Clarice Martins

University of Porto, Oporto, Porto, Portugal

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Publications (30)54.67 Total impact

  • Appetite 06/2015; 89:323. DOI:10.1016/j.appet.2014.12.074 · 2.69 Impact Factor
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    Appetite 06/2015; 89:311. DOI:10.1016/j.appet.2014.12.036 · 2.69 Impact Factor
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    ABSTRACT: PURPOSE: Evidence has shown that cardiorespiratory fitness (CRF) and physical activity (PA) are associated with metabolic risk (MR) since young ages. The purpose of the present study was to analyze whether the association between CRF and MR was independent of sedentary behavior (SB) and moderate to vigorous PA (MVPA). METHODS: Participants were 413 Portuguese students (226 girls and 187 boys) aged 10-18 years old. Metabolic risk was defined from a clustering score including age-and-sex adjusted z-scores for waist circumference, HDL-Cholesterol, triglycerides, fasting glucose and mean arterial pressure. CRF was defined from the maximal oxygen uptake estimated from the 20m Shuttle Run Test. PA was objectively measured with accelerometers, during 7 consecutive days. Total PA was expressed as the average counts per minute. To determine the time spent in different PA intensities, the following counts intervals were considered: 0-99 for sedentary PA (SEDPA), 100-2295 for light PA (LIGPA), 2296-4011 for moderate PA and ≥4012 for vigorous PA. Tertiles were calculated for MR, CRF, SEDPA and MVPA. The first tertile of MR was set as the group at high metabolic risk (HMR), while the two remaining tertiles were defined as low metabolic risk. The first tertile of CRF and MVPA was defined as “low fit” and “less active”, while the remaining two groups were set as “fit” and “active”, respectively, for each variable. Logistic regression was carried out with HMR as the outcome and CRF, SEDPA and MVPA levels as the independent variables, with adjustments for age and sex. Significance level was set at 5%. RESULTS: In the logistic regression model, no associations were found between MR and SEDPA (OR=1.060; 95%CI=0.668-1.682; P=0.804) or MVPA (OR=1.305; 95%CI=0.820-2.077; P=0.261). On the other hand, those who were low fit had an increased risk for being at HMR (OR=4.543; 95%CI=2.904-7.106; P<0.001), independently of age, sex, SEDPA and MVPA levels. CONCLUSIONS: In terms of public health, it seems critical that interventions with young populations should be focused in the enhancement of cardiorespiratory fitness, beyond calls for changes in physical activity and sedentary behaviors, to reduce metabolic risk.
    62nd ACSM's Annual Meeting, San Diego; 05/2015
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    ABSTRACT: Objectives: This study examined the utility of the Ruiz et al. cut-points when examining body mass index (BMI) and resting blood pressure in young people. Methods: Two hundred fifty-six children (154 girls and 102 boys) aged 7–16 years underwent assessment of BMI, physical maturation, resting systolic blood pressure (SBP) and diastolic blood pressure (DBP) and cardiorespiratory fit- ness using breath by breath gas analysis during treadmill testing to exhaustion. Results: Results from a series of 2 (fit vs. unfit) 3 2 (gender) ways analysis of covariance, controlling for maturation indicated higher SBP in the unfit group compared to the fit group (P 5 0.001), higher DBP in the unfit group compared to the fit group (P 5 0.04) and higher BMI (in unfit) than fit children (P 5 0.0001). Males had significantly higher BMI than females (P 5 0.04). Maturation as a covariate was significantly and positively associated with SBP (P 5 0.003), DBP (P 5 0.004), and BMI (P 5 0.001). Conclusions: This study suggests that the Ruiz et al. cut-points are valid in distinguishing between children with higher and lower BMI and resting BP values.
