The dates displayed for an article provide information on when various publication milestones were reached at the journal that has published the article activities on preceding journals at which the article was previously under consideration are not shown (for instance submission All content on this site: Copyright © 2025 Elsevier B.V., its licensors, and contributors. All rights are reserved, including those for text and data mining, AI training, and similar technologies. For all open access content, the relevant licensing terms apply. The first objective is to evaluate the time elapsed since the diagnosis of not meeting 24 h movement guidelines and the potential subsequent onset of metabolic syndrome in undergraduate students from low-income regions within 4 years of follow up. The second objective is to test the association between 24 h movement, mental wellbeing, eating behaviors, and abdominal obesity in the period of this pandemic. Research Methods and Advances in Epidemiology Volume 2 - 2022 | https://doi.org/10.3389/fepid.2022.1010832 Introduction: Obesity and its comorbidities are increasingly prevalent in Latin America with a more rapid growth in individuals with lower income The composition of movement behaviors within a 24 h period may have important implications for obesity metabolic and mental health in cross-sectional data a longitudinal study is needed to confirm the findings from the primarily cross-sectional evidence The COVID-19 pandemic has been associated with cardiometabolic outcomes and has impeded healthy behavior Objectives: The first objective is to evaluate the time elapsed since the diagnosis of not meeting 24 h movement guidelines and the potential subsequent onset of metabolic syndrome in undergraduate students from low-income regions within 4 years of follow up The second objective is to test the association between 24 h movement and abdominal obesity in the period of this pandemic Methods: The 24 h movement behavior and metabolic syndrome (24 h-MESYN) study is a multicentre cohort study that will include participants from two Brazilian cities within the 2022–2025 period to asses the first objective and also a nested case-control study at the baseline will be carried out to evaluate the second objective we conducted a feasibility study in the academic year of 2021 to assessing the psychometric properties of subjective tools and adjust the epidemiological conditions of the cohort's subsequent phases (like as prevalence of exposure of interest Statistical tests as Cohen's kappa agreement; factorial analysis; logistic Poisson and linear regression; and Kaplan-Meier analysis will be performed we designed 24 h movement behavior and metabolic syndrome (24h-MESYN) study aiming (i) to evaluate the time elapsed since the diagnosis of not fulfilling 24 h movement guidelines and the potential subsequent onset of metabolic syndrome in undergraduate students from low-income regions within 4 years of follow up; and (ii) to test the association between 24 h movement The 24h-MESYN study will be a 48-month longitudinal multicentre study (cohort follow-up), with five measurements over this period (Figure 1) The study is subdivided into three phases: a feasibility study (phase 1) a prospective cohort (phase 2) and a nested case-control study (phase 3) The feasibility study was conducted in the first half of 2021 The first wave (baseline) of the cohort should start in second half of 2022 or as soon as the Brazilian health authorities allow the return to face-to-face classes in that academic year Timeline of the 24 h movement behavior and metabolic syndrome (24h-MESYN) study the private university informed us that 2,225 students were registered enrolled in 9 undergraduate programs (Business Administration and Social Work); whereas the public university informed us that there were 968 students enrolled in four undergraduate programs (Physical Education After the institution's written consent the selected students will receive a formal and detailed invitation letter about risks where they will be able to voluntarily consent to collaborate with the project Participants who agree to participate in the study and sign (virtually in phase 1 and physically in the subsequent phases) the informed consent form will undergo informative clarifications about the days and data collection A premise of this multicentre study is to ensure that the data collection is performed in a standardized way, thereby achieving a good representation of reality and allowing comparisons of the data from the different cities involved in the study (18) the data collection will be conducted by two different fieldwork teams based on harmonized methodology These teams will conduct subjective and objective measurements in their respective study centers where each team will have a local coordinator who will be responsible for monitoring all data collection The final number of researchers in these teams depends on the possibilities of each center with a minimum of four researchers from health sciences among undergraduate and graduate students (at least one) The data management system will be centralized and coordinated by the general coordinator of the study at the Federal University of Tocantins standardized procedures will be adopted to optimize the accuracy and consistency of the findings obtained during the study such as manuals and standardized measurements and training and supervision of researchers This training will not involve blood collection