Metabolic Health In Children Research Articles

The multivariate physical activity signature associated with metabolic health in children and youth: An International Children’s Accelerometry Database (ICAD) analysis

There is solid evidence for an association between physical activity and metabolic health outcomes in children and youth, but for methodological reasons most studies describe the intensity spectrum using only a few summary measures. We aimed to determine the multivariate physical activity intensity signature associated with metabolic health in a large and diverse sample of children and youth, by investigating the association pattern for the entire physical intensity spectrum. We used pooled data from 11 studies and 11,853 participants aged 5.8–18.4 years included in the International Children's Accelerometry Database. We derived 14 accelerometry-derived (ActiGraph) physical activity variables covering the intensity spectrum (from 0–99 to ≥8000 counts per minute). To handle the multicollinearity among these variables, we used multivariate pattern analysis to establish the associations with indices of metabolic health (abdominal fatness, insulin sensitivity, lipid metabolism, blood pressure). A composite metabolic health score was used as the main outcome variable. Associations with the composite metabolic health score were weak for sedentary time and light physical activity, but gradually strengthened with increasing time spent in moderate and vigorous intensities (up to 4000–5000 counts per minute). Association patterns were fairly consistent across sex and age groups, but varied across different metabolic health outcomes. This novel analytic approach suggests that vigorous intensity, rather than less intense activities or sedentary behavior, are related to metabolic health in children and youth.

Leading dietary determinants identified using machine learning techniques and a healthy diet score for changes in cardiometabolic risk factors in children: a longitudinal analysis

BackgroundIdentifying leading dietary determinants for cardiometabolic risk (CMR) factors is urgent for prioritizing interventions in children. We aimed to identify leading dietary determinants for the change in CMR and create a healthy diet score (HDS) to predict CMR in children.MethodsWe included 5676 children aged 6–13 years in the final analysis with physical examinations, blood tests, and diets assessed at baseline and one year later. CMR score (CMRS) was computed by summing Z-scores of waist circumference, an average of systolic and diastolic blood pressure (SBP and DBP), fasting glucose, high-density lipoprotein cholesterol (HDL-C, multiplying by − 1), and triglycerides. Machine learning was used to identify leading dietary determinants for CMR and an HDS was then computed.ResultsThe nine leading predictors for CMRS were refined grains, seafood, fried foods, sugar-sweetened beverages, wheat, red meat other than pork, rice, fungi and algae, and roots and tubers with the contribution ranging from 3.9 to 19.6% of the total variance. Diets high in seafood, rice, and red meat other than pork but low in other six food groups were associated with a favorable change in CMRS. The HDS was computed based on these nine dietary factors. Children with HDS ≥8 had a higher decrease in CMRS (β (95% CI): − 1.02 (− 1.31, − 0.73)), BMI (− 0.08 (− 0.16, − 0.00)), SBP (− 0.46 (− 0.58, − 0.34)), DBP (− 0.46 (− 0.58, − 0.34)), mean arterial pressure (− 0.50 (− 0.62, − 0.38)), fasting glucose (− 0.22 (− 0.32, − 0.11)), insulin (− 0.52 (− 0.71, − 0.32)), and HOMA-IR (− 0.55 (− 0.73, − 0.36)) compared to those with HDS ≦3. Improved HDS during follow-up was associated with favorable changes in CMRS, BMI, percent body fat, SBP, DBP, mean arterial pressure, HDL-C, fasting glucose, insulin, and HOMA-IR.ConclusionDiets high in seafood, rice, and red meat other than pork and low in refined grains, fried foods, sugar-sweetened beverages, and wheat are leading healthy dietary factors for metabolic health in children. HDS is strongly predictive of CMR factors.

Usual Dietary Intake, Nutritional Adequacy and Food Sources of Calcium, Phosphorus, Magnesium and Vitamin D of Spanish Children Aged One to

Bone problems in the population begin to be establish in childhood. The present study aims to assess the usual calcium, phosphorus, magnesium, and vitamin D intakes, along with the food sources of these nutrients, in Spanish children participating in the EsNuPI (Estudio Nutricional en Población Infantil Española) study. Two 24 h dietary recalls were applied to 1448 children (1 to <10 years) divided into two sub-samples: one reference sample (RS) of the general population [n = 707] and another sample which exclusively included children consuming enriched or fortified milks, here called “adapted milks” (AMS) [n = 741]. Estimation of the usual intake shows that nutrient intake increased with age for all nutrients except vitamin D. Using as reference the Dietary Reference Values from the European Food Safety Authority (EFSA), calcium and magnesium intakes were found to be below the average requirement (AR) and adequate intake (AI), respectively, in a considerable percentage of children. Furthermore, phosphorus exceeded the AI in 100% of individuals and vitamin D was lower than the AI in almost all children studied. The results were very similar when considering only plausible reporters. When analyzing the food sources of the nutrients studied, milk and dairy products contributed the most to calcium, phosphorus, magnesium, and vitamin D. Other sources of calcium were cereals and vegetables; for phosphorus: meat, meat products, and cereals; for magnesium: cereals and fruits; and, for vitamin D: fish and eggs. These results highlight the desirability of improving the intake concerning these nutrients, which are involved in bone and metabolic health in children. The AMS group appeared to contribute better to the adequacy of those nutrients than the RS group, but both still need further improvement. Of special interest are the results of vitamin D intakes, which were significantly higher in the AMS group (although still below the AI), independent of age.

