Levels of Anxiety, Depression and Physical Activity of Mexican Children by Sex After Lockdown by Covid-19
Abstract
Objective: In Mexico, social distancing was implemented to prevent the spread of the COVID-19 virus, and previous studies have revealed negative effects on the mental and physical health of children in social isolation. Therefore, the study sought to describe the levels of anxiety, depression, and physical activity of children in northern Mexico by sex after lockdown conditions, using basic anthropometric measures and stages of sexual maturation as control variables.
Methods: This study follows a quantitative, non-experimental, cross-sectional descriptive design. No causal inference can be established.
Results: Findings suggest higher anxiety and depressive symptomatology in girls compared to boys, which may be associated with post-confinement conditions, both groups show low levels of physical activity and an earlier biological maturation with respect to their chronological age, reflecting a body mass index higher than the reference values and accelerated stages of sexual maturation in girls.
Conclusions: Findings suggest that post-confinement conditions may be associated with changes in psychological and physical health indicators in children in northern Mexico.
Introduction
Following the statements made by the World Health Organization (WHO) on March 11, 2020 related to the state of pandemic alarm caused by the COVID-19 virus (1). In Mexico, health authorities published in the Official Federal Gazette (DOF) the Agreement 02/03/20 by which they established as a health security measure to prevent the spread of the virus, the suspension of classes at different levels of basic education, in addition to confinement measures such as: social isolation and quarantine, limiting the exit of inhabitants only to essential work personnel (2).
Framed by this context, previous studies developed in isolation show that the sudden suspension of classes and prolonged confinement of children caused negative effects on their mental health (3, 4, 5). During isolation, children and adolescents were not only physically separated from their classmates and friends, but also from adults who are important to them, generating feelings of loneliness, fear and worry (6). It is worth mentioning that the literature reports the psychological impact caused by the initial phase of the confinement, causing anxiety levels in the moderate to severe category (7), as well as a higher incidence of children with difficulty in regulating their emotions with changes in mood, intolerance to the basic rules of coexistence, setbacks in the degree of independence, difficulty in falling asleep, manifestations associated with anxiety (8), a high prevalence of depressive symptoms in children has also been reported, 41.7% in a sample of 21 330 subjects (9), exposing the vulnerability of this age group to social isolation and confinement measures implemented globally as a strategy to reduce the spread of COVID-19.
Secondly, in addition to the mental health condition of children, other collateral effects of social isolation are recognized, which are related to physical health. Currently, the literature reveals that prevention measures involving social distancing forced children to stay at home, drastically reducing the opportunities for physical activity, including the limitation of being in open spaces and increasing the time spent in sedentary activities associated with overweight and obesity (10,11). Under COVID-19 confinement, the literature reports a considerable decrease in physical activity levels in several countries (12, 13, 14), and it has also been suggested that we are observing an increase in body mass index (BMI) and obesity in children, related to school closure time due to social isolation, which results in a reduction in physical activity (15, 16), a situation that has been associated with modifications in eating behavior that affect nutritional status, lifestyle and socioeconomic status which has generated a condition that the literature calls obesogenic environment (17, 18, 19).
Most of the previous studies have reported a detriment of mental health in the variables of anxiety, depression, and physical activity levels in confinement (20). Therefore, the main objective of this article is to describe the levels of anxiety, depression, and physical activity of children from northern Mexico by sex, after the confinement measures caused by COVID-19 in the reincorporation to the activities of the 2022-2023 school year, using as control variables the basic anthropometric measures and the stages of sexual maturation.
Materials and Methods
Study Design
This study follows a quantitative, non-experimental, cross-sectional descriptive design; therefore, causal inferences cannot be established, which shows the results corresponding to the initial evaluation of a larger study, which is being developed as part of a strategy of the educational authorities of Zone No. 14 of Physical Education of Ciudad Juarez, Chihuahua, Mexico to determine the psychophysiological impact of confinement on children attending the 2022-2023 school year. The study protocol was approved by the Research Ethics Committee (CEI 2022-2- 104) of the Universidad Autónoma de Ciudad Juárez (UACJ), and letters of informed consent and assent were obtained from all participants.