    American Journal of Human Biology 04/2015; 27(2):226–227. DOI:10.1002/jhb.22624 · 1.93 Impact Factor
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    ABSTRACT: This study aimed at examining the associations between weight status, body fat mass, and heart rate variability in prepubescent children, adjusting for physical activity levels. A cross-sectional investigation in which a total of 50 Caucasian pre-pubertal children (21 normal weight; 8 overweight; 21 obese), aged 6-10 years (8.33 ± 1.14), including both boys (n = 24) and girls (n = 26), were recruited from local schools. Total body fat and trunk fat were evaluated through dual-energy X-ray absorptiometry. Free-living physical activity levels were evaluated by accelerometer. Short-term heart rate variability acquisition was performed; time- and frequency-domain parameters were analysed. Logarithmic transformations of the low-frequency (LnLFnu), high-frequency (LnHFnu) normalized units and low-frequency/high-frequency (LnLFnu/HFnu) ratio were computed. Adjusting for age, Tanner stage, and moderate to vigorous physical activity levels, obese children compared to normal weight children showed a significant decreased LnHfnu (3.8 ± 0.2 vs 4.1 ± 0.2 %) and both higher LnLFnu (4.0 ± 0.4 vs 3.7 ± 0.3 %) and LnLFnu/LnHFnu ratio (1.1 ± 0.1 vs 0.9 ± 0.1). LnHFnu showed significant negative correlation with waist circumference (r = -0.598; P = 0.000), total body fat (r = -0.409; P = 0.011) and trunk fat (r = -0.472; P = 0.003). Both LnLFnu and LnLFnu/LnHFnu ratio showed positive correlations with waist circumference (r = 0.455; r = 0.513) and trunk fat (r = 0.370; r = 0.415). A higher amount of body fat mass, particularly central fat, was shown to be related to decreased parasympathetic modulation in time-domain heart rate variability. This finding highlights the potential cardiovascular risk that excessive fat mass may represent even at very young age.
    Clinical Autonomic Research 03/2015; DOI:10.1007/s10286-015-0277-y · 1.86 Impact Factor
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    ABSTRACT: Objectives: This study examined the utility of the Ruiz et al. cut-points when examining body mass index (BMI)" "and resting blood pressure in young people. Methods: Two hundred fifty-six children (154 girls and 102 boys) aged 7–16 years underwent assessment of BMI, physical maturation, resting systolic blood pressure (SBP) and diastolic blood pressure (DBP) and cardiorespiratory fit- ness using breath by breath gas analysis during treadmill testing to exhaustion. Results: Results from a series of 2 (fit vs. unfit) x 2 (gender) ways analysis of covariance, controlling for maturation indicated higher SBP in the unfit group compared to the fit group (P = 0.001), higher DBP in the unfit group compared to the fit group (P = 0.04) and higher BMI (in unfit) than fit children (P = 0.0001). Males had significantly higher BMI than females (P = 0.04). Maturation as a covariate was significantly and positively associated with SBP (P = 0.003), DBP (P = 0.004), and BMI (P = 0.001). Conclusions: This study suggests that the Ruiz et al. cut-points are valid in distinguishing between children with higher and lower BMI and resting BP values.
    American Journal of Human Biology 03/2015; 27(2):226–227. DOI:10.1002/ajhb.22624 · 1.93 Impact Factor
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    ABSTRACT: Nonalcoholic fatty liver disease (NAFLD) is one of the most frequent complications associated with excess adiposity and has been identified as the leading cause of liver disease in pediatric populations worldwide. Because cardiorespiratory fitness (CRF) is related to physical activity (PA) levels, and increased PA plays a protective role against NAFLD risk factors, the aim of this study was to analyze the association between PA and a fatty liver marker (alanine aminotransferase - ALT) in obese children and adolescents, independently of central adiposity or CRF. 131 obese children (83 girls, 7-15 year-olds) involved in a PA promotion program comprised the sample. Measurements included anthropometric and body composition evaluations (DEXA), biological measurements (venipuncture), CRF (progressive treadmill test), PA (accelerometry), and maturational stage (Tanner criteria). The associations between ALT with PA intensities, central obesity, and CRF were calculated by three different models of linear regression, adjusted for potential confounders. Level of significance was set at 95%. ALT was negatively associated with MVPA (β = -0.305), and CRF (β = -0.426), and positively associated with central obesity (β=.468). After adjustment for central obesity the negative and statistically significant association between ALT with MVPA (β = -0.364) and CRF (β = -0.550) still persists while a positive and significantly correlation was shown between ALT and SB (β = 0.382). Additional adjustment for CRF (Model 3) showed significant associations for all the PA intensities analyzed including light activity. PA at different intensities is associated to a fatty liver marker in obese children and adolescents, independently of central adiposity or CRF. Key pointsIn a previous study our group observed that there might be a potential protective effect of cardiorespiratory fitness (CRF) against abnormal ALT values;Considering that CRF is related to physical activity (PA), and increased PA plays a protective role against fatty liver, we hypothesized that it might be an association between PA and fatty liver in obese youth, independently of central adiposity or CRF;No other study has investigated these associations in obese youth;Our findings stresses the fact that moderate-to-vigorous and light physical activities, as well as lower sedentary behavior, is associated with lower fatty liver marker, independent of the effect of potential mediators, such as central obesity or CRF.