Association of Fish Consumption and Mercury Exposure During Pregnancy With Metabolic Health and Inflammatory Biomarkers in Children

The balance of mercury risk and nutritional benefit from fish intake during pregnancy for the metabolic health of offspring to date is unknown. To assess the associations of fish intake and mercury exposure during pregnancy with metabolic syndrome in children and alterations in biomarkers of inflammation in children. This population-based prospective birth cohort study used data from studies performed in 5 European countries (France, Greece, Norway, Spain, and the UK) between April 1, 2003, and February 26, 2016, as part of the Human Early Life Exposome (HELIX) project. Mothers and their singleton offspring were followed up until the children were aged 6 to 12 years. Data were analyzed between March 1 and August 2, 2019. Maternal fish intake during pregnancy (measured in times per week) was assessed using validated food frequency questionnaires, and maternal mercury concentration (measured in micrograms per liter) was assessed using maternal whole blood and cord blood samples. An aggregate metabolic syndrome score for children was calculated using the z scores of waist circumference, systolic and diastolic blood pressures, and levels of triglyceride, high-density lipoprotein cholesterol, and insulin. A higher metabolic syndrome score (score range, -4.9 to 7.5) indicated a poorer metabolic profile. Three protein panels were used to measure several cytokines and adipokines in the plasma of children. The study included 805 mothers and their singleton children. Among mothers, the mean (SD) age at cohort inclusion or delivery of their infant was 31.3 (4.6) years. A total of 400 women (49.7%) had a high educational level, and 432 women (53.7%) were multiparous. Among children, the mean (SD) age was 8.4 (1.5) years (age range, 6-12 years). A total of 453 children (56.3%) were boys, and 734 children (91.2%) were of white race/ethnicity. Fish intake consistent with health recommendations (1 to 3 times per week) during pregnancy was associated with a 1-U decrease in metabolic syndrome score in children (β = -0.96; 95% CI, -1.49 to -0.42) compared with low fish consumption (<1 time per week) after adjusting for maternal mercury levels and other covariates. No further benefit was observed with fish intake of more than 3 times per week. A higher maternal mercury concentration was independently associated with an increase in the metabolic syndrome score of their offspring (β per 2-fold increase in mercury concentration = 0.18; 95% CI, 0.01-0.34). Compared with low fish intake, moderate and high fish intake during pregnancy were associated with reduced levels of proinflammatory cytokines and adipokines in children. An integrated analysis identified a cluster of children with increased susceptibility to metabolic disease, which was characterized by low fish consumption during pregnancy, high maternal mercury levels, decreased levels of adiponectin in children, and increased levels of leptin, tumor necrosis factor α, and the cytokines interleukin 6 and interleukin 1β in children. Results of this study suggest that moderate fish intake consistent with current health recommendations during pregnancy was associated with improvements in the metabolic health of children, while high maternal mercury exposure was associated with an unfavorable metabolic profile in children.

Effect of multidimensional lifestyle interventions on metabolic risk reduction in children: a cluster randomised controlled trial

Few clinical trials have investigated lifestyle intervention effect on metabolic health in children. The study aimed to examine the effect of diet and physical activity intervention on the reduction of clustered metabolic risk score (CMRS) in children and moderators and mediators of the intervention effect. A multicentre, clustered randomised controlled trial was conducted with examination conducted at baseline and after intervention over one year. 7110 children (49.7% girls) with a mean of 9.06 (95% CI: 9.03, 9.09) years were included in the analysis. In Beijing, each three schools were randomly assigned to diet-only, physical activity-only intervention and control groups. In five other urban cities, each 15 schools were randomly assigned to comprehensive intervention and control groups. CMRS was computed by summing the Z scores of % fat mass, systolic blood pressure, fasting glucose, ratio of cholesterol to high-density lipoprotein, and triglyceride. Compared with controls (n = 2808), children in the comprehensive intervention group (n = 2848) had more reduction in CMRS (multivariate-adjusted mean difference (95% CI): −0.49 (−0.85, −0.14)). The body mass index (BMI) reduction explained 7.3% (95% CI 2.8%–18.1%) of the total intervention effect. The intervention was more effective in children with higher birthweight, lower parental BMI, or complete parental data. Diet-only or physical activity-only intervention had non-significant effects on CMRS reduction. Our multidimensional comprehensive intervention resulted in significant reduction in CMRS in primary school children and this effect was modified by birthweight, parental BMI, and parental involvement. A minority of metabolic risk reduction was mediated through BMI.Clinical Trial Registry number and website: ChiCTR-PRC-09000402, URL: http://www.chictr.org.cn