Participants
The sample size (n) was 240 children in the 5th grade of an elementary school, belonging to federal public schools in Physical Education Zone No. 14 in northern Mexico. The ages were 10-13 years (43.8% boys and 56.3% girls), of which the mean age of the sample was 10.42 years with a standard deviation (SD; ± 0.56 years). The sample size was determined according to the recommendations of experts in research methodology for the study of typical samples of human populations and regional organizations (21, 22).
The participants were selected considering the following inclusion criteria: to belong to a federal public school of Zone No. 14 of Physical Education; to be duly registered in the Educational Information System of the State of Chihuahua; to speak and read Spanish, as well as to have signed informed consent and assent. As exclusion criteria, it was considered to have a diagnosis of neurological disorder prior to the evaluations, students who presented a condition of intellectual disability or Down Syndrome and are integrated in the classroom as part of the Special Education program (USAER).
Procedure
The protocol was developed based on a previous study that considered population and variables similar to those of the present study (23) so initially the protocol was submitted for review to the CEI of the UACJ, later permission was requested from the authorities of the Ministry of Public Education Northern Region of Mexico, once the authorizations of both agencies were obtained, meetings were held with the directors of each school to make the protocol known and for the research team to become familiar with the safety measures implemented in the reinstatement to the 2022-2023 school year after the COVID-19 termination. It is worth mentioning that, with the corresponding approvals, a pilot test was developed in a federal elementary school from which the data were not considered for the present publication, from that pilot test it was determined to develop the evaluations in three phases (S). For this purpose, 5th grade elementary school students from seven schools that are part of Zone No. 14 of Physical Education and their parents were summoned by the educational institution.
Obtaining sociodemographic data
In this first phase (S1), letters of consent and informed assent were obtained in a face-to-face meeting per educational center at the beginning of the 2022-2023 school year, where sociodemographic data, socioeconomic level were also obtained using the questionnaire of the Mexican Association of Market and Opinion Intelligence Agencies (24), including a questionnaire of eight open-ended questions related to the state of social isolation and/or confinement and clinical history.
Basic anthropometric measurements
In the second phase (S2), basic anthropometric measurements of weight, height, waist circumference (WC) and hip circumference (HC) were obtained in the morning and in a controlled environment; these measurements were performed by anthropometrists certified Level 1 by The International Society for the Advancement of Kinanthropometry (ISAK). Weight and height were obtained in standing position with the TANITA UM- 081® scale with an accuracy of 100gr (25) and with the SECA 206® stadiometer measured in cm, with a range of 0-220 cm, and 1 mm of accuracy (26), the waist circumference perimeter was measured by placing the subject in a standing position with feet together and arms crossed, to place the tape horizontal to the floor between the iliac crest and the 10th rib, making not of the reading during the exhalation of the subject, and for the hip circumference considering the most prominent part of the buttock at the height of the trochanters, both measurements developed with the Lufkin® EXCECUTIVE THINLINE W606PM inextensible metallic tape. After the waist and hip measurements, the waist-hip ratios (WHR) were obtained from the waist circumference/hip circumference ratio (27, 28) and waist height (WHtR), waist circumference/height ratio (29, 30).
Age (years), sex, weight (kg), and height (cm) data was entered into the Excel book developed by the scientific community (31) to classify body mass index (BMI; kg/m2) by sex and specific age according to the world obesity federation (32) as well as cut-off points for body mass index (32,33).
