Effect of intense exercise on inflammatory cytokines and growth mediators in adolescent boys

Immunological and growth mediator response to cross-country training in adolescent females

BACKGROUND

Exercise affects growth and development through a complex interaction between the endocrine, immune, and nervous systems. To date very little is known about how these systems respond to exercise in children or adolescents. Moreover, there are few studies that have examined growth factors, pro-inflammatory cytokines, and peripheral blood mononuclear cell responses to 'real-life' or field exercise solely in girls.

AIM

To determine the acute exercise-induced alterations in the growth hormone (GH)-insulinlike growth factor-I (IGF-I) axis, inflammatory cytokines, and certain aspects of immune function (white blood cell [WBC] subpopulations and their associated adhesion molecules) in a group of adolescent girls following a typical cross country practice.

METHODS

Eight, healthy, postpubertal, high school females, 15-18 years old, performed a single, typical, one hour cross-country practice session. Blood was sampled before and after the session.

RESULTS

Following exercise, lactate increased by 364 +/- 67% (p < 0.001). Significant increases were noted in circulating IL-6 (p < 0.023), TNF-alpha (p < 0.027), IL-1beta (p < 0.047) and IL-1ra (p < 0.002), as well as a substantial increase in GH (p < 0.007). The exercise led to significant increases in all WBC subpopulations and platelets. The most significant changes were observed for natural killer cells (p < 0.0005). The exercise significantly influenced adhesion molecules (such as CD62L, CD54).

CONCLUSIONS

These data demonstrate that an intense exercise bout in adolescent females leads to profound increases in inflammatory cytokines, with substantial changes in WBC and adhesion molecules. The role of these frequent, almost-daily perturbations on growth, development and immunity has yet to be determined.

Effect of local cold-pack application on systemic anabolic and inflammatory response to sprint-interval training: a prospective comparative trial

We evaluated the effect of cold ice-pack application following a brief sprint-interval training on the balance between anabolic mediators [growth hormone (GH), insulin-like growth factor-I (IGF-I), testosterone], catabolic markers (cortisol, IGFBP-1), and circulating pro [Interlukin-6 (IL-6) and IL-1β]- and anti-inflammatory cytokines [IL-1 receptor antagonist (IL-1ra)]. Twelve males, elite junior handball players performed 4 × 250 m treadmill run, at 80% of each individual’s maximal speed, followed by a rest period with and without local cold-pack application. Pre, immediately post, and 60-min post-exercise blood samples were drawn. Exercise was associated with a significant increase in IL-6, GH, IGFBP-3, and testosterone levels. Local cold-pack application was associated with significant decreases in IL-1β, IL-1ra, IGF-I, and IGFBP-3 and a greater increase of IGFBP-1 during recovery. Local ice therapy immediately following sprint-interval training was associated with greater decreases in both pro- and anti-inflammatory cytokines and anabolic hormones supporting some clinical evidence for possible negative effects on athletic performance.

The effect of a brief sprint interval exercise on growth factors and inflammatory mediators

Exercise training efficiency depends on the intensity, volume, duration, and frequency of training, as well as on the athlete's ability to tolerate it. Recent efforts to quantify the effects of aerobic exercise training on hormonal response have suggested that exercise leads to simultaneous changes of antagonistic mediators. The effects of anaerobic exercise on these mediators are not known. Therefore, the aim of the present study was to evaluate the effects of a brief sprint interval session on the balance between anabolic (growth hormone [GH]--> insulin-like growth factor [IGF]-I axis) and catabolic hormones (cortisol), and circulating inflammatory cytokines such as interleukin (IL)-6. Twelve healthy elite junior handball players (17-20 years) participated in the study. Exercise consisted of a 4 x 250-m run on a treadmill, at a constant intensity of 80% of the personal maximal speed. Each run was separated by 3 minutes of rest. Blood samples were collected before, immediately after each 250-m run, and 1 hour after the last run. Exercise led to significant increases in GH (0.3 +/- 0.2 to 5.1 +/- 2.2 ngxml, p < 0.05), IGF binding protein (IGFBP)-3 (4191 +/- 2.48 to 4875 +/- 301 ngxml, p < 0.05), IL-6 (1.3 +/- 0.2 to 2.1 +/- 0.3 pgxml, p < 0.002), testosterone, and testosterone/cortisol ratio, and to a significant decrease in IGFBP-1 levels. Levels of IL-6 remained elevated 1 hour after the end of exercise. Exercise had no significant effects on IGF-I and cortisol levels. Changes in the GH-IGF-I axis and testosterone/cortisol ratio after the brief sprint interval exercise suggested exercise-related anabolic adaptations. The increase in IL-6 may indicate its important role in muscle tissue repair after anaerobic exercise. Changes in the anabolic-catabolic hormonal balance and in inflammatory mediators can be used as an objective tool to gauge the training intensity of different types of anaerobic exercises and training periods.