    Appetite 03/2015; 14(1):103-9. DOI:10.1016/j.appet.2014.12.037 · 2.69 Impact Factor
  • G. Silva, S. Lima, S. Yamada, C. Martins
    Journal of Sexual Medicine 01/2015; 12:30-31. · 3.15 Impact Factor
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    ABSTRACT: This study compared body mass index (BMI) and inverted BMI (iBMI) as predictors of body fatness in 177 Portuguese children (149 girls and 96 boys) aged 7-16 years. Participants undertook measures of height and body mass from which BMI (kg/m(2)) and iBMI (cm(2)/kg) were determined. Maturation was determined via self-report and fat mass index (FMI, kg/m(2)) via dual-energy X-ray absorptiometry. Significant relationships were evident between BMI and iBMI and FMI (both P=0.0001). BMI was not normally distributed (P=0.0001) but iBMI was (P>0.05). Analysis of covariance identified that BMI and iBMI, controlling for maturation, were both significant predictors of FMI (both P=0.0001) but that iBMI predicted a slightly greater amount of the variance (adjusted R(2)=0.970) compared with BMI (adjusted R(2)=0.968). This study suggests that iBMI is a similar proxy for body fatness compared with BMI in children.European Journal of Clinical Nutrition advance online publication, 8 January 2014; doi:10.1038/ejcn.2013.285.
    European journal of clinical nutrition 01/2014; 68(5). DOI:10.1038/ejcn.2013.285 · 2.95 Impact Factor
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    ABSTRACT: This study sought to analyze the associations between cardiorespiratory fitness (CRF), waist circumference (WC) and metabolic risk in children and adolescents. Participants were 633 subjects (58.7% girls) ages 10-18 years. Metabolic risk score (MRS) was calculated from HDL-cholesterol, triglycerides, fasting glucose and mean arterial pressure. MRS was dichotomized into low and high metabolic risk (HMRS). CRF was defined as the maximal oxygen uptake (VO2max) estimated from the 20 m Shuttle Run Test. The first quartile of CRF was set as the low fitness group. The fourth quartile of WC was defined as high central adiposity. With adjustments for age, sex and WC, CRF was correlated with MRS (r=-0.095; p<0.05). WC was correlated with MRS (r=0.150; p<0.001) after adjustments for age, sex and CRF. Participants who had low fitness levels, presented higher levels of MRS (p<0.001) compared to those who were fit, even after adjustment for age, sex and WC. In comparison with subjects who were fit with normal central adiposity, an increased odds ratio (OR) for being at HMRS was found for participants who were of low fitness level with high central adiposity (OR=2.934; 95%CI= 1.690-5.092) and for those who were of low fitness with normal central adiposity (OR=2.234; 95%CI=1.116-4.279). Results suggest that CRF relates to MRS independently of central adiposity.
    International Journal of Sports Medicine 04/2013; 34(10):912-916. DOI:10.1055/s-0033-1334967 · 2.37 Impact Factor
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    ABSTRACT: Nonalcoholic fatty liver disease (NAFLD) is one of the most frequent complications associated with excess adiposity. Its pathogenesis is complex and there are multiple factors that may contribute to it. To analyze whether cardiorespiratory fitness (CRF), waist circumference (WC), and C-reactive protein (CRP) are associated with alanine aminotransferase (ALT) in children with obesity. 79 overweight/obese children of both genders, 11-13 year-olds, with abnormal serum ALT from Porto public schools comprised the sample. Measurements included CRF (20-m Shuttle Run Test), WC (NHANES protocol), CRP and ALT (Cholestech LDX analyzer). Logistic regression adjusted for gender, maturation, and weight with ALT levels as dependent variable (risk vs. non risk), and WC (risk vs. non risk), CRP (risk vs. non risk), and CRF (fit vs. unfit) as independent variables. Level of significance was set at 95%. Logistic regression showed that obese fit children were less likely to have abnormal ALT values (OR=.031) In obese children, higher cardiovascular fitness appears to reduce the chance of decreased liver function.