Anxiety
The third phase (S3) was the completion of all the self-report instruments starting with the Spence Children's Anxiety Scale (SCAS) in the version validated in Spanish for children and adolescents (34) of which there are records in pediatric populations with a Cronbach's Alpha coefficient of 0.89 and 0.82 for the total score of the scale respectively (35, 36), evidencing that the SCAS scale is reliable and valid. Furthermore, it is worth mentioning that its factorial structure coincides with the classification proposed by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association (37), and in its revised version DSMIV- TR APA (38), for anxiety disorders in childhood and adolescence.
The SCAS instrument consists of 44 items, six of which are not scored, and are included to reduce the impact of the negative bias produced by the list of problems (34). Its presentation is Likert-type with four possible responses where 0 means never and 3 means always. The total score of the scale is generated from the sum of the points obtained for each of the items (35), thus obtaining the score for the second order factor of general anxiety (34) and the cut-off point was considered to be ≥ 52.2 for generalized anxiety disorder (39).
Depression
The second S3 instrument evaluated depressive symptomatology by means of the Depression Scale of the Center for Epidemiological Studies in the revised version (CESD-R) of 35 items (40), which extends the time limit to the last two weeks, to coincide with the DSM-IV criteria (37). The literature reports a Cronbach's Alpha coefficient of 0.93 for this instrument (40).
The cut-off point was calculated using the sample mean plus one standard deviation. While this approach is not equivalent to clinical diagnostic thresholds, it allows for relative classification within the sample and should be interpreted cautiously (41).
Physical Activity
The third instrument used to determine the level of physical activity (LPA) was the Physical Activity Questionnaire for Children (PAQ-C; 42), which has been validated and applied in Mexican children (43), with a Cronbach's Alpha coefficient of 0.817.
The instrument is made up of 10 items, of which the first nine are used to obtain the total score of the instrument and estimate the LPA, while the last question allows us to know which event prevented the child from engaging in regular physical activity (42). The categorical classification of the PAQ-C corresponds to five levels: where level one of physical activity (L1-PA) represents very low levels of PA; L2-PA represents low levels of PA; L3-PA is a regular level of PA; L3-PA is a regular level or moderate AP; L4-AP represents an active level and L5-AP very active (42,43).
Self-Reported Sexual Maturation
The fourth self-report instrument was a questionnaire with drawings and descriptions representing the five stages of sexual maturation stages or Tanner scale (44, 45), for the development of pubic hair in both sexes and genital development in boys, while in girls, the development of the mammary gland was assessed (46). Boys were asked to select the drawing and self- perception description of the developmental stage in which they were at the time of the assessment, in the case of girls they were asked to report menarche through a response question (Yes / No) in adherence to the protocol described in the literature (46).
Statistical Analysis
Given the descriptive aim of the study, the analysis focused on group comparisons rather than modeling relationships between variables. Future studies should incorporate multivariate approaches.
IBM® SPSS® statistical software was used for data analysis v.25 (SPSS Inc., Chicago, IL, USA). First, an exploratory analysis was performed using the Kolmogorov-Smirnov goodness-of-fit test, as well as the determination of the measures of central tendency: mean (M) and standard deviation (SD; ±) for each of the variables. Secondly, frequency distribution analyses were performed, and the Mann- Whitney U test was used to compare by sex.
Results
Sociodemographic characteristics
The sociodemographic characteristics of the 240 children in 5th grade of primary school in public schools show that the average age was 10.42 ± 0.56 years, with respect to the socioeconomic level (SES) the following distribution is shown: most of the children were located in the SES 4 (C-) representing 29.2 percent (%) corresponding to a frequency (f) of 70 children, followed by NSE 3 (C) with 28.7% (f = 69); for NSE 5 (D+) 17.5% (f = 42); NSE 2 (C+) 12.9% (f = 31); for NSE 5 (D) 7.1%, (f = 17); in NSE 1(A/B) 4.2%, (f = 10); and finally in NSE 7 (E) 0.4% (f = 1), representing 100% of the n= 240. That is, there is a predominance of the typical middle class (NSE 4), followed by the upper middle class (NSE 3) and the lower middle class (NSE 5), therefore, the profile of the families of the participants is characterized by the fact that the tutors have studies above primary school level, live in rented or owned houses or apartments that cover only the basic needs of space [bedroom-bathroom] and equipment [computer-basic internet] that ensure the minimum of practicality and comfort in the home.
