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Physical fitness, overweight and the risk of eating disorders in adolescents. The AVENA and AFINOS studies

Authors

  • A. M. Veses,

    Corresponding author
    1. Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science and Technology and Nutrition, Spanish National Research Council (CSIC), Madrid, Spain
    • Address for correspondence: Dr AM Veses, Immunonutrition Research Group. Department of Metabolism and Nutrition. Institute of Food Science and Technology and Nutrition. Spanish National Research Council (CSIC). C/José Antonio Novais, 10 (28040) Madrid. Spain. E-mail: amveses@ictan.csic.es

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  • D. Martínez-Gómez,

    1. Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science and Technology and Nutrition, Spanish National Research Council (CSIC), Madrid, Spain
    2. Department of Physical Education, Sport and Human Movement, Faculty of Education and Teaching Training, Autónoma University of Madrid, Madrid, Spain
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  • S. Gómez-Martínez,

    1. Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science and Technology and Nutrition, Spanish National Research Council (CSIC), Madrid, Spain
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  • G. Vicente-Rodriguez,

    1. Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Zaragoza, Spain
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  • R. Castillo,

    1. Department of Basic Psychology, School of Psychology, University of Malaga, Spain
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  • F. B. Ortega,

    1. Department of Physical Education and Sport, School and Sports Sciences, University of Granada, Granada, Spain
    2. Department of Medical Physiology, School of Medicine, University of Granada, Spain
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  • M. González-Gross,

    1. ImFINE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid, Spain
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  • M. E. Calle,

    1. Department of Preventive Medicine and Public Health and History of Science, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
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  • O. L. Veiga,

    1. Department of Physical Education, Sport and Human Movement, Faculty of Education and Teaching Training, Autónoma University of Madrid, Madrid, Spain
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  • A. Marcos,

    1. Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science and Technology and Nutrition, Spanish National Research Council (CSIC), Madrid, Spain
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  • for the AVENA,

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    • AVENA Study Group

      Coordinator: A Marcos, Madrid.

      Main Investigators: MJ Castillo, Granada. A Marcos, Madrid. S Zamora, Murcia.MGarcía Fuentes, Santander.MBueno, Zaragoza, Spain. Granada: MJ Castillo, MD Cano, R Sola (Biochemistry); A Gutiérrez, JL Mesa, J Ruiz (Physical fitness); M Delgado, P Tercedor, P Chillón (Physical activity); FB Ortega,MMartín, F Carreño, GV Rodríguez, R Castillo, F Arellano (Collaborators), Universidad de Granada, Granada. Madrid: A Marcos,MGonzález-Gross, J Wärnberg, S Medina, F Sánchez Muniz, E Nova, A Montero, B de la Rosa, S Gómez, S Samartín, J Romeo, R Álvarez, (Coordinator, immunology), A Álvarez (Cytometric analysis), L Barrios (Statistical analysis), A Leyva, B Payá (Psychological assessment). L Martínez, E Ramos, R Ortiz, A Urzanqui. (Collaborators). Institute of Nutrition and Food Sciences. Spanish National Research Council (CSIC-ÜCM), Madrid. Murcia: S Zamora,MGaraulet, F Pérez-Llamas, JC Baraza, JF Marín, F Pérez de Heredia, MA Fernández, C González, R García, C Torralba, E Donat, E Morales, MD García, JA Martínez, JJ Hernández, A Asensio, FJ Plaza, MJ López (Diet analysis), Department of Physiology, University of Murcia, Murcia. Santander: M García Fuentes, D González-Lamuño, P de Rufino, R Pérez-Prieto, D Fernández, T Amigo (Genetic study). Department of Pediatrics, University of Cantabria. Santander. Spain. Santander. Zaragoza: M Bueno, LA Moreno, A Sarriá, J Fleta, G Rodríguez, CM Gil, MI Mesana, JA Casajús, V Blay, MG Blay. (Anthropometric assessment), School of Health Sciences, University of Zaragoza, Zaragoza.

  • AFINOS Study Groups

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    • AFINOS Study Group

      Coordinator: A Marcos

      Main Investigators: Calle ME, Villagra A, Marcos A.

      Sub-study 1: ME Calle, E Regidor, D Martínez-Hernández, L. Esteban-Gonzalo, Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain. Sub-study 2: A Villagra, OL Veiga, J del-Campo, JM Moya, D Martínez-Gómez, B Zapatera, Department of Physical Education, Sport and Human Movement, Facultad de Formación del Profesorado y Educación, Autonoma University of Madrid, Madrid, Spain. Sub-study 3: A Marcos, S Gómez-Martínez, E Nova, J Wärnberg, J Romeo, LE Diaz, T Pozo, MA Puertollano, D Martínez-Gómez, B Zapatera, A Veses, Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC), Madrid, Spain.


  • The SCOFF questions*

    Do you make yourself Sick because you feel uncomfortably full?

    Do you worry you have lost Control over how much you eat?

    Have you recently lost more than One stone in a 3 month period?

    Do you believe yourself to be Fat when others say you are too thin?

    Would you say that Food dominates your life?

    *One point for every “yes”; a score of ≥2 indicates a likely case of anorexia nervosa or bulimia

Summary

What is already known about this subject

    What is already known about this subject
  • Eating disorders are among the public health issues facing adolescents.
  • An excess of body fat has been associated with an increased risk of these disorders.
  • The association of physical fitness with eating disorders has not yet been analysed in adolescents.

What this study adds

    What this study adds
  • This study confirms that the overweight and obesity increase the risk of developing eating disorders.
  • The present study shows that there is an inverse association between physical fitness levels and the risk of eating disorders.
  • This study suggests that physical fitness might attenuate the influence of overweight on the development of eating disorders in adolescents.

Background

Eating disorders together with the overweight and obesity are important health concerns in adolescents.

Objective

To analyse the individual and combined influence of overweight and physical fitness on the risk of developing eating disorders in Spanish adolescents.

Methods

The sample consisted of 3571 adolescents (1864 females), aged 13 to 18.5 years, from Spain who participated in the AVENA and AFINOS studies. The risk of eating disorders was evaluated using the SCOFF questionnaire. Body mass index was calculated and the adolescents were classified into two groups: overweight (including obesity) and non-overweight according to Cole's cut-off points. Cardiorespiratory fitness in the AVENA Study was assessed by the 20-m shuttle-run test and the overall physical fitness level was self-reported in the AFINOS Study.

Results

Overweight adolescents had a higher risk of developing eating disorders than non-overweight adolescents (odds ratio [OR] = 4.91, 95% confidence interval [CI]: 3.63–6.61 in the AVENA Study and OR = 2.45, 95% CI: 1.83–3.22 in the AFINOS Study). Also, adolescents with medium and low levels of physical fitness had a higher risk of developing eating disorders (OR = 1.51, 95% CI: 1.05–2.16, and OR = 2.25, 95% CI: 1.60–3.19, respectively, in the AVENA Study, and OR = 1.73, 95% CI: 1.37–2.17, and OR = 4.11 95% CI: 2.98–5.65, respectively, in the AFINOS Study) than adolescents with high levels of physical fitness. In both studies, the combined influence of overweight and physical fitness showed that adolescents with lower levels of physical fitness had an increased risk of developing eating disorders in both non-overweight and overweight groups.

Conclusions

Physical fitness might attenuate the influence of overweight on the development of eating disorders in adolescents.

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