Browsing by Author "Verstraeten, Roosmarijn"

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Dietary intake practices associated with cardiovascular risk in urban and rural Ecuadorian adolescents: a cross-sectional study
(2014) Ochoa Avilés, Angélica María; Verstraeten, Roosmarijn; Lachat, Carl; Andrade, Susana; Van Camp, John; Donoso, Silvana; Kolsteren, Patrick
Background Cardiovascular diseases (CVD) are amongst the leading causes of death worldwide. Risk factors of CVD develop during childhood and adolescence, and dietary quality has been linked to the development of CVD itself. This study examines the association between dietary patterns and cardiovascular risk in a group of urban and rural Ecuadorian adolescents from different socioeconomic backgrounds. Methods A cross-sectional study was conducted from January 2008 to April 2009 among 606 adolescents from the 8th, 9th and 10th grade in an urban area (Cuenca), and 173 adolescents from a rural area (Nabón) in Ecuador. Data collection involved measuring anthropometric data (weight, height and waist circumference), blood pressure, dietary intake (2-day 24 h recall) and socio-demographic characteristics. Fasting blood lipids and glucose were measured in a subsample of 334 adolescents. Factor analysis was used to identify dietary patterns and linear regression models were used to (i) identify differences in food intake practices according to socioeconomic status and place of residence and (ii) establish relationships between dietary patterns and cardiovascular risk factors. Results Median energy intake was 1851 kcal/day. Overall, fiber, fish and fruit and vegetables were scarcely consumed, while added sugar, refined cereals and processed food were important constituents of the diet. Two dietary patterns emerged, one labelled as “rice-rich non-animal fat pattern” and the other one as “wheat-dense animal-fat pattern”. The first pattern was correlated with a moderate increase in glucose in urban participants, while the second pattern was associated with higher LDL and cholesterol blood levels in rural participants. Conclusions This group of adolescents presented various dietary practices conducive to CVD development. Effective strategies are needed to prevent CVD in the Ecuadorian population by encouraging a balanced diet, which contains less refined cereals, added sugar, and processed food, but has more fruits, vegetables and whole grain cereals.
Dietary intake practices associated with cardiovascular risk in urban and rural Ecuadorian adolescents: A cross-sectional study
(2014) Ochoa Avilés, Angélica María; Verstraeten, Roosmarijn; Lachat, Carl; Andrade Tenesaca, Dolores Susana; Van Camp, John; Donoso Moscoso, Silvana Patricia; Kolsteren, Patrick
Background: Cardiovascular diseases (CVD) are amongst the leading causes of death worldwide. Risk factors of CVD develop during childhood and adolescence, and dietary quality has been linked to the development of CVD itself. This study examines the association between dietary patterns and cardiovascular risk in a group of urban and rural Ecuadorian adolescents from different socioeconomic backgrounds. Methods. A cross-sectional study was conducted from January 2008 to April 2009 among 606 adolescents from the 8th, 9th and 10th grade in an urban area (Cuenca), and 173 adolescents from a rural area (Nabón) in Ecuador. Data collection involved measuring anthropometric data (weight, height and waist circumference), blood pressure, dietary intake (2-day 24 h recall) and socio-demographic characteristics. Fasting blood lipids and glucose were measured in a subsample of 334 adolescents. Factor analysis was used to identify dietary patterns and linear regression models were used to (i) identify differences in food intake practices according to socioeconomic status and place of residence and (ii) establish relationships between dietary patterns and cardiovascular risk factors. Results: Median energy intake was 1851 kcal/day. Overall, fiber, fish and fruit and vegetables were scarcely consumed, while added sugar, refined cereals and processed food were important constituents of the diet. Two dietary patterns emerged, one labelled as rice-rich non-animal fat pattern and the other one as wheat-dense animal-fat pattern. The first pattern was correlated with a moderate increase in glucose in urban participants, while the second pattern was associated with higher LDL and cholesterol blood levels in rural participants. Conclusions: This group of adolescents presented various dietary practices conducive to CVD development. Effective strategies are needed to prevent CVD in the Ecuadorian population by encouraging a balanced diet, which contains less refined cereals, added sugar, and processed food, but has more fruits, vegetables and whole grain cereals.