Altered kinetics of interleukin-6 and other inflammatory mediators during exercise in children with type 1 diabetes

BACKGROUND

Leukocyte mobilization and secretions of cytokines, chemokines, and growth factors in children during exercise are necessary biochemical signals for physiological growth and long-term cardiovascular protection. Because of glycemic instability, altered exercise responses, particularly the proinflammatory cytokine interleukin (IL)-6, may occur in type 1 diabetes mellitus (T1DM) that could influence the onset/progression of diabetic vascular complications. Relatively little is known, however, on most molecular aspects of immunomodulatory adaptation to exercise in diabetic children.

METHODS

We therefore studied 21 children (age, 13.4 +/- 0.3 years; 13 boys/8 girls) with T1DM and 21 age-matched healthy controls during 30 minutes of intense and intermittent cycling exercise. Euglycemia was maintained during and for greater than 90 minutes before exercise; blood samples for IL-6 and other cytokines/chemokines were drawn before, during (every 6 minutes), and after (every 15 minutes) exercise.

RESULTS

In T1DM, exercise-induced IL-6 peak occurred earlier and with greater magnitude than that in controls; an exploratory analysis of additional inflammatory mediators displayed a similarly accelerated/exaggerated pattern in T1DM, including the kinetic profiles of tumor necrosis factor alpha, IL-4, IL-12p70, IL-17, granulocyte-monocyte colony-stimulating factor, monocyte chemoattractant protein-1, macrophage inflammatory protein-1alpha, and eotaxin (interferon-inducible protein-10 was the only measured variable essentially indistinguishable between groups).

CONCLUSION

Therefore, during intense and intermittent exercise, significant alterations in the immunologic pattern of inflammatory regulation occurred in children with T1DM as compared with healthy controls. Our findings underscore how the understanding of all the underlying molecular mechanisms is a necessary prerequisite for achieving effective use of exercise and the full manifestation of its health benefits, particularly in understudied populations such as children with T1DM who are at increased risk for cardiovascular complications.

Impacto da atividade física e esportes sobre o crescimento e puberdade de crianças e adolescentes

OBJETIVO: Apresentar revisão atualizada e crítica sobre o impacto do esporte e da atividade física no crescimento, desenvolvimento puberal e mineralização óssea de crianças e adolescentes. FONTES DE DADOS: Pesquisa bibliográfica nos bancos de dados Medline e Lilacs (1987-2007), selecionando os artigos escritos em inglês, português ou espanhol, a partir dos descritores "esportes" e "exercícios", em combinação com "crescimento", "puberdade" e "mineralização óssea". Foram examinados 252 artigos e 48 deles selecionados. SÍNTESE DOS DADOS: Diferentes modalidades esportivas não aumentam ou diminuem a estatura. Ocorre um viés de seleção, no qual fatores constitucionais determinam a seleção de biótipos privilegiados para determinados esportes. O exercício físico leve a moderado estimula o crescimento e deve ser incentivado. A atividade física extenuante, principalmente quando associada à restrição dietética, afeta o crescimento, o desenvolvimento puberal, a função reprodutiva e a mineralização óssea. A musculação praticada por jovens pré-púberes pode ser prejudicial, se não for realizada sob supervisão, já que há um potencial risco de lesão na cartilagem de crescimento. Entretanto, quando bem supervisionada, pode levar a um aumento de força e resistência muscular. CONCLUSÕES: Os efeitos deletérios dos esportes sobre o crescimento e desenvolvimento só foram observados em atletas de elite submetidos a treinamento intensivo e restrição alimentar. Alterações hormonais e de citocinas inflamatórias são parte da fisiopatologia desse processo. É necessário que estudos longitudinais avaliem as repercussões da atividade física recreacional sobre a estatura final.