All data were self-reported electronically We all participants included in the study were enrolled in the university Students who reported incomplete data were excluded from the analysis of the corresponding instrument (e.g incomplete data from vigorous physical activity leads to the exclusion of that answer to the questionnaire from the reliability and validity analysis) precision 5% and design effect of 2.0 (multistage sampling) for a two-sample proportions test The estimated sample size was 200 in each research center we corrected this estimation for population ratio (2,225/968 = 2.3) achieving a minimum sample size of 279 and 121 students from the private (Maranhão research center) and the public (Tocantins research center) institution we will invite 502 students (349 from the private and 152 from the public institution) the sample will be selected by random sampling in two stages a list of all students from up to second semester offered will requested From this list in each stratum a simple random sampling will be carried out with probability proportional to the number of students in each institution study program and shift (e.g. morning and afternoon) in relation to the total number of students in each selected program of studies and shift students will be randomly invited to participate in the study The probability of selection for each student will be condionted on the number of students in these two stratums and an additional invitation rate of 30.0% for males We will collect the data in four visits per wave we will conduct an explanation of the 24h-MESYN study objectives/methodology and we will delivery the informed consent form As this study phase will occur presencially the student will sign two copies of the informed consent form (one for the student and another one for the researcher) participants will answer the questionnaires eletronically and will undergo an anthropometric and blood pressure assessment we will deliver the results to the students We will adopt the same eligibility criteria as for phase 1 other inclusion criteria will be added: students must be regularly enrolled up to second semester and present in the classroom on the day of the objective measurements We will exclude participants who fail to provide complete information about age only those students who answer the questionnaire and participate in the anthropometric measurements will be qualified for the blood sample collection Students who report a physical disability will be evaluated but they will be excluded from the analysis In phase 3, we will conduct a case–control study in the cohort first wave to test associations between 24 h movement, mental wellbeing, eating behaviors (exposures), and abdominal obesity (main outcome) and in a subgroup of students with the data collected in the baseline (21). Students with prevalent abdominal obesity will be selected as a case. We will adopt four controls per case and they will be paired by sex and age (±1 year) (24) The variables that will be measured are described in Table 1 Metabolic syndrome will be based on the International Diabetes Federation criteria (2) which establish the presence of any 3 of 5 risk factors: presence of abnormal waist circumference (≥ 90 cm in men; ≥ 80 cm in women) blood pressure (systolic ≥ 130 and/or diastolic ≥ 85 mmHg) ≤ 40 mg/dL in men; ≤ 50 mg/dL in women) and fasting blood glucose (≥ 100 mg/dL) A blood venous sample will be collected using a Vacutainer system (Becton Dickinson, Oxford, UK). This procedure will be carried out in the morning, after an 8–12 h overnight fast. Participants will be instructed to fast on the morning of the collection day. Samples will be collected and analyzed by a previously accredited laboratory following international protocols and recommendations (18) such as: do not perform moderate-to-vigorous physical activities and do not consume products with caffeine and alcoholic beverages and avoid drinking water in the hours preceding the assessments The exposures will be 24 h movement behavior, mental wellbeing (perceived stress and satisfaction with life) and eating behaviors. These exposures will be subjectively measured by self-adminstered validated questionnaires. All subjective instruments are available at Google Forms (https://forms.gle/L92wXsVaxxfPNgpE8) a questionnaire that assesses the cognitive component of life satisfaction with response options ranging from 1 (strongly disagree) to 7 (strongly agree) Eating behaviors (psychosocial aspects) will be measured via the Dutch Eating Behavior Questionnaire (DEBQ) (36) evaluated on a scale rated between 1 and 5 (never/rarely/sometimes/often/veryoften) comprising three subscales: food restriction (10 items); emotional intake (13 items); and external intake (10 items) We will retrieve variables about sociodemographic and economic characteristics academic environment and COVID-19 (perceived) burden using self-admininstered instruments We will also assess the body mass index objectively Sociodemographic variables will be based on questions addressing biological sex, age, ethnicity, marital status and neighborhood (37). Socioeconomic status will be assessed by the Brazilian Economic Classification Criteria (38) a self-administered instrument that uses a point system for possession of goods and education of the family head with A being the most educated and wealthy and E the least The questionnaire estimates the purchasing power of individuals and families we will include questions addressing