Factors affecting physical activity in ecuadorian adolescents: a focus group study
(2015-03) Van Royen, Kathleen; Verstraeten, Roosmarijn; Andrade, Susana; Ochoa Avilés, Angélica María; Donoso, Silvana; Maes, Lea; Kolsteren, Patrick
Factors affecting physical activity in ecuadorian adolescents: a focus group study
(2015) Van Royen, Kathleen; Verstraeten, Roosmarijn; Andrade Tenesaca, Dolores Susana; Ochoa Avilés, Angélica María; Donoso Moscoso, Silvana Patricia; Maes, Lea; Kolsteren, Patrick
Background: Physical inactivity levels are increasingly prevalent among Ecuadorian adolescents. School-based interventions can be potentially effective in promoting physical activity but must be informed by cultural-specific factors. Methods: Twelve focus groups were carried out with adolescents (n = 80) in rural and urban Ecuador to identify factors influencing physical activity. In addition, 4 focus group discussions with parents (n = 32) and 4 with school staff (n = 32) were conducted. Individual and environmental factors were questioned using the ‘Attitude, Social influences and Self-efficacy’ model and the socioecological model as theoretical frameworks. Results: Factors influencing physical activity varied between groups. In the rural area farming and norms for girls impeded leisure-time physical activity, whereas urban groups emphasized traffic and crime concerns. Groups from a low socioeconomic status more frequently mentioned a fear of injuries and financial constraints. Several factors were common for all groups including preferences for sedentary activities, poor knowledge, time constraints and laziness, as well as a lack of opportunities at home and school, unsupportive parental rules and lack of role models. Conclusion: A conceptual framework including the identified factors emerged to inform the design of a cultural-sensitive school-based intervention to improve physical activity among Ecuadorian adolescents. Future interventions should be tailored to each setting.
Individual and environmental factors influencing adolescents’ dietary behavior in low- and middle-income settings
(2016) Verstraeten, Roosmarijn; Jef L., Leroy; Pieniak, Zuzanna; Ochoa Avilés, Angélica María; Holdsworth, Michelle; Verbek, Wim; Maes, Lea; Kolsteren, Patrick
Objective Given the public health importance of improving dietary behavior in chronic disease preven-tion in low- and middle-income countries it is crucial to understand the factors influencingdietary behavior in these settings. This study tested the validity of a conceptual frameworklinking individual and environmental factors to dietary behavior among Ecuadorian adoles-cents aged 10–16 years. Methods A cross-sectional survey was conducted in 784 school-going Ecuadorian adolescents inurban and rural Southern Ecuador. Participants provided data on socio-economic status,anthropometry, dietary behavior and its determining factors. The relationships between indi-vidual (perceived benefits and barriers, self-efficacy, habit strength, and a better under-standing of healthy food) and environmental factors (physical environment: accessibility tohealthy food; social environment: parental permissiveness and school support), and theirassociation with key components of dietary behavior (fruit and vegetables, sugary drinks,breakfast, and unhealthy snack intake) were assessed using structural equation modeling. Results The conceptual model performed well for each component of eating behavior, indicatingacceptable goodness-of-fit for both the measurement and structural models. Models forvegetable intake and unhealthy snacking showed significant and direct effects of individual. factors (perceived benefits). For breakfast and sugary drink consumption, there was a direct and positive association with socio-environmental factors (school support and parental permissiveness). Access to healthy food was associated indirectly with all eating behaviors (except for sugary drink intake) and this effect operated through socio-environmental (parental permissiveness and school support) and individual factors (perceived benefits). Conclusion Our study demonstrated that key components of adolescents’ dietary behaviors are influenced by a complex interplay of individual and environmental factors. The findings indicate that the influence of these factors varied by type of dietary behavior
Physical fitness among urban and rural ecuadorian adolescents and its association with blood lipids: a cross sectional study