Fat and carbohydrate metabolism during submaximal exercise in children

During exercise, the contribution of fat and carbohydrate to energy expenditure is largely modulated by the intensity of exercise. Age, a short- or long-term diet enriched in carbohydrate or fat substrate stores, training and gender are other factors that have also been found to affect this balance. These factors have been extensively studied in adults from the perspective of improving performance in athletes, or from a health perspective in people with diseases. During the last decade, lifestyle changes associated with high-energy diets rich in lipid and reduced physical activity have contributed to the increase in childhood obesity. This lifestyle change has emerged as a serious health problem favouring the early development of cardiovascular diseases, insulin resistance or type 2 diabetes mellitus. Increasing physical activity levels in young people is important to increase energy expenditure and promote muscle oxidative capacity. Therefore, it is surprising that the regulation of balance between carbohydrate and lipid use during exercise has received much less attention in children than in adults. In this review, we have focused on the factors that affect carbohydrate and lipid metabolism during exercise and have identified areas that may be relevant in explaining the higher contribution of lipid to energy expenditure in children when compared with adults. Low muscle glycogen content is possibly associated with a low activity of glycolytic enzymes and high oxidative capacity, while lower levels of sympathoadrenal hormones are likely to favour lipid metabolism in children. Changes in energetic metabolism occurring during adolescence are also dependent on pubertal events with an increase in testosterone in boys and estrogen and progesterone in girls. The profound effects of ovarian hormones on carbohydrate and fat metabolism along with their effects on oxidative enzymes could explain that differences in substrate metabolism have not always been observed between girls and women. Finally, although the regulatory mechanisms of fat and carbohydrate balance during exercise are quite well identified, there are a lack of data specific to children and most of the evidences reported in this review were drawn from studies in adults. Isotope tracer techniques and nuclear magnetic resonance will allow non-invasive investigation of the metabolism of the different substrate sources in skeletal muscle.

The association between insulin resistance and cytokines in adolescents: the role of weight status and exercise

Increased adiposity is associated with insulin resistance (IR) and an inflammatory response in adults. We tested the hypotheses that cytokines associated with adiposity are also correlated with IR in early adolescents and that these relationships are moderated by weight status, levels of vigorous physical activity (VPA), or maximal aerobic power (pVO2max). Body mass, stature, and a fasting blood sample were obtained from 120 midpubertal adolescents (60 girls and 60 boys). Habitual VPA was obtained by a survey. Predicted VO2max was determined using a cycle ergometer test. Weight status was based on body mass index (BMI) percentiles (normal weight=BMI<75th percentile, overweight=BMI>95th percentile). Glucose, insulin, adiponectin, resistin, tumor necrosis factor-alpha (TNF-alpha), and interleukin-6 were measured; and IR index was based on the Homeostatic Model Assessment. Adiponectin, resistin, and TNF-alpha were associated with IR in all adolescents (R2=0.329, P<.001; R2=0.152, P=.001; and R2=0.141, P=.002; respectively); but interleukin-6 was not (R2=0.148, P=.114). The degree of association between adiponectin and IR was stronger in overweight than in normal-weight adolescents (P<.050). When regression models included weight status, neither TNF-alpha nor resistin was significantly related to IR (P>.050). Exercise did not moderate the association between these cytokines and IR. However, higher levels of VPA and/or pVO2max were associated with higher adiponectin, lower resistin, and lower TNF-alpha in at least one of the sexes. Our results indicate that the pathophysiology of obesity is already established in early adolescents. Increased adiposity, resulting in reduced adiponectin and increased resistin and TNF-alpha, may link these cytokines with IR in adolescents.