Of the clinical and health characteristics, it is reported that 100% do not suffer from chronic noncommunicable diseases. In relation to social isolation caused by COVID-19 prevention measures, 88.3% (f = 12) remained in social isolation without living with other children outside the nuclear or extended family (only among siblings, cousins and direct family members), only 2.1% (f = 5) reported having been ill with COVID-19 proven by laboratory tests.
Regarding the confinement period, parents reported that 30.4% (f = 73) of the children showed more aggressive behavior during the confinement period confinement, 12.5% (f = 30) had setbacks in the degree of independence (returned to sleep with a family member, mother, father or siblings).
Basic anthropometric characteristics
On the other hand, the profile of basic anthropometric measurements is shown in Table 1, highlighting that the majority of the sample (57.1%; f = 137) is in the normal weight category according to the BMI_cat cut-off points. Likewise, when comparing the BMI_cat of the group of boys vs. girls, it was found that the highest percentage per group are located in the normal weight children category, the details are presented in Figure 1.
Insert Table 1
Insert Figure 1 (a), (b) and (c)
Psychological characteristics
Anxiety
Regarding the anxiety variable, it was found that the generalized anxiety disorder factor presented a mean of 12.4 (SD = 3.08) arbitrary units (ua) in the boys' group, while for the girls' group the M= 14.03 ± 3.65 ua presenting statistically significant differences by sex (p= 0.001) for this factor.
On the other hand, when analyzing the global anxiety index through the total score of the instrument, an M = 74.48 (SD = 13.86) ua was found in the group of boys and M = 83.07 (SD = 17.82) ua in girls, therefore, when comparing the values it was found that there are statistically significant differences by sex (p = 0.000).
Depression
The total score of the instrument shows an M = 14.08 (SD = 3.43) ua, therefore, the threshold established to determine whether there is presence or absence of depressive symptomatology is ≥17.51 ua. On the other hand, the results by sex show an M = 13.76 (SD = 2.97) ua in the group of boys, and M= 14.33 (SD = 3.7) ua in girls, with no differences by sex (p = 0.22). In addition, Figure 2 shows the distribution by sex with respect to the cut-off point.
Insert Figure 2 (a) and (b)
Physical Activity
The results show an M = 2.8 (SD = 0.79) ua in the group of boys, while for the group of girls an M = 2.53 (SD = 0.67) ua is reported, when comparing the groups, significant differences were found with a value of p = 0.01. Figure 3 shows the distribution of frequencies by sex with respect to the categorical classifications of the PAQ-C.
Insert Figure 3 (a) and (b)
Self-Reported Sexual Maturation
It was found that in the group of boys, most of them (40%; f = 42), were located in stage two (G2) of the Tanner scale for the development of genitalia, which shows that they still present infantile-pre-adolescent characteristics in genital development, in Figure 4(a) the complete distribution is represented. Regarding pubic hair (PH) development in the group of boys, the majority (48.6%; f = 51), reported to be in stage number two (PH2), it is interpreted that pubic hair development presents infantile- prepubescent characteristics, the distribution is shown in Figure 4(b).
Insert Figure 4 (a) and (b)
In the group of girls when considering the stages of development of the mammary glands (B), most of them (45.9%; f = 62) were located in stage three (3B-) considered as pubertal stage, the other information is presented in Figure 5(a), on the other hand, the development of PH most of them were located in PH2 represented by 45.9% (f = 62), therefore it can be interpreted that the majority of the group of girls is in prepubertal stage, in Figure 5(b) the information is complemented with the distribution by stage.