Environmental and intrinsic factors shaping gut microbiota composition and diversity and its relation to metabolic health in children and early adolescents: A population-based study

ABSTRACT Background Gut microbiota, by influencing multiple metabolic processes in the host, is an important determinant of human health and disease. However, gut dysbiosis associated with metabolic complications shows inconsistent patterns. This is likely driven by factors shaping gut microbial composition that have largely been under-evaluated, at a population level, in school-age children, especially from developing countries. Results Through characterization, by 16S sequencing, of the largest gut microbial population-based school-aged children cohort in Latin America (ORSMEC, N = 926, aged 6–12 y), we identified associations of 14 clinical and environmental covariates (PFDR<0.1), collectively explaining 15.7% of the inter-individual gut microbial variation. Extrinsic factors such as markers of socioeconomic status showed a major influence in the most abundant taxa and in the enterotypes' distribution. Age was positively correlated with higher diversity, but only in normal-weight children (rho = 0.138, P =2 × 10−3). In contrast, this correlation although not significant, was negative in overweight and obese children (rho = −0.125, P = 0.104 and rho = −0.058, P = 0.409, respectively). Finally, co-abundance groups (CAGs) were associated with the presence of metabolic complications. Conclusions Our study offers evidence that the presence of overweight and obesity could impair the microbial diversity maturation associated with age. Furthermore, it provides novel results toward a better understanding of gut microbiota in the pediatric population that will ultimately help to develop therapeutic approaches to improve metabolic status.

Accelerometer epoch setting is decisive for associations between physical activity and metabolic health in children

ABSTRACTWhen analysing physical activity (PA) levels using accelerometry, the epoch setting is critical to capture intensity-specific PA correctly. The aim of the present study was to investigate the PA intensity signatures related to metabolic health in children using different epoch settings. A sample of 841 Norwegian children (age 10.2 ± 0.3 years; BMI 18.0 ± 3.0; 50% boys) provided data on accelerometry (ActiGraph GT3X+) and several indices of metabolic health (aerobic fitness, abdominal fatness, insulin sensitivity, lipid metabolism, blood pressure) that were used to create a composite metabolic health score. We created intensity spectra from 0–99 to ≥ 10000 counts per minute (cpm) for files aggregated using 1, 10, and 60-second epoch periods and used multivariate pattern analysis to analyse the data. The association patterns with metabolic health differed substantially between epoch settings. The intensity intervals most strongly associated with metabolic health were 7000–8000 cpm for data analysed using 1-second epoch, 5500–6500 cpm for data analysed using 10-second epoch, and 4000–5000 cpm analysed using 60-second epoch. Aggregation of data over different epoch periods has a clear impact on how PA intensities in the moderate and vigorous range are associated with childhood metabolic health.

1316-P: Adiponectin-Related Genetic Variation and Dietary Pattern Associations with Metabolic Health in Children across Weight Status: From a Large Cohort Study