A pediatric perspective on inflammation and oxidative stress in response to exercise

Dr. Oded Bar-Or was a giant in the area of pediatric exercise science and made numerous contributions to the health of children around the world. He also had a significant impact on a relatively new area of pediatric exercise science — pediatric exercise immunology. Under his supervision, some aspects of the immunobiology of exercise have been unravelled from a pediatric perspective. In general, healthy children experience less inflammatory stress in response to standardized exercise, while demonstrating an exercise-induced elevation in the anabolic cytokine IL-8. Mechanisms for the maturity- and age-dependent changes in cytokine responses to exercise are unknown, but may involve oxidative stress. Studies of oxidative stress and exercise in children are scant, but preliminary data suggests that, like the inflammatory cytokine response to exercise, children may experience less oxidative stress in response to intense exercise. We propose that the links between exercise, inflammatory and oxidative stress, and growth factors will be important to understand in the context of how exercise contributes to optimal growth and development during childhood. This understanding will be particularly relevant for childhood diseases that restrict growth.

Lack of sex differences in the IGF-IGFBP response to ultra endurance exercise

The insulin-like growth factor (IGF)-IGF binding proteins (BP) and the pituitary-gonadal axes were investigated during ultra endurance exercise in 16 endurance-trained athletes (seven women). Median duration of the race was 6.3 days. Although food and drink were ad libitum, energy balance was negative. Blood samples were drawn before (PRE), at the end of (END) and 24 h after (POST24h) the race. Serum concentrations of total IGF-I (t-IGF-I) and free IGF-I (f-IGF-I) decreased by 33 (SD 38)% and 54 (19)%, respectively. The decrease in t-IGF-I appeared to be associated to the total energy deficit during the race. At END, the IGFBP-3 fragmentation and IGFBP-1 were increased but these changes did not predict changes in f-IGF-I. An increase in POST24h IGFBP-2 levels in women was the only sex difference. Testosterone was decreased by 67 (12)% in the men and estradiol became undetectable in the women without any detectable increase in LH and/or FSH. In conclusion ultra endurance exercise results in similar IGF-IGFBP responses in men and women reflecting a catabolic state. IGFBP-2 was the only exception, with increased levels in women after exercise. A concomitant decrease in gonadal hormones was not related to endocrine changes in the IGF-IGFBP axis but may be related to local changes in IGF-I expression.

Kinetic profiles of 18 systemic pro- and anti-inflammatory mediators during and following exercise in children

While acute changes in systemic pro-/antiinflammatory cytokines occur with exercise, individual kinetics during and following exercise remain unclear; particularly, information is scarce regarding children. This study investigated the exercise-induced kinetic profiles of major pro-/anti-inflammatory mediators in 21 healthy children (13.9 +/- 0.8 yr, 7 M/14 F). Exercise was 30 min of intermittent cycling at approximately 80% VO2max. Multiple blood samples were drawn at baseline, during, and following exercise for cytokines assay. IL-1alpha, IL-6, IL-17, IL-8, IP-10, MIP-1alpha, and MIP-1beta initially decreased (nadir: 14-19 min into exercise) and subsequently exceeded baseline levels (peaks: 20-24 min into exercise). TNF-alpha, IL-12p70, IL-1RA, IL-4, EGF, TGF-alpha, GM-CSF, Eotaxin, and MCP-1 were moderately and persistently decreased throughout. VEGF was unchanged; sCD40L was elevated during exercise and recovery. Our results indicate that key immunomodulators display non-linear, biphasic kinetic profiles in response to exercise, suggesting that detection of exercise-induced changes over baseline may depend on exercise duration and sampling timing.

Calpain proteolysis of insulin-like growth factor binding protein (IGFBP) -2 and -3, but not of IGFBP-1

Calpains are cytoplasmic Ca(2+)-regulated cysteine proteases that may regulate insulin-like growth factor (IGF)-independent actions of insulin-like growth factor binding proteins (IGFBPs) through IGFBP proteolysis. In this study, [(125)I]-labeled IGFBP-2 and -3, but not IGFBP-1, were proteolyzed by Ca(2+)-activated m-calpain in vitro. Degradation of higher concentrations of the recombinant proteins IGFBP-2 and -3 by m-calpain was dose-dependent, but was terminated within 20 min by autolysis. By subjecting proteolytic fragments to N-terminal amino acid sequence analysis, the primary cleavage sites in IGFBP-2 and -3 were localized to the non-conserved central linker regions. Using the biosensor technique, in vitro binding of m-calpain to IGFBP-3 was demonstrated to be a Ca(2+)-dependent reaction with a rapid on/off rate.