Insert Figure 5 (a) and (b)
Discussion
Additionally, unmeasured factors such as parental mental health, family stress, and school reintegration processes may partially explain the observed results, highlighting the multifactorial nature of post-pandemic child health outcomes. However, some studies have reported heterogeneous or non-significant differences in mental health outcomes by sex following the COVID-19 pandemic, suggesting that contextual, cultural, and family-related factors may play a relevant role.
The present study aimed to describe the levels of anxiety, depression, and physical activity of children in northern Mexico by sex after lockdown conditions. The study reveals three main results. First, there is a high incidence of anxiety disorders in the children of Zone 14 of Physical Education in northern Mexico, the findings may be associated with post-confinement conditions; however, no causal relationships can be inferred due to the study design. Alternative explanations such as family stress, school reintegration, and environmental factors should be considered.
Secondly, it can be observed that the symptomatology of depressive disorder was more present in the group of girls than in the group of boys. Finally, in the third instance, the levels of physical activity of the sample in general are low even in the reincorporation to school activities in the 2022-2023 school year.
Anxiety levels
The present study reveals that anxiety levels are high following measures of confinement among children, in a way that confirms and is consistent with what the literature has predicted as the effect and collateral damage of social isolation caused by the COVID-19 pandemic on the psychological health of the target population (18, 47, 48, 49). It is worth mentioning that anxiety levels in this age group are consistent with previous studies developed in confinement situation (35, 50).
The possible causes of the tendency to increase the levels of anxiety caused by the state of social isolation or confinement are associated with age, since the literature reports that anxiety disorders and depression are more common among younger people compared to adults and the elderly in this context caused by the pandemic of COVID- 19, in addition it is reported that the symptoms of anxiety and depression are related to the difficulties within family relationships and restrictions caused by the pandemic as the reduction of outdoor activities (51).
On the other hand, it is still worth noting that another factor associated with increased anxiety is the information that children and adolescents obtain regarding COVID-19. The literature reports that out of a total of 745 children, 37.4% (f = 279) are affected by the information and the main factor of concern is associated with the possible health problems that the virus may cause them, a situation reported by 58.1% (f = 433) of children (48), without omitting that in this age group, compared to adults, the cognitive capacity is very different with respect to the ability to understand and interpret the information (52).
One of the aspects to consider regarding the increase in post-confinement anxiety levels is the fact that in children the reactions and response to a traumatic event does not necessarily manifest itself immediately since these may appear weeks or months after the traumatic event, and this has been learned from other epidemics such as that caused by the Ebola virus (53).
Depression
Secondly, concerning the levels of depression, the findings of the present study coincide with previous studies in which it was found that girls are more vulnerable to suffer from depressive symptoms in the context of social isolation or traumatic events (53, 54). This trend of a high incidence of depressive symptomatology in girls has been observed in epidemiological studies on normo-type subjects, in Mexico one out of four girls evidenced to have significant symptoms of depression (40), another epidemiological study developed in Mexico with a sample of 57,403 subjects found that female adolescents were more vulnerable to present depressive symptomatology compared to the opposite sex (55).
In an attempt to explain this trend, the literature reports that various adverse situations in childhood that are associated with psychopathological disorders: such as family economic adversity related to the inability to meet basic needs, the same confinement that causes a reduction of social and physical contact, which leads to frustration and feelings of loneliness (56), in addition to this, the cultural context also has an influence since from a gender perspective, understood as the social role played by the subject, associated with behaviors or attitudes and even stereotypes that define masculinity and femininity, in children this situation could mask the symptomatology so as not to expose themselves in the socialized role of what it means to be masculine (57).