(2014) Ochoa Avilés, Angélica María; Lachat, Carl K.; Andrade Tenesaca, Dolores Susana; Kolsteren, Patrick Wilfried; Cardon, Greet Maria; Rojas Reyes, Rosendo Ivan; Donoso Moscoso, Silvana Patricia; Van Camp, John Hendrik; Verstraeten, Roosmarijn
Background: Physical fitness has been proposed as a marker for health during adolescence. Currently, little is known about physical fitness and its association with blood lipid profile in adolescents from low and middle-income countries. The aim of this study is therefore to assess physical fitness among urban and rural adolescents and its associations with blood lipid profile in a middle-income country. Methods: A cross-sectional study was conducted between January 2008 and April 2009 in 648 Ecuadorian adolescents (52.3% boys), aged 11 to 15 years, attending secondary schools in Cuenca (urban n = 490) and Nabón (rural n = 158). Data collection included anthropometric measures, application of the EUROFIT battery, dietary intake (2-day 24 h recall), socio-demographic characteristics, and blood samples from a subsample (n = 301). The FITNESGRAM standards were used to evaluate fitness. The associations of fitness and residential location with blood lipid profile were assessed by linear and logistic regression after adjusting for confounding factors. Results: The majority (59%) of the adolescents exhibited low levels of aerobic capacity as defined by the FITNESSGRAM standards. Urban adolescents had significantly higher mean scores in five EUROFIT tests (20 m shuttle, speed shuttle run, plate tapping, sit-up and vertical jump) and significantly most favorable improved plasma lipid profile (triglycerides and HDL) as compared to rural adolescents. There was a weak association between blood lipid profile and physical fitness in both urban and rural adolescents, even after adjustment for confounding factors. Conclusions: Physical fitness, in our sample of Ecuadorian adolescents, was generally poor. Urban adolescents had better physical fitness and blood lipid profiles than rural adolescents. The differences in fitness did not explain those in blood lipid profile between urban and rural adolescents.
Predictors of validity and reliability of a physical activity record in adolescents
(2013) Verstraeten, Roosmarijn; Lachat, Carl; Ochoa Avilés, Angélica María; Hagstromer, Maria; Huybregts, Lieven Fernand; Andrade Tenesaca, Dolores Susana; Donoso Moscoso, Silvana Patricia; Van Camp, John; Maes, Lea; Kolsteren, Patrick
Background: Poor to moderate validity of self-reported physical activity instruments is commonly observed in young people in low- and middle-income countries. However, the reasons for such low validity have not been examined in detail. We tested the validity of a self-administered daily physical activity record in adolescents and assessed if personal characteristics or the convenience level of reporting physical activity modified the validity estimates. Methods: The study comprised a total of 302 adolescents from an urban and rural area in Ecuador. Validity was evaluated by comparing the record with accelerometer recordings for seven consecutive days. Test-retest reliability was examined by comparing registrations from two records administered three weeks apart. Time spent on sedentary (SED), low (LPA), moderate (MPA) and vigorous (VPA) intensity physical activity was estimated. Bland Altman plots were used to evaluate measurement agreement. We assessed if age, sex, urban or rural setting, anthropometry and convenience of completing the record explained differences in validity estimates using a linear mixed model. Results: Although the record provided higher estimates for SED and VPA and lower estimates for LPA and MPA compared to the accelerometer, it showed an overall fair measurement agreement for validity. There was modest reliability for assessing physical activity in each intensity level. Validity was associated with adolescents’ personal characteristics: sex (SED: P = 0.007; LPA: P = 0.001; VPA: P = 0.009) and setting (LPA: P = 0.000; MPA: P = 0.047). Reliability was associated with the convenience of completing the physical activity record for LPA (low convenience: P = 0.014; high convenience: P = 0.045). Conclusions: The physical activity record provided acceptable estimates for reliability and validity on a group level. Sex and setting were associated with validity estimates, whereas convenience to fill out the record was associated with better reliability estimates for LPA. This tendency of improved reliability estimates for adolescents reporting higher convenience merits further consideration.
