Abstract
Objective: To evaluate, in pre-adolescents and adolescents, the frequency of body image dissatisfaction and distortion and to assess the association between these factors and physical activity and body mass index (BMI). Design: Cross-sectional study. Methods: 234 children (10-17 years) from a Porto high school were evaluated. Dissatisfaction with body image (FID) was assessed by Collins' child figure drawings for pre-adolescents and adolescents. FID was calculated as the discrepancy between the "ideal figure" and the "perceived figure". Body image distortion (BID) was calculated as the discrepancy between the "perceived figure" and the "real figure". The Baecke questionnaire was applied to determine the habitual physical activity index (HPAI) of each participant. Results: Girls were more dissatisfied than boys with their body image (68.1% vs 52.9%). A high proportion of students of both genders and age groups revealed BID (71.8%) with 51.3% underestimating their body image and 20.5% overestimating it. A negative association was found between the FID and BID (girls: r = -.259, p = .006: boys: r = -.414, p < .001). High levels of physical activity were associated with a protective effect on FID, OR = 0.38, 95% CI [0.16, 0.87] for 3rd vs 1st quartile of HPAI: OR = 0.29, 95% CI [0.12, 0.86], for 4th vs 1st quartile of HPAI, both adjusted for BMI and gender, but HPAI was not associated with BID. Conclusion: FID and BID are highly frequent and inversely associated. BID increases directly with BMI percentiles in both genders while physical activity has a protective effect on dissatisfaction of body image.

Abstract
The aim of this study was to evaluate the effect of a lifestyle intervention programme (nutrition and exercise counselling) on metabolic syndrome (MS) components, adipokines (leptin, adiponectin) and ghrelin levels in overweight children. A total of 61 overweight children aged 7-9 years (>= 85th body mass index (BMI) percentile; 27 boys/34 girls) were randomly assigned and completed a 1-year individual (IT) or group-based treatment (GT). Anthropometric and biochemical parameters were assessed at baseline, at 6 months and at 1 year. Twenty-two normal weight children (< 85th BMI percentile; 7-9 years old; 13 boys/nine girls) were also evaluated at baseline. Insulin resistance (IR) was determined by the homeostasis model assessment of IR (HOMA-IR). Overweight children presented significantly higher blood pressure, triglycerides, apolipoprotein B, insulin, HOMA-IR, leptin, C-reactive protein and homocysteine levels, while apolipoprotein A-I was significantly lower. At baseline, MS was present in ten overweight children, of which only five maintained it at 1 year. Leptin and ghrelin levels were associated with IR and MS components. MS was predicted by apolipoprotein A-I, insulin and pre-puberty. The lifestyle intervention led to a significant improvement in standard deviation score of BMI, waist circumference/height ratio and lipid profile. Changes in insulin, HOMA-IR, leptin and adiponectin were not significant. Ghrelin behaved differently between IT and GT. The GT intervention seems to be more successful, with a decrease in BMI Z-score and an improvement of metabolic parameters. In conclusion, overweight children have multiple risk factors associated with MS. A lifestyle intervention programme seems to be an effective mean for reducing obesity and MS components and improving adipokines concentrations.

Abstract
Excess weight may be related to the development of adverse cardiometabolic risk factors in children. The aim of this study was to evaluate the effect of a lifestyle intervention program (nutrition and exercise counseling) on anthropometric parameters and metabolic syndrome (MS) components in Portuguese overweight/obese children. A total of 83 overweight/obese children aged 7-9 years were assigned to a 1-year individual or group-based treatment (GT); 61 children (z-score BMI (zBMI): 1.93 +/- A 0.28; 27 boys and 34 girls) completed the program. Anthropometric and biochemical parameters were assessed at baseline, at 6 months and at 1 year. The overweight/obese children, compared to normal-weight ones, presented significantly higher blood pressure, total-cholesterol, total-cholesterol/high density lipoprotein cholesterol (HDL) ratio, triglycerides, Apolipoprotein B and C-reactive protein levels, while HDL and Apolipoprotein A-I were significantly lower. At baseline, the prevalence of MS was 16.4% in overweight/obese and 0% in normal-weight children. The number of components of MS was significantly higher in children with higher zBMI. Lifestyle intervention led to a significant improvement in zBMI, waist circumference/height ratio, HDL, triglycerides, Apolipoprotein A-I, and Apolipoprotein B levels. The prevalence of MS decreased to 14.8%. The GT intervention seems to be more successful, with a significant decrease in zBMI and an increase in HDL and a lower drop-out rate. Overweight/obese children have multiple risk factors associated with the MS. Lifestyle intervention, both individual and group-based treatment, led to an improvement in the degree of overweight/obesity and in MS components.

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