The literature reports that another factor associated with depressive symptomatology in minors is the fact of being a child of a migrant family, especially if it is dependent on the mother, since being in a context or community different from that of their origin, the child-adolescent will face different belief systems and values, which results in greater stress and less social support, generating vulnerability to depressive symptomatology (58), taking into account that the present study was developed in Ciudad Juarez, Chihuahua, recognized as a city of migration, due to the fact that 28% of the population was born in another geographic entity and may be a factor that affects the incidence of depressive symptomatology in the present sample (59). Although migration is discussed as a contextual factor, it was not directly measured in this study and should be interpreted cautiously.
Physical Activity
Concerning the physical activity levels of the present study in the L2-PA category, it seems to confirm the assertion of experts, who stated that health measures of social isolation as a method of containing the spread of COVID-19 would considerably reduce the chances of developing PA among children, especially those living in urban areas (11). In addition, the results are consistent with previous studies that also report low levels of physical activity among children with similar ages to the present sample (60, 12), the confinement status has affected the performance of PA without evidencing significant differences by sex (61). Specialists estimate that the reduction in BP levels was 53% due to behavioral and lifestyle modifications in the context of the presence of COVID-19 (62).
These coincidences may be mainly due to the fact that governments of different nations have employed similar social restrictions as measures of COVID-19 containment. In fact, it is estimated that 50% of the world's population was under government-imposed restrictions, creating similar conditions globally with respect to the state of social distancing (63), therefore, the lack of opportunities to be in open spaces such as parks, school playgrounds and even the conditions in which the child lives such as: the size and type of housing, whether the property has open spaces or not, in addition to the work characteristics of their parents (whether they work at home or have to leave the house) are variables that can affect the level of PA (61), it is worth mentioning that socioeconomic status is a factor that can modify BP patterns, it has been reported that the lower the socioeconomic level, the lower the BP levels are also observed (64).
Tanner Stages
On the other hand, the characteristics of the maturation stages of the present sample when compared with the referential data of the Mexican population used proposed by Chavarro et al. (46), it can be appreciated that the group of boys present similar tendencies regarding genital development classifying both samples under the category of infantile-pre-adolescent stage G2. In contrast, the group of girls in the present study disagrees with the referential values for B3 and PH2 of Chavarro et al. (46).
These differences can be attributed to what is called in the scientific literature as biological age (physiological processes of maturation, accelerated or delayed), which does not necessarily correspond to the chronological age that is quantified by the duration of the life of a human being (65), i.e. in the group of girls in the present protocol there could have been an earlier biological maturation with respect to the chronological-logical age, presenting menarche at early ages compared to the referential study (46), if so, post-menarche, physical and physiological changes are accelerated allowing physical changes related to mammary gland and pubic hair development to be observed at intervals of up to six months (44). However, this should be interpreted cautiously given the self-reported nature of Tanner staging.
Anthropometric characteristics
The basic anthropometric characteristics of the present sample in the BMI variable for both sexes differ from studies comparing cohorts of subjects with similar ages in pre-COVID-19 situation and during COVID-19 which report lower values than those found in the study for the two cohorts (66). When comparing the results with the normative values for the Mexican pediatric population, they differ from those proposed since they are above these values (67), even if they are compared with studies developed in samples with similar sociodemographic characteristics from the northeast of the country (68, 43), the results remain above the mean reported for this age group.
Of the WHR indices, both groups present a mean above the 50th percentile developed from a sample of Mexican-American children (69), likewise, the values found for the waist-to-height ratio (WHtR) are higher than those of a previous study that analyzed body composition in the same region of northern Mexico (70).
In light of the literature this situation was foreseen, since it was mentioned that because of the confinement measures by COVID-19 the children would present increases in body weight, another possible reason why they present values higher than the mean reported from previous studies, may be due to what the literature calls Reaction Norm, where the behavior of genetics is potentiated or limited depending on the environment, as well as the biological age status that as mentioned above in the case of the group of girls the development seems to be accelerated with respect to parallel groups (65), we should not forget that anthropometric characteristics or profiles are influenced by racial, ethnic and even population groups (69) but also by environmental factors and sociocultural characteristics (68) perhaps for that reason the values differ from previous studies.