The effect of brief exercise on circulating CD34+ stem cells in early and late pubertal boys

We tested the hypothesis that exercise could stimulate CD34+ peripheral blood hematopoietic stem cells (PBSC) in children. Fourteen early pubertal boys (EP, age 10.3 +/- 0.3 y) and 13 late pubertal boys (LP, age 16.5 +/- 0.4 y) performed 20 min of moderate-to-vigorous cycle ergometer exercise. Blood was drawn before and after exercise. Cells were stained for surface CD34+. Plasma granulocyte colony stimulating factor (G-CSF), Fms-like tyrosine kinase-3 (FLT-3), and stromal cell-derived factor-1 (SDF-1) were measured using ELISA. Exercise substantially increased PBSC (in EP from 112 +/- 21 to 182 +/- 30 cells/microL, p=0.0007; in LP from 63 +/- 8 to 152 +/- 21, p=0.0008), and to a smaller extent FLT-3 (in EP from 98 +/- 5 to 110 +/- 6 pg/mL, p<0.0001; in LP from 73 +/- 6 to 92 +/- 6, p<0.0001) and G-CSF (in EP from 26 +/- 4 to 29 +/- 4 pg/mL, p<0.0001; in LP from 14 +/- 1 to 18 +/- 1, p<0.0001). Baseline levels of PBSC, FLT-3, and G-CSF were significantly higher in EP. Exercise increased SDF-1 alpha only in LP, and the FLT-3 increase was greater in LP than EP. Brief exercise affects PBSC and PBSC mediators in children.

Local changes in the insulin-like growth factor system in human skeletal muscle assessed by microdialysis and arterio-venous differences technique

IGF-I plays a direct role in whole body glucose homeostasis primarily by stimulating skeletal muscle glucose uptake. IGF-I is also involved in exercise induced muscle hypertrophy. Knowledge regarding local changes in muscle IGF-I bioavailability and its regulation by IGFBPs at rest and during exercise is limited. We have therefore explored changes in total IGF-I levels as well as circulating IGFBP levels and their post-translational modifications over an exercising leg. For the first time we have determined IGF-I levels in exercising skeletal muscle microdialysate in an attempt to assess local IGF-I bioavailability. Eighteen healthy young men performed one legged knee-extension exercise during 45min. Blood samples were taken from the femoral artery and vein of the exercising leg. No significant differences between arterial and venous concentrations of total IGF-I or IGFBP-1 were detected over the leg at any time. IGF-I concentrations increased significantly during exercise in the artery but not in the vein. Total IGFBP-1 increased after exercise in both artery and vein. The increase in non-plus less phosphorylated forms of IGFBP-1 was less pronounced and did not reach statistical significance. The proportion of fragmented IGFBP-3 (IGFBP-3 proteolysis) assessed by Western immunoblotting did not change significantly during or after exercise. Although optimization and validation of IGF-I determinations in muscle microdialysate (md) will be required, our first results using this technique demonstrate a significant 2-fold increase in mdIGF-I collected during and after exercise. We conclude that determination of A-V-differences appears to be of limited value in the assessments of local muscle change in the IGF-system. A substantial release of IGF-I during short time is required to detect significant change in the large circulating store of IGF-I. We suggest that an optimized and validated microdialysis technique for determination of local IGF-I may be advantageous in future studies.