Adiponectin and related genetic variants are associated with adipose tissue function and cardio-metabolic risks. Moreover, dietary patterns affect metabolic health partly through modulating secretion of adiponectin from adipose tissue. We aimed to examine interactions between adiponectin related genetic variants and dietary patterns on metabolic health in different weight status. Childhood lifestyle factors, adiponectin and six related genetic variants (loci in/near ADIPOQ, CDH13, WDR11FGF, CMIP and PEPD) from GWAS were assessed in 3,482 children aged 6-18 years from BCAMS cohort in 2004. In 2015, 352 of these individuals completed an in-depth follow-up examination. Being metabolically unhealthy was defined as having any metabolic syndrome component or a HOMA-IR≥3.0. In multiple models, rs6773957 at ADIPOQ locus (OR=1.25, 95% CI=1.08-1.46, P =0.004) and rs4783244 at adiponectin receptor CDH13 locus (OR=0.83, 95% CI =0.70-0.98, P =0.025) were significantly correlated with metabolic risks independent of adiponectin levels and life-style factors in normal weight children, and these associations were less obvious in overweight/obesity group. Moreover, we observed a significant interaction effect between rs6773957 and dietary patterns (P =0.008) for metabolic health in normal weight children. The adiponectin-decreasing allele at rs6773957 locus was associated with greater metabolic risks in response to unfavorable dietary patterns, while no significant genotype effect was found in healthy dietary patterns. Similar interaction was found in the subgroup analysis using longitudinal data (P=0.033). In conclusion, healthy dietary patterns might affect adiponectin gene expression, which may particularly improve adipose tissue function and metabolic health independently of weight change. ADIPOQ locus confers more metabolic risks in healthy dietary patterns when contrasted with adverse dietary patterns. Disclosure S. Gao: None. G. Li: None. S.M. Willi: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Roche Diagnostic USA. Research Support; Self; Jaeb Center for Health Research, National Institute of Allergy and Infectious Diseases, Sanofi-Aventis. Other Relationship; Self; National Institute of Diabetes and Digestive and Kidney Diseases. M. Li: None. Funding National Key Research and Development Program of China (2016YFC1304801); Key Program of Beijing Municipal Science &amp; Technology Commission (D111100000611001, D111100000611002); Beijing Natural Science Foundation (7172169); Beijing Science &amp; Technology Star Program (2004A027); Novo Nordisk (2011A002); National Key Program of Clinical Science (WBYZ2011-873); Chinese Academy of Medical Sciences (2017PT32020, 2018PT32001); Jingxi Scientific Program of Beijing Chaoyang Hospital (JXPY201606)

The Triaxial Physical Activity Signature Associated with Metabolic Health in Children.

The use of uniaxial summary measures from accelerometry (i.e., counts per minute or minutes spent in moderate-to-vigorous intensity) substantially restricts information about physical activity (PA), and is probably a result of reliance on analytic approaches that cannot handle collinear variables. In the present study, we aimed to determine the multivariate triaxial PA intensity signature related to metabolic health in children, by investigating associations of the whole spectra of PA intensities from all axes using multivariate pattern analysis. We included 841 children (age, 10.2 ± 0.3 yr; body mass index, 18.0 ± 3.0; 50% boys) from the Active Smarter Kids study conducted in Norway 2014 to 2015 providing valid data on accelerometry (ActiGraph GT3X+) and several indices of metabolic health (aerobic fitness, abdominal fatness, insulin sensitivity, lipid metabolism, blood pressure) that were used to create a composite metabolic health score. We created intensity spectra from 0 to 100 to ≥10,000 counts per minute for separate axes and used multivariate pattern analysis to analyze the data. The explained variance of metabolic health was 3.2% for counts per minute from the vertical axis, 17.0% for the vertical axis intensity spectrum, and 29.5% for the full model including all axes. Thus, including full triaxial intensity spectra improved the model for metabolic health tenfold compared with using overall PA (counts per minute) from the vertical axis only. The intensity signature associated with metabolic health differed across the axes. Our findings show that the three different axes carry distinct information about children's PA and the relation of PA to their health and demonstrate a great potential for triaxial accelerometry and a multivariate analytic approach to advance the field of PA epidemiology.

Low-calorie sweetener use, weight, and metabolic health among children: A mini-review.

A reduction in the consumption of added sugars and sugar-sweetened beverages (SSBs) is a key focus of public health recommendations for a healthy diet among children. One approach to lower added sugar intake is to instead use low-calorie sweeteners (LCSs), which contain no or few calories. Consumption of LCSs is increasing worldwide, with the most marked rise observed among children and adolescents. However, the extent to which LCS consumption is helpful or harmful for weight management is controversial, particularly when LCS consumption begins in childhood. Herein, we summarize the limited existing literature examining effects of paediatric LCS consumption on appetite, energy intake, and body weight. While positive associations between LCS consumption and weight gain are reported in observational analyses, the majority of intervention studies, some of which blinded children to the contents of the drinks, report benefits of LCSs for reducing excessive child weight gain. Several potential mechanisms have been proposed to explain LCS effects on body weight, including LCS-induced promotion of appetite and energy intake. Yet studies assessing effects of beverages with LCSs (LCSBs) compared with SSBs on child appetite report mixed findings. Some demonstrate that children completely compensate for the diluted energy content of LCSBs by eating more solid food calories at subsequent meals compared with children administered SSBs, while others report a reduction in total energy intake with LCSB ingestion. Given the limited studies and resulting uncertainty as to whether LCSs benefit or worsen weight and metabolic health in children is integral that effects of LCS use during childhood continue to be investigated in future prospective studies.

Physical activity in adolescents and children and relationship to metabolic health.

