}$beta = -0.74; 95% CI: -1.47, -0.07) and positively with caloric midpoint ($\widehat {{\rm{\beta }}}$beta = 0.35; 95% CI: 0.02, 0.69). However, associations lost significance in model 3. The association between chronotype and dietary habits may be benefit from being studied considering school terms and summer holidays. Future larger prospective studies are needed to clarify the role of summer holidays on this inter-relationship.

Maternal influences on children’s diet have been widely studied, while paternal and household frameworks require further research. This study aimed to evaluate how individual, socioeconomic and household characteristics at birth and 7 years (y) impact children's fruit and vegetable (FV) and energy-dense foods (EDF) intake at 10y, distinguishing maternal and paternal effects. The sample included 2750 children evaluated at 7 and 10y in the Portuguese birth cohort Generation XXI. The children’s food intake was assessed through a Food Frequency Questionnaire at both ages, where 4 food groups were defined: FV, ‘Sweet foods’, ‘Salty snacks’, and ‘Soft drinks’. The associations between food intake at 7y, parents’ and children’s characteristics, and food intake at 10y were evaluated via binary logistic regression models. Offspring of older mothers with higher age and education, who live with siblings and had higher family income were likelier to have 5 servings of FV daily at 10y. Children eating 5 portions/day of FV at 7y had higher odds of keeping this pattern at 10y. Higher maternal age and education, and father’s education decreased the odds of having soft drinks daily at 10y. Higher family income was linked with lower odds of weekly salty snacks and daily sweet foods at 10y. In conclusion, parental education, maternal age, living with siblings, and higher family income influenced children’s FV and EDF intake at 10y. Mothers’ effects appear to impact children’s food intake more than fathers’.

Temporal energy intake (EI) and physical activity (PA) patterns may be associated with obesity. We aimed to derive and characterise temporal EI and PA patterns, and assess their cross-sectional association with weight status, in 6-to-14-year-old Portuguese participants of the National Food, Nutrition and Physical Activity Survey 2015-2016. We extracted times and EI of all eating occasions from two 1-d food diaries/24-h recalls, while types and times of PA from 4-d PA diaries. We derived EI patterns (n 714) and PA patterns (n 595), using, respectively, a hierarchical and K-means cluster analysis, considering the average proportion of total daily EI (%TEI) and PA intensity (%TPA), within each 2-h interval across the 24-h day. Patterns were labelled based on the 2-h intervals of %TEI/TPA peaks. We assessed the association between patterns and overweight or obesity (BMI z-score ≥ +1 sd) using adjusted logistic regressions (OR (95 % CI)). Three EI patterns emerged: 1 - 'Early afternoon and early evening'; 2 - 'Early afternoon and late evening'; and 3 - 'Late morning, early and mid-afternoon and late evening'. EI Pattern 3 v. Pattern 1 was negatively associated with overweight or obesity (0·49 (0·26, 0·92)). PA Pattern 1 - 'Late morning, mid-afternoon and early evening' v. Pattern 2 - 'Late afternoon', was not associated with weight status (0·95 (0·65, 1·38)). A daily EI pattern with more and even %TEI peaks at earlier daytime periods, rather than fewer and higher, may be negatively associated with overweight or obesity amongst this population whereas the identified PA patterns might have no relationship.

Schools appear to be a key place to develop healthy eating habits. Currently in Portugal there is no mandatory legislation regarding school mid-morning snacks, allowing the children to bring all types of foods from home. This study aims to assess the effects of a school-based intervention in the dietary and nutritional quality of mid-morning snacks among children of São Miguel Island, Azores. The protocol describes the design of a quasi-experimental study that will include children attending second grade. The intervention involves children, school and family and will consist of two main components: i) a dietary education component through a storybook; and ii) dietary evaluations of mid-morning snacks brought from home during the intervention. The effects will be evaluated through assessment of the dietary quality of mid-morning snacks converted into a nutritional traffic-light label. To measure children’s nutrient intake an electronic database, including the Portuguese Food Composition Table will be used. Data on mid-morning snacks foods will be collected pre- and post-intervention. Through the implementation of this school-based intervention that involves children, their parents and teachers we expect to improve children’s food choices in mid-morning snacks. Ultimately, it is expected that these findings will contribute to the short- and long-term development of future dietary interventions in schools.

