Clarice Martins

University of Porto, Oporto, Porto, Portugal

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Publications (21)36.49 Total impact

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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 09/2015; 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.
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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 · 3.07 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 · 2.27 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
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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 · 2.27 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 · 1.70 Impact Factor
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    ABSTRACT: The purpose of this study was to examine the association between muscular fitness (MF), assessed by 2 components of Fitnessgram test battery, the Curl-Up and Push-Ups tests and the metabolic risk score among adolescent girls. A total of 229 girls (aged 12-15 years old) comprised the sample of this study. Anthropometric data (height, body mass, waist circumference) were collected. Body mass index (BMI) was also calculated. Muscular strength was assessed taking into account the tests that comprised the FITNESSGRAM test battery, i.e. the curl-up and the push-up. Participants were then categorized in one of 3 categories according the number of tests in which they accomplished the scores that allow them to be classified in health or above health zone. The blood pressure [BP], fasting total cholesterol [TC], low density lipoprotein-cholesterol [LDL-C], high density lipoprotein-cholesterol [HDL-C], triglycerides [TG], glucose, and a metabolic risk score (MRS) were also examined. Physical Activity Index (PAI) was obtained by questionnaire. Higher compliance with health-zone criteria (good in the 2 tests), adjusted for age and maturation, were positive and significantly (p </= 0.05) associated with height (r = 0.19) and PAI (r = 0.21), while a significant but negative association was found for BMI (r = -0.12); WC (r = -0.19); TC (r = -0.16); TG (r = -0.16); LDL (r = -0.16) and MRS (r = -0.16). Logistic regression showed that who were assigned to MF fittest group were less likely (OR = 0.27; p = 0.003) to be classified overweight/obese and less likely (OR = 0.26; p = 0.03) to be classified as having MRS. This last association was also found for those whom only performed 1 test under the health zone (OR = 0.23; p = 0.02). Our data showed that low strength test performance was associated with increased risk for obesity and metabolic risk in adolescent girls even after adjustment for age and maturation.
    Diabetology and Metabolic Syndrome 06/2010; 2:42. DOI:10.1186/1758-5996-2-42 · 2.50 Impact Factor
    This article is viewable in ResearchGate's enriched format
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    ABSTRACT: In the present study, we examined different categories of cardiorespiratory fitness and obesity and their relationship with risk of cardiovascular disease (CVD) factors in youth. We hypothesized that youngsters with low cardiorespiratory fitness would be at greater risk of CVD risk factors, whether they are obese or not. This study was carried out as a part of a longitudinal research project conducted in the Porto and Braga districts, Portugal, with children and adolescents aged 10-16 years of age. A total of 392 children (173 boys, 219 girls) participated in the study. We used a chi-square test to analyse the relationship between the participants' cardiorespiratory fitness and body weight (non-overweight or overweight/obese). For the purpose of this study, a new variable with four groups was created: non-overweight +unfit (37.4%), non-overweight + fit (35%), overweight/obese + unfit (11%) and overweight/obese + fit (10%). A one-way analysis of variance was used to compare the differences according to fitness and fatness groups. The main finding of this study was that regardless of fatness, participants with higher cardiorespiratory fitness presented with a lower prevalence of CVD risk factors.
    European Journal of Sport Science 03/2010; 10(2):121-127. DOI:10.1080/17461390903307842 · 1.31 Impact Factor
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    ABSTRACT: Objectives: To investigate the relationship between cardiovascular diseases risk factors, cardiorespiratory fitness and three different indicators of fatness, and investigate if these relationships are independent by each other. Methods: 491 children and adolescents were evaluated. Standardized metabolic risk scores were computed. Multiple linear regression and Univariate Analysis of Variance – GLM were used. Results: Fit youngsters presented a better profile for each of the risk factors. Belonging to the unfit category increased the risk of having high MRS. After adjustments for fatness indicators, the relationship between fitness and MRS disappeared, and obesity indicators presented significant relationship with the MRS. Conclusion: Fitness and fatness are associated with clustered risks by different pathways.
    The Open Sports Sciences Journal 01/2010; 3(1):149-154. DOI:10.2174/1875399X01003010149
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    ABSTRACT: To analyse whether changes in physical activity index (PAI), screen time (ST: television, computer) and body mass index (BMI) made a contribution to longitudinal changes in fitness of children and adolescents. Additionally, we analysed the interaction between baseline fitness level and changes in fitness. This is a 3-year longitudinal study of 345 high school students aged 11-19 years. Students performed curl-ups, push-ups and 20-m shuttle run tests from Fitnessgram. PA and ST were evaluated using a standard questionnaire. Standardized scores of fitness tests were summed. Changes over time were calculated as Delta(1) (2007 minus 2006), Delta(2) (2008 minus 2007) and Delta(3) (2008 minus 2006). Changes in PAI were positively and independently associated with changes in fitness in Delta(1), Delta(2) and Delta(3). Changes in BMI were negatively associated with changes in fitness in Delta(3). Participants highly fit at baseline were those who showed positive changes in PAI over Delta(3), decreased changes in ST and had the lowest increase in BMI over 3 years compared with those low-fit at baseline. Changes in BMI were associated with changes in fitness over 3 years. However, changes in PAI were the best predictor for changes in fitness in each year and over the 3 years of evaluation in youth.
    Acta Paediatrica 10/2009; 99(1):140-4. DOI:10.1111/j.1651-2227.2009.01536.x · 1.97 Impact Factor
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    ABSTRACT: Elevated blood pressure (BP) has been reported in young people and seems to be associated with body mass index (BMI) and reduced physical activity (PA). This study sought to analyse the association of BP with BMI, PA intensity patterns and cardiorespiratory fitness (CRF) in youth. A cross-sectional study was carried out including 66 boys (13.91+/-1.76) and 97 girls (14.02+/-1.71). Anthropometric characteristics, CRF and BP were assessed during school time and accelerometers were utilized to determine intensity of PA. The linear regression model, adjusted for age, sex and height, showed that higher values of BMI were associated (p<or=0.05) with higher values of systolic blood pressure (SBP) (1.39; 95% CI: 0.56; 2.23) and diastolic blood pressure (DBP) (1.52; 95% CI: 0.68; 2.37). Additionally, SBP, but not DBP, was inversely associated (p<or=0.05) with moderate PA (-0.25; 95% CI: -0.47; -0.02) and positively correlated with sedentary activities (0.04; 95% CI: 0.00; 0.08). The present study showed that BMI and time spent in sedentary activities were inversely associated with SBP. However, time spent in moderate PA was positively associated with SBP. BMI was the single predictor of DBP.
    Annals of Human Biology 05/2009; 36(4):379-87. DOI:10.1080/03014460902817976 · 1.15 Impact Factor
  • Medicine &amp Science in Sports &amp Exercise 01/2009; 41. DOI:10.1249/01.mss.0000353667.70625.5f · 4.46 Impact Factor
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    ABSTRACT: We analyzed the 5-year longitudinal relationship between cardiorespiratory fitness (CRF) and cardiovascular diseases (CVD) risk factors in children. A total of 153 students (66 boys and 87 girls) were evaluated in 1998 and 2003. Multilevel modeling was used to determine the effect of CRF across time (Model 1, adjusted for time and Model 2-Model 1 with further adjustment for gender and age). In both models, a significant main effect was found for body mass index (BMI) (P <or= 0.05). Data showed that in children, lower levels of CRF are associated with higher levels of BMI over a 5-year follow-up period.
    American Journal of Human Biology 10/2008; 21(1):121-3. DOI:10.1002/ajhb.20826 · 1.93 Impact Factor