Prevalence and socioeconomic differences of risk factors of cardiovascular disease in Ecuadorian adolescents
(2012) Ochoa Avilés, Angélica María; Andrade Tenesaca, Dolores Susana; Donoso Moscoso, Silvana Patricia; Huynh, Thi Thanh Tuyen; Verstraeten, Roosmarijn; Lachat, Carl; Rojas Alvarado, Rosendo Andres; Manuel Keenoy, Begoña; Kolsteren, Patrick
Purpose: The aim of this paper is to report the prevalence of cardiovascular risk factors and socioeconomic differences in school-going Ecuadorian adolescents. Methods: A cross-sectional study was performed from January 2008 until April 2009 in 770 adolescents aged 10 to 16 years old, who attend secondary schools in an urban (Cuenca), and rural area (Nabón) in Ecuador. Data collected for the overall sample included anthropometric variables (weight, height and waist circumference), blood pressure and socio-demographic characteristics. Fasting blood glucose and lipid profile determinations were collected in a subsample of 334 adolescents. Results: The most prevalent cardiovascular risk factors were dyslipidemia (34.2%), abdominal obesity (19.7%) and overweight (18.0%). The prevalence of the remaining cardiovascular risk factors were high levels of blood pressure (6.2%) and obesity (2.1%). Boys were 3.3 times (P < 0.001) more likely to have risk levels of blood pressure. Compared to their peers from lower socioeconomic groups, children from better off socioeconomic strata were 1.5 times (P = 0.048) more likely to be overweight/obese and 1.5 times (P = 0.046) more likely to have abdominal obesity. Overweight and obese children were 4.4 times more likely to have dyslipidemia (P < 0.001). Children living in the rural area were 2.8 times (P = 0.002) more likely to have dyslipidemia than those from the urban area. Conclusions: Our results demonstrate the advanced levels of the nutrition transition in this Ecuadorian adolescent population. Primary health care should monitor and take actions to address this public health problem in adolescents.
School-based intervention on healthy behaviour among ecuadorian adolescents: effect of a cluster-randomized controlled trial on screen-time health behavior, health promotion and society
(2015) Andrade Tenesaca, Dolores Susana; Verloigne, Maité; Cardon, Greet; Kolsteren, Patrick; Ochoa Avilés, Angélica María; Verstraeten, Roosmarijn; Donoso Moscoso, Silvana Patricia; Lachat, Carl
Background: Effective interventions on screen-time behaviours (television, video games and computer time) are needed to prevent non-communicable diseases in low- and middle-income countries. The present manuscript investigates the effect of a school-based health promotion intervention on screen-time behaviour among 12- to 15-year-old adolescents. We report the effect of the trial on screen-time after two stages of implementation. Methods: We performed a cluster-randomised pair matched trial in urban schools in Cuenca-Ecuador. Participants were adolescents of grade eight and nine (mean age 12.8 ± 0.8 years, n = 1370, control group n = 684) from 20 schools (control group n = 10). The intervention included an individual and environmental component tailored to the local context and resources. The first intervention stage focused on diet, physical activity and screen-time behaviour, while the second stage focused only on diet and physical activity. Screen-time behaviours, primary outcome, were assessed at baseline, after the first (18 months) and second stage (28 months). Mixed linear models were used to analyse the data. Results: After the first stage (data from n = 1224 adolescents; control group n = 608), the intervention group had a lower increase in TV-time on a week day (β = −15.7 min; P = 0.003) and weekend day (β = −18.9 min; P = 0.005), in total screen-time on a weekday (β = −25.9 min; P = 0.03) and in the proportion of adolescents that did not meet the screen-time recommendation (β = −4 percentage point; P = 0.01), compared to the control group. After the second stage (data from n = 1078 adolescents; control group n = 531), the TV-time on a weekday (β = 13.1 min; P = 0.02), and total screen-time on a weekday (β = 21.4 min; P = 0.03) increased more in adolescents from the intervention group. No adverse effects were reported. Discussion and Conclusion: A multicomponent school-based intervention was only able to mitigate the increase in adolescents’ television time and total screen-time after the first stage of the intervention or in other words, when the intervention included specific components or activities that focused on reducing screen-time. After the second stage of the intervention, which only included components and activities related to improve healthy diet and physical activity and not to decrease the screen-time, the adolescents increased their screen-time again. Our findings might imply that reducing screen-time is only possible when the intervention focuses specifically on reducing screen-time.
Tackling overweight and obesity in Ecuador: policies and strategies for prevention
(2017) Ochoa Avilés, Angélica María; Verstraeten, Roosmarijn; Rivas Mariño, Gabriela