Bisphenol A (BPA) is an endocrine disruptor used in food contact materials, by the application of polycarbonate plastics and epoxy resins. The main objective of this study is to compare the estimate of daily BPA exposure at 13 years of age and in the adult Portuguese population, using different methodological approaches, and assess the associations between this exposure and sociodemographic characteristics.Methodology: Cross-sectional data of 13-years follow-up from a population-based birth cohort Generation XXI (GXXI) (n = 2804) and from the National Food, Nutrition and Physical Activity Survey (IAN-AF 2015-2016) (n = 3845, & GE;18 years old) was used. Dietary information was collected through three food diaries for adolescents and two non-consecutive 24-hour-recalls for adults.To estimate the daily exposure to BPA, three methodological approaches were used. "Food groups attribution" merged the food consumption data with the concentration of BPA in food groups. "Regression tree model" and "random forest" combined food consumption information with urinary BPA, measured in a subsample of 24-hour urine (in adolescents n = 216, and in adults n = 82), both used to predict BPA exposure in the remaining sample. The fit-index of the methodologies was assessed through the root mean square error (RMSE), mean absolute error (MAE) and Spearman correlation coefficient (& rho;). Associations between BPA exposure and sociodemographic variables were tested by linear regression models, adjusted for sex, age groups (in adults) and educational level. Tolerable Daily Intake (TDI) of 0.2 ng/kg body weight (bw), recently proposed by the European Food Safety Authority (EFSA), was used for the risk characterization of BPA exposure.Results: The "random forest" was found as the best methodology to estimate the daily BPA exposure (adolescents: RMSE = 0.989, MAE = 0.727, & rho; = 0.168; adults: RMSE = 0.193, MAE = 0.147, & rho; = 0.250). The median dietary BPA exposure, calculated by "food groups attribution", was 79.1 and 46.1 ng/kg bw/day for adolescents and adults, respectively, while "random forest" estimated a BPA exposure of 26.7 and 38.0 ng/kg bw/day. 99.9% of the Portuguese population presented a daily exposure above TDI. Male adolescents, females and higher educated adults, were those more exposed to BPA. Conclusions: The estimated daily BPA exposure strongly depends on the methodological approach. Food groups attribution may overestimate the exposure while the random forest appears to be a better methodological approach to estimate BPA exposure. Nevertheless, for all methods, the Portuguese population presented an unsafe BPA exposure by largely exceeding the safe levels proposed by EFSA.

Introduction Physical activity among children and adolescents remains insufficient, despite the substantial efforts made by researchers and policymakers. Identifying and furthering our understanding of potential modifiable determinants of physical activity behaviour (PAB) and sedentary behaviour (SB) is crucial for the development of interventions that promote a shift from SB to PAB. The current protocol details the process through which a series of systematic literature reviews and meta-analyses (MAs) will be conducted to produce a best-evidence statement (BESt) and inform policymakers. The overall aim is to identify modifiable determinants that are associated with changes in PAB and SB in children and adolescents (aged 5–19 years) and to quantify their effect on, or association with, PAB/SB. Methods and analysis A search will be performed in MEDLINE, SportDiscus, Web of Science, PsychINFO and Cochrane Central Register of Controlled Trials. Randomised controlled trials (RCTs) and controlled trials (CTs) that investigate the effect of interventions on PAB/SB and longitudinal studies that investigate the associations between modifiable determinants and PAB/SB at multiple time points will be sought. Risk of bias assessments will be performed using adapted versions of Cochrane’s RoB V.2.0 and ROBINS-I tools for RCTs and CTs, respectively, and an adapted version of the National Institute of Health’s tool for longitudinal studies. Data will be synthesised narratively and, where possible, MAs will be performed using frequentist and Bayesian statistics. Modifiable determinants will be discussed considering the settings in which they were investigated and the PAB/SB measurement methods used. Ethics and dissemination No ethical approval is needed as no primary data will be collected. The findings will be disseminated in peer-reviewed publications and academic conferences where possible. The BESt will also be shared with policy makers within the DE-PASS consortium in the first instance. Systematic review registration CRD42021282874.

