Abstract
The purpose of this study was to assess the effects of a six-months' nutrition program, delivered and taught by classroom teachers with in-service nutrition training, on the prevention of overweight and obesity among children in grades 1 to 4. In this randomized trial, four hundred and sixty four children from seven elementary schools were allocated to a nutrition educational program delivered by their own teachers. Intervened teachers had 12 sessions of three hours each with the researchers throughout six months, according to the topics nutrition and healthy eating, the importance of drinking water and healthy cooking activities. After each session, teachers were encouraged to develop activities in class focused on the learned topics. Sociodemographic, anthropometric, dietary, and physical activity assessments were performed at baseline and at the end of the intervention. In the intervention group the increase in Body Mass Index (BMI) z-score was significantly lower than in the control group (p = 0.009); fewer proportion of children became overweight in the intervened group compared with the control (5.6% vs. 18.4%; p = 0.037). Our study provides further support to decrease the overweight epidemic, involving classroom teachers in a training program and making them dedicated interventionists.

Abstract
Background: Growth trends have never been studied in adolescents of the Autonomous Region of Madeira, Portugal. Aims: To analyse growth trends in weight, height, body mass index (BMI), waist circumference (WC), mid-upper arm circumference (MUAC) and triceps skin-fold thickness (TST) of adolescents (10-17 years old) of the Autonomous Region of Madeira between 1996-1998 and 2007-2009. Subjects and methods: A cross-sectional study was carried out between 2007-2009, including 4314 adolescents, 2237 girls and 2077 boys (10-17 years old). To study secular growth trends, data were compared with a sample from 1996-1998, comparing the means for each anthropometric variable by age and sex using the independent-sample t-test. Results: An average increase was found in weight of 5.8 kg in boys and 6.3 kg in girls; in height of 3.0 cm in boys and 3.7 cm in girls; in BMI of 1.5 kg/m(2) in boys and 1.7 kg/m(2) in girls; in WC a difference of 5.6 cm and 4.9 cm for boys and girls, respectively, and for MUAC a difference of 2.7 cm in boys and 2.0 cm in girls. No differences were found in TST in boys, but in girls an increase of 1.2mm was observed. Conclusions: A general increase in anthropometric measurements, more marked in weight, BMI, WC and MUAC and at younger ages, was observed.

Abstract
Background: Body fat is related to changes in lipid profile, blood pressure and metabolism of insulin and glucose, known as the metabolic syndrome (MS). The aim of this study was to estimate the prevalence of metabolic syndrome (MS) and its components among overweight and obese Portuguese schoolchildren, and to identify associated clinical and biochemical characteristics. Methods: A total of 82 children (14 overweight and 68 obese; 40 boys and 42 girls) aged 7-9 years, underwent anthropometric measurements. A blood sample was obtained to assess biochemical parameters. Insulin resistance (IR) was determined by the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). MS was defined by the National Cholesterol Education Program Adult Treatment Panel III criteria modified by Cook. Results: The prevalence of MS was 15.8%. Abdominal obesity was present in all children. Frequency of elevated blood pressure, low HDL-cholesterol and elevated triglyceride concentrations were 62.6%, 13.4% and 11.0%, respectively. None of the children presented impaired fasting glucose, however hyperinsulinemia (7.3%) and IR (8.5%) were observed. The number of components of MS was higher in children with higher z-BMI (rho = 0.411; p < 0.001). MS was associated with higher leptin concentrations. No association was found with adiponectin or ghrelin levels. Leptin correlated positively with obesity, glucose metabolism, lipid profile, hepatic function and C-reactive protein, and negatively with HDL and Apolipoprotein A-I/B ratio. Conclusions: This study shows a significant prevalence of MS among obese schoolchildren. Abdominal obesity and elevated blood pressure were the most frequent components of this syndrome. Dyslipidemia, IR and high levels of leptin were also associated with MS in this young group.

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.