To summarize the recent developments relating to the role of physical activity in improving insulin resistance and metabolic syndrome in children and adolescents. The current literature strengthens previous findings on the relationship between physical activity and metabolic health in children; suggests a protective role for physical activity in the setting of obesity; examines population-specific findings; addresses specific effects of different modalities of physical activity in improving health; reveals potential mediators in the relationship between physical activity and metabolic health; and suggests new markers of metabolic health that could potentially be used as outcomes in future physical activity studies. Recent research generally confirms the role of physical activity in decreasing insulin resistance and metabolic syndrome in children and adolescents. However, the current literature is limited by unstandardized research methods and definitions, and also aggregation of different age groups, genders, and weight status. Future research should address these issues to offer targeted physical activity interventions.

Impact of early events and lifestyle on the gut microbiota and metabolic phenotypes in young school-age children

BackgroundThe gut microbiota evolves from birth and is in early life influenced by events such as birth mode, type of infant feeding, and maternal and infant antibiotics use. However, we still have a gap in our understanding of gut microbiota development in older children, and to what extent early events and pre-school lifestyle modulate the composition of the gut microbiota, and how this impinges on whole body metabolic regulation in school-age children.ResultsTaking advantage of the KOALA Birth Cohort Study, a long-term prospective birth cohort in the Netherlands with extensive collection of high-quality host metadata, we applied shotgun metagenomics sequencing and systematically investigated the gut microbiota of children at 6–9 years of age. We demonstrated an overall adult-like gut microbiota in the 281 Dutch school-age children and identified 3 enterotypes dominated by the genera Bacteroides, Prevotella, and Bifidobacterium, respectively. Importantly, we found that breastfeeding duration in early life and pre-school dietary lifestyle correlated with the composition and functional competences of the gut microbiota in the children at school age. The correlations between pre-school dietary lifestyle and metabolic phenotypes exhibited a striking enterotype dependency. Thus, an inverse correlation between high dietary fiber consumption and low plasma insulin levels was only observed in individuals with the Bacteroides and Prevotella enterotypes, but not in Bifidobacterium enterotype individuals in whom the gut microbiota displayed overall lower microbial gene richness, alpha-diversity, functional potential for complex carbohydrate fermentation, and butyrate and succinate production. High total fat consumption and elevated plasma free fatty acid levels in the Bifidobacterium enterotype are associated with the co-occurrence of Streptococcus.ConclusionsOur work highlights the persistent effects of breastfeeding duration and pre-school dietary lifestyle in affecting the gut microbiota in school-age children and reveals distinct compositional and functional potential in children according to enterotypes. The findings underscore enterotype-specific links between the host metabolic phenotypes and dietary patterns, emphasizing the importance of microbiome-based stratification when investigating metabolic responses to diets. Future diet intervention studies are clearly warranted to examine gut microbe-diet-host relationships to promote knowledge-based recommendations in relation to improving metabolic health in children.

The multivariate physical activity signature associated with metabolic health in children

BackgroundPhysical activity is a cornerstone for promoting good metabolic health in children, but it is heavily debated which intensities (including sedentary time) are most influential. A fundamental limitation to current evidence for this relationship is the reliance on analytic approaches that cannot handle collinear variables. The aim of the present study was to determine the physical activity signature related to metabolic health in children, by investigating the association pattern for the whole spectrum of physical activity intensities using multivariate pattern analysis.MethodsWe used a sample of 841 children (age 10.2 ± 0.3 years; BMI 18.0 ± 3.0; 50% boys) from the Active Smarter Kids study, who provided valid data on accelerometry (ActiGraph GT3X+) and several indices of metabolic health (aerobic fitness, abdominal fatness, insulin sensitivity, lipid metabolism, blood pressure) that were used to create a composite metabolic health score. We created 16 physical activity variables covering the whole intensity spectrum (from 0–100 to ≥ 8000 counts per minute) and used multivariate pattern analysis to analyze the data.ResultsPhysical activity intensities in the vigorous range (5000–7000 counts per minute) were most strongly associated with metabolic health. Moderate intensity physical activity was weakly related to health, and sedentary time and light physical activity were not related to health.ConclusionsThis study is the first to determine the multivariate physical activity signature related to metabolic health in children across the whole intensity spectrum. This novel approach shows that vigorous physical activity is strongest related to metabolic health. We recommend future studies adapt a multivariate analytic approach to further develop the field of physical activity epidemiology.Trial registrationThe study was registered in Clinicaltrials.gov (www.clinicaltrials.gov) 7th of April 2014 with identification number NCT02132494.