Limitations and strengths
The authors acknowledge some limitations in the development of the study. This study has several limitations. First, its cross-sectional and descriptive design does not allow causal inference. Second, the sample was limited to a specific region, which restricts generalizability. Third, Tanner stages were self-reported, which may introduce measurement bias. Finally, the absence of pre-pandemic data limits the ability to attribute findings directly to confinement.
On the other hand, one of the strengths of the present study is that methodologically the sample size is adequate for regional organizational studies, as well as the fact that the protocol was developed in a face-to-face manner with pencil and paper instruments, differing from the tendency in the context of pandemics that used digital media to which a certain bias is attributed. On the other hand, it is worth mentioning as a strength the basic anthropometric characteristics of the sample and the profile of the stages of sexual maturation, which previous studies had not considered.
Finally, future lines of research should consider a longitudinal panel design that allows studying the natural development of the observed phenomenon, including the assessment not only of the children, but also considering the participation of parents or guardians.
Conclusions
These findings suggest that post-confinement conditions may be associated with changes in psychological and physical health indicators; however, causal relationships cannot be established.
Funding: "This research was funded by Secretaría de Investigación Científica y Desarrollo Tecnológico Dirección de Investigación, under the Programa de Apoyo a la Investigación Científica y tecnológica (PAICYT 2021)".
Institutional Review Board Statement: "The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board (or Ethics Committee) UNIVERSIDAD AUTÓNOMA DE CIUDAD JUÁREZ (protocol code CEI- 2022-2-104)".
Informed Consent Statement: "Informed consent and of assent was obtained from all subjects involved in the study".
Acknowledgments: We thank the educational authority of the Zona de Educación Física No.14 del Subsitema Federal Dra. Maria Teresa Rodriguez Hernández, as well as the authorities of the Elementary Level belonging to the Federal Subsystem, M.G.E. Claudia Moncada, for the support and pertinent management for the adequate development of the present protocol.
Conflicts of Interest: "The authors declare no conflict of interest."
Authors' Contributions:
R.M.C.C. and G.H.C. designed and directed the project; H.H.P., J.Q.C., B.R.C. and J.H.R conceived and planned the experiments; H.H.P., J.Q.C. and J.H.R carried out the experiments; Z.N.A.R., R.M.C.C., G.H.C. and B.R.C. contributed to sample preparation; G.H.C., H.H.P., J.Q.C., J.H.R, R.M.C.C. and Z.N.A.R analyzed the data; H.H.P., J.Q.C., J.H.R, Z.N.A.R., G.H.C. and R.M.C.C. contributed to interpreting the results, H.H.P., R.M.C.C., J.H.R. and J.Q.C. took the lead in writing the manuscript with input from all authors. All authors discussed the results and commented on the manuscript.
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Annexes
Table 1. Profile of basic anthropometric measurements of the sample in general and by sex.
Variables | Total n1 | Sex | p valor | |
M ± SD | n2 M ± SD | n3 M ± SD | ||
Weight (kg) | 41.3 ± 11.14 | 41.7 ± 11.1 | 40.9 ± 11.1 | 0.59 |
Height (cm) | 143.4 ± 7.4 | 142.9 ± 7.1 | 143.7 ± 6.4 | 0.38 |
BMI (kg/m2) | 19.9 ± 4.6 | 20.24 ± 4.4 | 19.7 ± 4.7 | 0.30 |
BMI_cat | 22.1 ± 5.4 | 22.5 ± 5.2 | 21.7 ± 5.6 | 0.11 |
WC (cm) | 65.7 ± 10.2 | 67.6 ± 10.3 | 64.2 ± 10 | 0.006* |
HC (cm) | 78.1 ± 10.3 | 77.6 ± 10.2 | 78.5 ± 10.4 | 0.71 |
WHR | 0.84 ± 0.05 | 0.87 ± 0.05 | 0.81 ± 0.05 | 0.000* |
WHtR | 0.45 ± 0.06 | 0.47 ± 0.06 | 0.44 ± 0.06 | 0.001* |
Total n1= 240 children; n2 = 105 boys; n3 = 135 girls; WHR= waist-hip ratio waist circumference (cm) / hip circumference (cm); WHtR= waist-height ratio is waist circumference (cm) / height (cm); M= mean; SD = standard deviation.