    Pediatric exercise science 02/2013; 25(1):3-11. · 1.61 Impact Factor
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    ABSTRACT: Background: The purpose of this study was to examine whether adolescents who have high levels of cardiorespiratory fitness (CRF) co-existing with low levels of television (TV) viewing present a better metabolic risk profile compared to their low fit and high TV viewing counterparts. Subjects and methods: A total of 372 students (aged 12-15 years old) comprised the sample of this study. Anthropometric data (body mass index and waist circumference) was collected. CRF was calculated based upon the 20 metres shuttle run test. A questionnaire was used to estimate weekly TV viewing. Information about biological maturity and parental education was collected. Participants were then categorized into one of four category profiles according to the scores they achieved: low TV-Fit; high TV-Fit; low TV-Unfit and high TV-Unfit. Metabolic risk score (MRS) was calculated based on the sum of the Z-scores of all the metabolic variables analysed. Results: Logistic regression analyses indicated that the high TV-Unfit group was almost 3-times more likely to be assigned to the high MRS group (OR = 2.85, 95% CI = 1.08-7.50) compared to their low TV-Fit group counterparts. Conclusions: The data showed that the high TV-Unfit group was associated with an increased metabolic risk in adolescents after adjustment for gender, age, biological maturity and parental education.
    Annals of Human Biology 01/2013; DOI:10.3109/03014460.2012.752524 · 1.15 Impact Factor
  • Journal of Science and Medicine in Sport 12/2012; 15:S74-S75. DOI:10.1016/j.jsams.2012.11.179 · 3.08 Impact Factor
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    ABSTRACT: Background: Metabolic Syndrome (MS) is highly prevalent among obese children with fatty liver. However, it is well-known that there is a lower prevalence of MS in individuals with higher cardiorespiratory fitness (CRF). Aim: To analyse the association between CRF with features of the MS in obese children that present fat liver indicators, namely abnormal alanine aminotransferase (ALT) values. Methods: A total of 79 obese students (40 girls), 10-11 year-olds ( ± 0.60), with abnormal serum ALT from Porto public schools comprised the sample. Measurements included CRF (20-metre Shuttle Run Test), Metabolic Risk Factors (MRF), according to MS International Diabetes Federation criteria, ALT values (Cholestech LDX(®) analyser) and maturational stage (Tanner criteria). Logistic regression analysis was used to determine the influence of CRF on MRF adjusted for sex, maturation, and BMI. Results: The logistic regression showed that, despite being classified as being obese and presenting abnormal levels of ALT, those classified as fit were less likely to have MS than their unfit counterparts (OR = 0.52; p ≤ 0.05). Conclusion: Obese-fit children with abnormal ALT values have a significant reduction in the likelihood to be classified as having MS, even after adjustments for gender, maturation and BMI, Thus, CRF might be an important factor for tackling fatty liver among obese.
    Annals of Human Biology 10/2012; 40(1). DOI:10.3109/03014460.2012.727470 · 1.15 Impact Factor
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    ABSTRACT: Introduction: Obesity is characterized by changes in the activity of the autonomic nervous system (ANS), more specifically altered balance between the parasympathetic nervous system and sympathetic nervous system. Power spectral analysis of heart rate variability (HRV) allows for the characterization of sympathovagal balance. Salivary alpha-amilase (sAA) is an emerging biomarker for stress and there is evidence that might reflect changes in the ANS (Nater & Rohleder, 2009). The aim of the present study was to analyse the relationship between obesity, HRV and sAA in school children. Methods: A total of 30 school children (11 normal weight and 19 obese), 6-10 year-olds (8.33 ± 1.14), of both genders (13 Males; 17 Females) were analyzed. Measurements included anthropometric variables (weight, height, waist circumference as well as BMI). Children were then categorized in obese/non-obese BMI groups (CDC Growth Charts). Maturation status was determined by Tanner s criteria. Autonomic function was evaluated by HRV short term evaluation (Task Force, 1996) and salivary alpha-amylase analysis (Salimetrics, UK). Descriptive statistics and partial correlations with gender, age and maturational stage adjustments were used to examine the relationship between the analysed variables. Results: The HRV analysis showed that obese children presented significantly higher low frequency/high frequency ratio (LF/HF) than their normal weight counterparts. Additionally, positive correlations between obesity indicators (BMI and waist circumference) and LF/HF (p=.000) were observed. No significant correlations were observed between sAA and obesity indicators. Conclusion: Our data support the evidence that obesity status is positively correlated with LF/HF in children, which can be an indicator of autonomic dysfunction. No other significant correlations were observed. Although we were not able to demonstrate an association between the sAA and obesity, more studies are needed to clarify this biomarker potential. References: Nater UM, Rohleder N (2009). Salivary alpha-amylase as a non-invasive biomarker for the sympathetic nervous system: current state of research. Psychoneuroendocrinology.34(4):486-96, May. Task Force of the European Society of Cardiolo-gy and the North American Society of Pacing and Electrophysiology (1996). Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation. 93(5):1043-65, Mar.