Associations of volumes and patterns of physical activity with metabolic health in children: A multivariate pattern analysis approach

Physical activity (PA) favorably affects metabolic health in children, but it is unclear how total volumes versus patterns (bouts and breaks) of PA relate to health. By means of multivariate pattern analysis that can handle collinear variables, we determined the associations of PA volumes and patterns with children's metabolic health using different epoch settings. A sample of 841 Norwegian children (age 10.2 ± 0.3 years) provided in 2014 data on accelerometry (ActiGraph GT3X+), using epoch settings of 1, 10, and 60 s and several indices of metabolic health used to create a composite metabolic health score. We created 355 PA indices covering the whole intensity and bout duration spectrum, and used multivariate pattern analysis to analyze the data. Findings showed that bouts of PA added information about childhood health beyond total volumes of PA for all epoch settings. Yet, associations of PA patterns with metabolic health were completely dependent on the epoch settings used. Vigorous PA was strongly associated with metabolic health, while associations of light and moderate PA were weak to moderate, and associations of sedentary time with metabolic health was non-existing. Short intermittent bursts of PA were favorably associated with children's metabolic health, whereas associations of prolonged bouts were weak. This study is the first to determine the multivariate physical activity association pattern related to metabolic health in children across the whole PA intensity and bout duration spectrum. The findings challenge our understanding of PA patterns, and are of major importance for the analysis of accelerometry data.

Aerobic fitness and metabolic health in children: A clinical validation of directly measured maximal oxygen consumption versus performance measures as markers of health.

High aerobic fitness is consistently associated with a favorable metabolic health profile in children. However, measurement of oxygen uptake, regarded as the gold standard for evaluating aerobic fitness, is often not feasible. Thus, the aim of the present study was to perform a clinical validation of three measures of aerobic fitness (peak oxygen consumption [VO2peak] and time to exhaustion [TTE] determined from a graded treadmill protocol to exhaustion, and the Andersen intermittent running test) with clustered metabolic health in 10-year-old children. We included 93 children (55 boys and 38 girls) from Norway during 2012–2013 in the study. Associations between aerobic fitness and three different composite metabolic health scores (including lipoprotein subgroup particle concentrations, triglyceride, glucose, systolic blood pressure, and waist-to-height ratio) were determined by regression analyses adjusting for sex. The relationships among the measures of aerobic fitness were r = 0.78 for VO2peak vs. TTE, r = 0.63 for VO2peak vs. the Andersen test, and r = 0.67 for TTE vs. the Andersen test. The Andersen test showed the strongest associations across all markers of metabolic health (r = − 0.45 to − 0.31, p < 0.002), followed by VO2peak (r = − 0.35 to − 0.12, p < 0.256), and TTE (r = − 0.28 to − 0.10, p < 0.334). Our findings indicate that indirect measures of aerobic fitness do not stand back as markers of metabolic health status in children, compared to VO2peak. This is of great importance as good field tests provide opportunities for measuring aerobic fitness in many settings where measuring VO2peak are impossible.

An intervention to promote physical activity in Mexican elementary school students: building public policy to prevent noncommunicable diseases.

Physical activity is an important component of strategies for health promotion and prevention of noncommunicable diseases. It is also associated with decreased risk for cardiovascular disease in overweight and obese adults and children. This article addresses the initial description of a physical activity intervention for children attending public elementary schools in Mexico. The objective was to develop a replicable model based on a strategic public, private, academic, and social partnership that would have a short-term impact on the metabolic health of children and be useful for building effective public policy. Forty-nine schools (20000 students) participated, and 5 schools were selected for evaluation. The intervention included a 30-minute supervised middle-effort interchangeable routine, 5 days a week for a complete school year, adapted for different school conditions and students of different ages. Evaluation included anthropometric measurements and biochemical markers. Actual prevalence of combined overweight and obesity in these children was 31.9%. The intervention was successfully implemented in all schools. No change in body mass index, waist circumference, or other anthropometric indicators was found. However, changes in biochemical markers showed a significant decrease in blood glucose, total cholesterol, and cholesterol-low-density lipoproteins, reflecting a positive effect on cardiovascular health indicators.