academic environment: maternal education (incomplete high school personal and family income (in minimum wages) and daily workload (hours per day) Regarding the academic environment, the following data will be collected: undergraduate study program area, shift, time (semester), number of classes enrolled (in the semester) and time spent studying for classes (hours per day). For the COVID-19 burden, we will retrieve data from knowledge, sources of information, behaviors, and academic and life difficulties via a questionnaire based on the fact sheets of the Centers for Disease Control and Prevention (CDC) (39) for seven of which the answer can be true or false while three questions will assess the level of agreement with the statements on a 5-point scale (0 = “strongly disagree” to 4 = “agree totally”) we will measure weight (kg) and height (cm) The body mass index will be calculated using the standard formula (BMI = weight/height2) We will perform all statistical analyses using Stata version 15.0 (Stata Corporation We will consider p values ≤ 0.05 statistically significant The normality of the variables will be evaluated using the Shapiro-Wilk test Continuous variables will be described by their means and standard deviations. Categorical variables will be described by absolute and relative frequency, and 95% confidence interval (40) we will use time series to describe the trend of the variables A descriptive analysis will identify the time elapsed between exposure to 24 h movement behavior to a metabolic syndrome event the contextual variable will be the research center we will use the Durbin-Wu-Hausmann method to determine random or fixed intercept model We will analyse the fit using the Hosmer-Lemeshow test we will adopt a significance value of 80% (p ≤ 0.20) Metabolic syndrome conceptual predictors for university students in a pandemic period Also adopted as outcome for assessing the secondary objective we found that the proportion of students who fulfilled the guidelines was 7.7% (n = 15) sensitivity analysis and prevalence ratio of study adherence The 24h-MESYN study was designed by experienced researchers to investigate the composition of movement behaviors within the course of a 24 h period during the pandemic of undergraduate students from low-income regions and their associations with other behaviors and health outcomes based on longitudinal data Preliminary achievements in phase 1 of the study were to improve our data collection skills and adjusting the epidemiological conditions to design the cohort's subsequent phases (e.g. We believe that this can be extrapolated to our results We have not received any complaints regarding the questionnaire's format or length we speculate that our decreased partipation rate in Q2 can be attributable to the length of the questionnaire We could possibly explain this due to a decrease in the participants' motivation to complete a second questionnaire within a short lead time The studies involving human participants were reviewed and approved by the Research Ethics Committee of Universidade Ceuma (ID: 4.055.604) and Universidade Federal do Tocantins (ID: 5.161.340) The students/participants provided their written informed consent to participate in this study MN-F and KM were responsible for study coordination and AF were resposible for data collection All authors contributed to the article and approved the submitted version data collection and analysis were supported by the Brazilian Government from National Counsel of Technological and Scientific Development (CNPq; proc MN-F received a postdoctoral scholarship from Programa Nacional de Pós-Doutorado/Capes (PNPD/CAPES) LO and LS received a scientific initiation scholarship from the National Council for Scientific and Technological Development (CNPq; proc AA received a scientific initiation scholarship from the Institute of Higher Education of Southern Maranhão (IESMA/UNISULMA) AF was supported by UTHealth School of Public Health Start-up Funding All authors acknowledge the university dean/chair of both universities that agreed to participate in this observational study as well as the students for their voluntary participation in the 24h-MESYN (feasibility) study Etiane Paes and Shirley Cunha Feuerstein for helping in the study logistic All authors thank the Coordinators of the South American Youth/Child Cardiovascular and Environmental (SAYCARE) Study Heraclito Barbosa de Carvalho Augusto Cesar Ferreira de Moraes and Francisco Leonardo Torres-Leal for help in the design of the study The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher Obesity and COVID-19 in Latin America: a tragedy of two pandemics-official document of the Latin American federation of obesity societies Harmonizing the metabolic syndrome: a joint interim statement of the 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need in my research Carvalho HB and Ferreira de Moraes AC (2022) 24 h movement behavior and metabolic syndrome study protocol: A prospective cohort study on lifestyle and risk of developing metabolic syndrome in undergraduate students from low-income regions during a pandemic Received: 03 August 2022; Accepted: 07 September 2022; Published: 29 September 2022 Copyright © 2022 Nascimento-Ferreira, Marin, Abrão Ferreira, Oliveira, Bandeira, Silva Sousa, Miranda de Sousa, Cardoso, Silva, Rosa, de Carvalho, Pereira de Carvalho Silva, Franco, Torres-Leal, Barbosa de Carvalho and Ferreira de Moraes. 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