Acrylamide exposure, mainly resulting from food cooking and processing, has been associated with a higher risk of health problems, due to genotoxic effects. This study aims to estimate acrylamide dietary exposure of the Portuguese population and its associated factors. Dietary data collected through 2 non-consecutive 24 hour recalls or food diaries from a representative sample of the Portuguese population from the National Food, Nutrition and Physical Activity Survey was used (n = 5811; 3-84 years). Occurrence data of acrylamide in food were obtained from EFSA. The margins of exposure (MOE) were calculated for peripheral neuropathy and neoplastic effects. The association between acrylamide and socio-demographic characteristics was estimated through linear regression models. For the total population, the estimated median daily dietary exposure per body weight to acrylamide was 0.38 mu g/kg/day, ranging from 0.14 to 0.88 mu g/kg/day for the 5(th) and 95(th) percentile, respectively. Children aged between 1-2 years had the highest acrylamide exposure (median 0.75 mu g/kg/day, 95(th) percentile 1.41 mu g/kg/day). For the peripheral neuropathy and neoplastic effects, the median MOE estimated was 1140 and 451, respectively. Men compared to women had a higher acrylamide dietary exposure, as well as smokers compared to non-smokers. Elderly and less educated individuals were inversely associated with acrylamide exposure. 'Bread and rusks' (24.2%) were the main source of acrylamide, followed by 'coffee' (21.3%). The current dietary exposure to acrylamide in the Portuguese population is of concern mainly regarding neoplastic effects. Our results point to the need to reduce exposure to acrylamide, especially in men, young children, higher educated individuals and smokers.

Background/aims: There is a consistent body of evidence on the association between single nutrients and cognition, but the role of a healthful dietary pattern on cognition in children has been seldomly studied. This study aims to assess the association between dietary patterns at 4 years (y) and cognitive abilities at 10-13y and examine whether adiposity mediated these associations. Methods: This study used data from a sub-sample of the population-based birth cohort Generation XXI, with complete information on diet and cognition (n = 3575). At 4y, data on dietary intake was collected by a validated food frequency questionnaire and dietary patterns were derived by latent class analysis, namely Energy-dense food (EDF) pattern, Snacking pattern and Healthier pattern (Reference). At 10-13y, the Portuguese Version of the Wechsler Intelligence Scale for Children (R)-Third Edition was administered by trained psychologists and age-adjusted composite scores were computed: a Full-Scale Intelligence Quotient (IQ), plus a Verbal IQ, Performance IQ and Processing Speed IQ. Age- and sex-specific body mass index (BMI) z-scores, body fat percentage from bioimpedance, and waist-to-weight ratio and waist-tohip ratio were used as measures of adiposity. Regression coefficients and 95% confidence intervals (CI) were computed using linear regression models (adjusted for maternal age and education, pre-pregnancy BMI, smoking and alcohol intake during pregnancy, child's sex, birthweight, exclusive breastfeeding duration and having siblings at 4y). Mediation analysis was conducted using path analysis. Results: After adjustment, children classified in the EDF or a Snacking patterns at 4y were more likely to have lower scores on total IQ (13 = -0.116; 95%CI:-0.192,-0.039 and 13 = -0.148; 95%CI -0.252,-0.044, respectively), Verbal IQ (13 = -0.104; 95%CI -0.177, -0.031 and 13 = -0.163; 95%CI -0.262,-0.064, respectively) and Performance IQ (13 = -0.116 95%CI -0.193,-0.040 and 13 = -0.147; 95% CI -0.250,-0.042, respectively) at 10-13y, when compared to those classified in the Healthier pattern. None of the adiposity measures seemed to explain the associations between dietary patterns and IQ. Conclusion: This study supports that early unhealthy dietary patterns were associated with lower child's cognitive ability, but this effect did not seem to be mediated by adiposity. (c) 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