Erratum

Clinical ObesityVolume 5, Issue 5 p. 291-291 ErratumFree Access Erratum This article corrects the following: Physical activity, sleep duration and metabolic health in children fluctuate with the lunar cycle: science behind the myth A. Sjödin, M. F. Hjorth, C. T. Damsgaard, C. Ritz, A. Astrup, K. F. Michaelsen, Volume 5Issue 2Clinical Obesity pages: 60-66 First Published online: March 23, 2015 First published: 17 September 2015 https://doi.org/10.1111/cob.12117AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Physical activity, sleep duration and metabolic health in children fluctuate with the lunar cycle: science behind the myth A. Sjödin, M. F. Hjorth, C. T. Damsgaard, C. Ritz, A. Astrup and K. F. Michaelsen In the above-mentioned article, the authors have identified an error. Beta (95%CI) values from the log-transformed variables (HOMA-IR, Insulin, and Leptin) presented in Table 1 were incorrectly back-transformed. First, the estimated difference in HOMA-IR between full moon and half moon should not be 0.03 (95% CI: 0.005;0.05) as stated in the article but instead be 0.08 (95% CI: 0.01;0.14) and the estimated difference in HOMA-IR between full moon and new moon should not be 0.05 (95% CI: 0.02;0.08) as stated in the article but instead be 0.14 (95% CI: 0.05;0.22). Secondly, the estimated difference in Insulin between full moon and half moon should not be 0.09 (95% CI: 0.004;0.18) as stated in the article but instead be 1.85 (95% CI: 0.08;3.62) and the estimated difference in Insulin between full moon and new moon should not be 0.15 (95% CI: 0.03;0.27) as stated in the article but instead be 3.03 (95% CI: 0.64;5.41). Finally, the estimated difference in Leptin between full moon and half moon should not be 1.2 (95% CI: 0.5;1.8) as stated in the article but instead be 434 (95% CI: 191;676) and the estimated difference in Leptin between full moon and new moon should not be 0.7 (95% CI: −0.1;1.6) as stated in the article but instead be 276 (95% CI: −52;605). All p-values are unchanged. These changes do not change the overall conclusions of the article. Table 1. Behaviours and metabolic variables according to lunar phases (n = 751–793) Variables Observations Mean ± standard deviation or median (interquartile range) Full moona – half moonb beta (95 % CI) Full moona – new moonc beta (95 % CI) Behaviours Moderate-to-vigorous PA (min per day) 13 464 41 (21; 68) −5.0 (−6.5; −3.6)** −3.2 (−4.7; −1.7)** Light PA (min per day) 13 464 375 ± 80 0.1 (−3.0; 3.2) 1.7 (−1.4; 4.9) Sedentary time (min per day) 13 464 477 ± 99 1.4 (−2.6; 5.4) −1.9 (−6.0; 2.2) Sleep duration (min per night) 13 762 550 ± 49 2.4 (0.3; 4.4)* 4.1 (2.0; 6.2)** Metabolic variables HOMAIR 2005 1.46 (1.03; 2.05) 0.08 (0.01; 0.14)* 0.14 (0.05; 0.22)* Insulin (pmol L−1) 2005 43.8 (31.6; 60.5) 1.85 (0.08; 3.62)*e 3.03 (0.64; 5.41)* Glucose (mmol L−1) 2057 5.2 ± 0.5 0.05 (0.005; 0.10)*e 0.12 (0.06; 0.18)** Mean arterial blood pressure (mmHg) 2148 79.5 ± 6.0 0.6 (0.1; 1.1)* 0.8 (0.2; 1.4)* Diastolic blood pressure (mmHg) 2148 66.0 ± 6.4 0.7 (0.2; 1.2)* 0.9 (0.3; 1.6)* Systolic blood pressure (mmHg) 2148 106.5 ± 7.6 0.4 (−0.2; 0.9) 0.4 (−0.3; 1.2) Ghrelin (pg mL−1) 2028 996 ± 383 −29 (−46; −13)** −5 (−28; 18) Leptin (pg mL−1)d 2017 4013 (2223; 8056) 434 (191; 676)** 276 (−52; 605) Data are presented as unstandardized regression coefficients (β) or % difference with 95% confidence intervals using a linear mixed model with school, class and subject as random effects and weekday, month, age, gender, Tanner stage, number of parents born in Denmark and highest education of parents as fixed factors. a Full moon ±4 d (Include 25 to 35% of the observations in all models). b ±5–9 d from full moon (Include 35 to 36% of the observations in all models). c ±10–14 d from full moon (Include 29 to 39% of the observations in all models). d Additionally adjusted for total body fat. e Significant associations vanished after Bonferroni adjustments. *P < 0.05; **P < 0.001 indicate significant difference from full moon ±4 d. HOMAIR, homeostatic model assessment of insulin resistance; PA, physical activity. Reference Sjödin A, Hjorth MF, Damsgaard CT, Ritz C, Astrup A, Michaelsen KF. Physical activity, sleep duration and metabolic health in children fluctuate with the lunar cycle: science behind the myth. Clin Obes 2015; 5: 60– 66. Volume5, Issue5October 2015Pages 291-291 ReferencesRelatedInformation

Metabolic Health in Short Children Born Small for Gestational Age Treated With Growth Hormone and Gonadotropin-Releasing Hormone Analog: Results of a Randomized, Dose-Response Trial.