Effect of rhIL-6 infusion on GH-->IGF-I axis mediators in humans

Exercise leads to simultaneous increases in mediators signaling apparently antagonistic functional responses such as growth factors and inflammatory mediators. The aim of the present study was to demonstrate the physiological effect of IL-6 on circulating components of the growth hormone (GH)-insulin-like growth factor-I (IGF-I) axis. Twelve men (ages 26 +/- 2 yr) were divided into two groups (n = 6 in each group), receiving either albumin or recombinant human (rh) IL-6 infusion. IL-6 was infused via an antecubital vein, and a contralateral antecubital vein was used for blood sampling. The IL-6 dose was chosen to reach plasma levels of IL-6 characteristic of intense exercise (5 microg/h, for 3 h, resulting in plasma levels of 100 pg/ml). Blood samples for GH, GH binding protein, IGF-I, and IGF binding protein (IGFBP)-1 and -3 were collected at baseline, 30 min, and 1, 2, 3, 4, 5, and 8 h after the beginning of the rhIL-6 infusion. IL-6 levels increased only in the rhIL-6-infused group (P < 0.0005) and returned to baseline after the infusion was stopped. IL-6 infusion led to a significant increase in GH, peaking 1 h after the beginning of infusion (P < 0.001). A decrease in total IGF-I levels was noted only in the rhIL-6-infused group (P < 0.027). An initial decrease in IGFBP-1 levels was noted in both groups during infusion (P < 0.03). Following the initial decrease, there was a significant increase in IGFBP-1 levels only in the IL-6-infused participants, peaking at 2 after the infusion cessation (P < 0.001). IL-6 infusion had no effect on GH binding protein, IGFBP-3, and acid-labile subunit levels. rhIL-6 levels similar to the levels found after strenuous exercise induced a typical exercise-associated GH-->IGF-I axis response (increase GH, decreased IGF-I, and elevated IGFBP-1). The results suggest that IL-6 plays a role in the GH-->IGF-I response to intense exercise.

Immunological changes in response to exercise: influence of age, puberty, and gender

PURPOSE

This study tested the hypothesis that exercise-induced perturbation and recovery of the immune system would vary with age, puberty, and gender in healthy children and adolescents.

METHODS

Twelve-year-old girls (YG; N = 14) and boys (YB; N = 20), and 14-yr-old girls (OG; N = 11) and boys (OB; N = 13) cycled for 60 min at 70% VO2max. Blood was collected before, at 30 and 60 min of exercise, and at 30 and 60 min of recovery to measure total leukocytes, leukocyte and lymphocyte subsets, and cytokines. Age and pubertal (Tanner stage) effects within genders and gender effects within age and pubertal groups were determined.

RESULTS

Exercise-induced increases in lymphocytes, CD3-CD16+CD56+ counts, and IL-6 were approximately 83, 90, and 390% greater in OG versus YG (P < 0.05). Recovery leukocytosis and neutrophilia were approximately 56 and 35% greater in OB versus YB (P < 0.05). Pubertal stage did not have a statistically significant influence on responses in girls, but the lowest pubertal stage consistently showed smaller changes in lymphocytes and CD3-CD16+CD56+ counts. Recovery neutrophilia was approximately 120% greater in postpubertal boys versus prepubertal or pubertal boys (P < 0.05). Responses of lymphocytes and CD3-CD16+CD56+ counts, respectively, were approximately 120 and 82% greater in OG versus OB (P < 0.05), with no differences between YG and YB. Exercise-induced increases in total leukocytes, lymphocytes, and CD3-CD16+CD56+ counts were at least 35% greater in girls versus boys of similar pubertal status (P < 0.05). Regardless of age, puberty, or gender, IL-8 levels were significantly higher during recovery versus rest (P < 0.05).

CONCLUSION

These results highlight the need to control for age, puberty, and gender when interpreting immunologic responses to exercise in a pediatric population.

Effect of a high-fat meal on the growth hormone response to exercise in children

Exercise-induced growth hormone (GH) secretion may significantly modulate growth and development in children. Altered physiological GH responses, therefore, may reduce the beneficial effects of exercise. High-fat food ingestion before exercise blunts the GH response in adults, but it is unknown whether this occurs in children. We therefore performed standard exercise tests, following a high-fat meal or placebo, in 12 children, age 11-15 (6 M, 6 F). GH, insulin-like growth factor-I, glucose, insulin, glucagon, cortisol, epinephrine and interleukin-6 samples were drawn at baseline, end-exercise, and 30 and 60 min post-exercise. While GH was similar at baseline in all experiments, the exercise-induced GH peak was lower after the high-fat meal (6.7 +/- 1.6 ng/l vs 11.8 +/- 2.4 ng/l, p <0.02). Other exercise responses were not affected by prior fat ingestion. A high-fat meal before exercise, therefore (a common event in Western societies), may reduce the growth factor response to exercise in children, with potential implications for growth and development.