BACKGROUND & AIMS:Ultra-processed foods (UPF) consumption has increased greatly over the last decades but its impact on health remains unclear. This study aimed to evaluate the prospective effect of different degrees of food processing on children's cardiometabolic profile. METHODS:Children from the Portuguese population-based birth cohort Generation XXI evaluated at 7 and 10 years of age (y), with dietary information at 7 y and anthropometric measurements at 10 y, were included in the present study (n = 3034). Dietary data were collected by 3-day food diaries and all reported food items were classified according to the degree of processing using the NOVA classification system. The daily consumption of the NOVA classification groups was calculated (in grams, as a proportion of total grams and total energy intake). The cardiometabolic outcomes included were serum markers [fasting glucose, insulin, blood lipids], anthropometric measurements [body mass index (BMI) and waist circumference (WC)], body composition [fat-free mass (FFM) and fat mass (FM)] and blood pressure (BP). Age- and sex-specific sample z-scores were obtained for all outcomes. Principal Component Analysis was used to identify a potential cluster of cardiovascular risk factors. Generalized linear models were fitted to evaluate the association between the consumption according to the processing degree (as absolute gram intake) and the individual cardiometabolic risk factors and cluster, adjusted for child's sex, maternal age and education and remaining NOVA groups. A mediation role of children's BMI in the previous analysis were tested. RESULTS:At 7 y, the daily median consumption of un/minimally processed, processed and UPF was 1210 g, 113 g and 433 g (68%, 6% and 25% of the total grams, as well as 51%, 15% and 31% of the total energy intake, respectively). After adjustment, an increase of 100 g in the consumption of un/minimally processed at 7 y was associated with a lower BMI (βˆ = -0.028; 95%CI: -0.043; -0.014), WC (βˆ = -0.020; 95%CI: -0.032; -0.008), FM (βˆ = -0.023; 95%CI: -0.035; -0.011), insulin (βˆ = -0.022; 95%CI: -0.036; -0.008) and BP (systolic BP: βˆ = -0.014; 95%CI: -0.025;-0.004; diastolic BP: βˆ = -0.013; 95%CI: -0.020;-0.005), at 10 y. BMI was a mediator between the consumption of un/minimally processed foods and BP. Positive associations were found between consumption of processed foods and the cluster 'higher blood pressure', while an inverse association was described between un/minimally processed and the cluster 'higher blood pressure'. No significant associations were found between the UPF consumption and any cardiometabolic outcomes. CONCLUSIONS:High consumption of unprocessed or minimally processed foods has a favourable effect on later children's cardiometabolic health, namely lower body weight and body fat, lower waist circumference, blood pressure insulin serum levels.

Summary Background/Objectives Few studies have assessed the independent and longitudinal effects of each macronutrient intake on adiposity throughout childhood. We aimed to prospectively assess the independent associations between each macronutrient intake at 4, 7, and 10 years (protein, carbohydrates, fat, and fibre) and each measure of adiposity from 7 to 10 years of age by sex. Methods Data from the population‐based birth cohort Generation XXI was used ( n = 3999). At 4, 7, and 10 years old, dietary, anthropometric and sociodemographic data were collected. The dietary intake of the children was evaluated by a validated food frequency questionnaire. Age‐ and sex‐specific body mass index z‐scores (zBMI), percentage of body fat (%FM) from bio‐impedance, and waist‐to‐hip ratio (Whr) were used as measures of adiposity. Path analysis tested the independent associations between each macronutrient intake (protein, carbohydrates, fat, and fibre) and each measure of adiposity from 7 to 10 years of age. Results In fully adjusted models, an increase in energy from fibre intake at the age of 7 was associated with lower zBMI at the same age (β = −0.073; 95%CI [−0.127,‐0.019]) and at 10 years (β = −0.083; 95%CI [−0.137,‐0.029]). Similar results were found for %FM and Whr, and in each sex separately. At the age of 10, an increase in energy from fibre intake was associated with lower %FM and Whr, while an increase in energy from protein was associated with an increase in Whr (β = 0.061; 95%CI [0.014, 0.107]). Conclusions Our study supports the protective effect of fibre intake on adiposity development during childhood in both sexes.