Previously we showed that pubertal children born small for gestational age (SGA) with a poor adult height (AH) expectation can benefit from treatment with GH 1 mg/m(2) per day (∼ 0.033 mg/kg/d) in combination with 2 years of GnRH analog (GnRHa) and even more so with a double GH dose. GnRHa treatment is thought to have negative effects on body composition and blood pressure. Long-term effects and GH-dose effects on metabolic health in children treated with combined GH/GnRHa are unknown. This study aimed to investigate body composition, blood pressure, and lipid profile during GH treatment, either with or without 2 years of additional GnRHa. To assess whether GH 2 mg/m(2) per day (∼ 0.067 mg/kg/d) results in a similar or even more favorable metabolic health at AH than GH 1 mg/m(2) per day. This was a longitudinal, randomized, dose-response GH trial involving 107 short SGA children (58 girls) treated with GH until AH (GH randomized 1 or 2 mg/m(2)/d during puberty). Sixty-four children received additional GnRHa. At AH, metabolic parameters were compared between children treated with combined GH/GnRHa and those with only GH. The GH dose effect on metabolic health was evaluated in a subgroup of 47 children who started GH treatment in early puberty (randomized 1 or 2 mg/m(2)/d) with 2 years of GnRHa. At AH, fat mass percentage (FM%) SD score (SDS), lean body mass (LBM) SDS, blood pressure SDS, and lipid profile were similar between children treated with combined GH/GnRHa and those with only GH. In the pubertal subgroup, FM% SDS was lower during treatment with GH 2 mg/m(2) per day. There was no GH dose-dependent effect on LBM SDS, blood pressure, and lipid profile. Combined GH/GnRHa treatment has no long-term negative effects on metabolic health compared with only GH. Started in early puberty, a GH dose of 2 mg/m(2) per day results in a similar metabolic health at AH and a more favorable FM% than GH 1 mg/m(2) per day.

Physical activity, sleep duration and metabolic health in children fluctuate with the lunar cycle: science behind the myth

Behaviours of several animal species have been linked to lunar periodicity. Evidence for such links in humans is weak; however, recently, shorter sleep duration was reported around full moon in two small samples of adults. As restrictions in sleep duration have been shown to adversely affect glucose regulation and physical activity to improve glucose regulation, one could speculate that cardiometabolic risk factors might also be affected by the lunar phase. We retrospectively examined 795 Danish children, aged 8–11 years, with more than 13 000 24-h accelerometer recordings of activity and sleep as well as 2000 measurements of different cardiometabolic risk factors, including insulin sensitivity, appetite hormones and blood pressure, during nine lunar phases. During the period around full moon, children were 5.0 and 3.2 min per day less active, slept 2.4 and 4.1 min per night longer, had 0.03 and 0.05 higher homeostatic model assessment of insulin resistance and 0.6 and 0.8 mmHg higher mean arterial blood pressure compared with days around half moon and new moon, respectively (all P ≤ 0.02). Furthermore, ghrelin was lower and leptin was higher during the period around full moon compared with days around half moon (both P < 0.001). The results suggest that physical activity rather than sleep is responsible for the metabolic alterations observed around full moon. However, we have no understanding of potential mechanisms that may mediate a potential true link between childhood behaviour and the lunar cycle or confounders that may explain this, apparently leading to fluctuation in a number of cardiometabolic risk markers conjointly with lunar phases.

Effects of protein intake on blood pressure, insulin sensitivity and blood lipids in children: a systematic review.

High protein intake in early childhood is associated with obesity, suggesting possible adverse effects on other cardiometabolic outcomes. However, studies in adults have suggested beneficial effects of protein intake on blood pressure (BP) and lipid profile. Whether dietary protein intake is associated with cardiovascular and metabolic health in children is unclear. Therefore, we aimed to systematically review the evidence on the associations of protein intake with BP, insulin sensitivity and blood lipids in children. We searched the databases Medline, Embase, Cochrane Central and PubMed for interventional and observational studies in healthy children up to the age of 18 years, in which associations of total, animal and/or vegetable protein intake with one or more of the following outcomes were reported: BP; measures of insulin sensitivity; cholesterol levels; or TAG levels. In the search, we identified 6636 abstracts, of which fifty-six studies met all selection criteria. In general, the quality of the included studies was low. Most studies were cross-sectional, and many did not control for potential confounders. No overall associations were observed between protein intake and insulin sensitivity or blood lipids. A few studies suggested an inverse association between dietary protein intake and BP, but evidence was inconclusive. Only four studies examined the effects of vegetable or animal protein intake, but with inconsistent results. In conclusion, the literature, to date provides insufficient evidence for effects of protein intake on BP, insulin sensitivity or blood lipids in children. Future studies could be improved by adequately adjusting for key confounders such as energy intake and obesity.