*p < .05 statistical difference.
(a)
(b)
(c)
(a) Distribution of overall sample BMI_cat; UW-3= under weigth level 3 (<16 km/m2); UW-2= under weigth level 2 (16-16.9 km/m2); under weigth level 1 (17-18.49 km/m2); NW= normal weigth (18.5-24.9 km/m2); OW= over weigth (25-29.9 km/m2); OB-1= obesity type 1 (30-34.9 km/m2); OB-2= obesity type 2 (35-39.9 km/m2); OB-3= obesity type 3 (≥40 km/m2); * indicates the highest percentage within the distribution of 57.1% (f = 137). (b) BMI_cat distribution of the group of children. UW-2= under weigth level 2; under weigth level 1; NW= normal weigth; OW= over weigth; OB-1= obesity type 1; OB-2= obesity type 2; * indicates the highest percentage within the distribution. 48.6% (f = 51). (c) BMI_cat distribution of the girls group. UW-3= under weigth level 3; under weigth level 1; NW= normal weigth; OW= over weigth; OB-1= obesity type 1; OB-2= obesity type 2; OB-3= obesity type 3; * indicates the highest percentage within the distribution 63.7% (f = 86).
(b)
(a) Corresponds to the group of children n= 105 (100%); of which 11.4 % (f = 12) obtained a score above the threshold to classify with depressive symptomatology, 88.6% (f = 93) were below the threshold to classify with depressive symptomatology and 88.6% (f = 93) were below the threshold to classify with depressive symptomatology. Corresponds to the group of girls n= 135 (100%); 17% (f = 23) scored above the cut-off point, the remaining 83% (f = 112) scored below.
(b)
- In the group of children n= 105 (100%); the majority 53.3% (f = 56) were located in the L2- PA with low PA levels, followed by the L3-PA with 23.8% (f = 25) regular or moderate PA levels; finally L1-PA and L4-PA presented the same values with 11.4% (f = 12) respectively, where the first is equivalent to very low levels of PA and L4-PA represents an active level. (b) In the group of girls n= 135 (100%); the majority 52.6% (f = 71) were located in L2-PA with low levels of PA, followed by L3-PA with 24.4% (f = 33) regular or moderate level of PA; then L1-PA 20.0% (f = 27) equivalent to very low levels of PA and finally L4-PA 3% (f = 4) with an active level.
(a)
(b)
(a) This panel shows the distribution of the group of children n=105 (100%) with respect to genital development; in the G3 39% (f =41); in the G4 10.5% (f =11); in the G1 7.6% (f =8) and finally the G5 with 2.9% (f =3). (b) This shows the distribution of the group of children n=105 (100%) with respect to the development of pubic hair; for PH1 32.4% (f = 34); in PH3 12.4% (f = 13); PH4 4.8% (f = 5) and finally in PH5 1.9% (f = 2).
(a)
(b)
(a) This panel presents the distribution of the group of girls n= 135 (100%) with respect to mammary glands, in second place the B2 stage 42.2% (f = 57); followed by B1 with 6.7% (f = 9); then B4 3.7% (f = 5) and finally B5 with 1.5% (f = 2). (b) This panel shows the distribution of the group of girls n=135 (100%) with respect to the development of pubic hair; for PH1 32.6% (f = 44); in PH3 20.7% (f = 28); PH4 0.7% (f = 1), with no presence of girls in the PH5 stage.