    17th Annual Congress of the European College of Sports Science, Brugge (Belgium); 07/2012
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    European Congress on Obesity (ECO 2012), Lyon (France); 05/2012
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    ABSTRACT: The main goal of this study was to analyze the associations between cardiorespiratory fitness (CRF) and body mass index (BMI) with self-rated health (SRH) of adolescent girls. This was a cross-sectional study of 533 adolescents girls, aged from 10 to 18 years old. CRF was predicted by maximal multistage 20-m shuttle-run test according to procedures described from FITNESSGRAM. Girls' obesity status was classified according to International Obesity Task Force and Self-rated health (SRH) was assessed by questionnaire. The findings showed that among adolescent girls 23.2% had negative SRH. Girls who were classified as unfit were more likely to report negative SRH in both univariate logistic (OR: 3.05; CI: 1.91-4.87; P < .05) and multivariate (OR: 2.93; CI: 1.82-4.72; P < .05) regression analyses compared with their fit peers. Obese girls were more likely to report negative SRH (OR: 2.30; CI: 1.14-4.62; P < .05) compared with their normal-weight counterparts. However such association was lost in multivariate analyses suggesting an effect of CRF. Negative perception of health was associated with lower CRF and weight status although such association it is mediated by CRF condition.
    Journal of Physical Activity and Health 03/2012; 9(3):378-81. · 1.95 Impact Factor
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    ABSTRACT: The aim of this study was to analyze longitudinal associations between cardiorespiratory fitness, physical activity and body mass index in a 4-year longitudinal study. 170 students (97 girls and 73 boys) aged at baseline from 11 to 17 years were followed. Students performed 20-m-SR; physical activity patterns and parents' education were evaluated using a standard questionnaire. Body mass index was categorized according to established cut points. In a multilevel analysis using MLwIN, 2 level structures were defined: first for individuals and second for time observations. In a longitudinal 2 level analysis, cardiorespiratory fitness was -negatively associated with body mass index for girls and boys, respectively (p<0.05; R2=0.63; 0.62), especially with obesity category (p<0.01; R2=0.58; 0.60). In girls, independent associations were observed between CRF and PA categories regarding participation "almost every day" in organized (p<0.05; R2=0.50) and non-organized sports outside school (p<0.05; R2=0.52) and participation in sports competitions (p<0.05; R2=0.51). In boys, associations were found only with participation in sports competitions (p<0.05; R2=0.50). The results highlight the importance of youth participation in organized activities and competitive sports over time to achieve health-related fitness benefits.
    International Journal of Sports Medicine 02/2012; 33(4):325-9. DOI:10.1055/s-0031-1297955 · 2.37 Impact Factor
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    ABSTRACT: A better understanding of the different domains and characteristics of children's and adolescent's physical activity (PA) could be a strategy to clarify the association of this behaviour with the early development of cardiovascular risk factors. To examine the relationship between leisure time physical activity (LTPA) and sports competition activities (SCA) with high blood pressure (HBP) levels in a sample of children and adolescents from Porto, Portugal. This is a cross-sectional study, which comprised 503 boys and 572 girls, aged 8-17 years old. LTPA and SCA were assed by self-reported. Students were assigned as active and non-active in SCA or LTPA according to their self-reported participation. Participants were classified as HBP when they are above of the last quartile for systolic and/or diastolic BP adjusted for gender and age. Do not be engaged in LTPA (OR: 1.47; 95% CI: 1.12; 1.93) and SCA (OR: 1.36; 95% CI: 1.02; 1.81) was significantly associated with the likelihood of being HBP. However, when cardiorespiratory fitness (CRF) (OR: 1.23; 95% CI: 0.91; 1.67) and body mass index (BMI) (OR: 1.31; 95% CI: 0.98; 1.75) were included on SCA model, the association between SCA with HBP did not showed significant results. Children and adolescents who are not engaged in SCA or LTPA are more likely to be classified as having HBP; however, the relationship between SCA and HBP was dependent of CRF and BMI. Further, PA strategies should take these differences on the relationship between HBP, SCA and LTPA.
    Child Care Health and Development 05/2011; 37(3):329-34. DOI:10.1111/j.1365-2214.2010.01179.x · 1.83 Impact Factor