Effect of prior hyperglycemia on IL-6 responses to exercise in children with type 1 diabetes

The proinflammatory cytokine interleukin-6 (IL-6) may modulate the onset and progression of complications of diabetes. As this cytokine increases after exercise, and many other exercise responses are altered by prior glycemic fluctuations, we hypothesized that prior hyperglycemia might exacerbate the IL-6 response to exercise. Twenty children with type 1 diabetes (12 boys/8 girls, age 12-15 yr) performed 29 exercise studies (30-min intermittent cycling at approximately 80% peak O2 uptake). Children were divided into four groups based on highest morning glycemic reading [blood glucose (BG) < 150, BG 151-200, BG 201-300, or BG > 300 mg/dl]. All exercise studies were performed in the late morning, after hyperglycemia had been corrected and steady-state conditions (plasma glucose < 120 mg/dl, basal insulin infusion) had been maintained for > or = 90 min. Blood samples for IL-6, growth factors, and counterregulatory hormones were drawn at pre-, end-, and 30 min postexercise time points. At all time points, circulating IL-6 was lowest in BG < 150 and progressively higher in the other three groups. The exercise-induced increment also followed a similar dose-response pattern (BG < 150, 0.6 +/- 0.2 ng/ml; BG 151-200, 1.2 +/- 0.8 ng/ml; BG 201-300, 2.1 +/- 1.1 ng/ml; BG > 300, 3.2 +/- 1.4 ng/ml). Other measured variables (growth hormone, IGF-I, glucagon, epinephrine, cortisol) were not influenced by prior hyperglycemia. Recent prior hyperglycemia markedly influenced baseline and exercise-induced levels of IL-6 in a group of peripubertal children with type 1 diabetes. While exercise is widely encouraged and indeed often considered part of diabetic management, our data underscore the necessity to completely understand all adaptive mechanisms associated with physical activity, particularly in the context of the developing diabetic child.

Exercise, caloric restriction, and systemic oxidative stress

BACKGROUND

In humans, the main sources of reactive oxygen species (ROS), the molecules causing oxidative stress, are mitochondrial superoxide ions and neutrophil-derived oxidative radicals. Circulating antioxidants contribute to the protection against oxidative stress. Although the formation of ROS and secretion of antioxidants are independently regulated by exercise and diet, little is known about their combined effect. We hypothesized that relatively brief, intense exercise training may reduce systemic oxidation via an intrinsic mechanism, independent of changes in circulating antioxidants and of neutrophil-derived enzymes (as may be caused by concomitant caloric restriction).

METHODS

Nineteen volunteers exercised for 7 days, 3 hours/day at 75% of oxygen uptake. Caloric intake was either 110% of caloric expenditure (high calorie, n=10) or 75% of caloric expenditure (low calorie, n=9). Blood samples for F2-isoprostanes, catalase, myeloperoxidase (MPO), interleukin-x (IL-x), white blood cells (WBCs), and other metabolic variables were taken at baseline, at the end of training, and 1 week after completion of the study.

RESULTS

Serum F2-isoprostanes (microg/mL), markers of lipid peroxidation, were similarly reduced after 7 days of exercise in the high-calorie (from 35+/-4 to 27+/-2) and low-calorie (from 35+/-3 to 24+/-2) groups. Similar reductions were observed in IL-x concentrations. Conversely, no change was observed in circulating concentrations of the antioxidant catalase. Whereas total WBCs and neutrophil counts were significantly reduced in the low-calorie group only, no difference in neutrophil-derived MPO was measured between groups.

CONCLUSION

A significant reduction in systemic oxidation may occur relatively early during intense exercise training in healthy young men, independent of caloric intake. The potential contribution to these effects of circulating antioxidants and neutrophil-derived oxidative enzymes will require further investigation.

Inflammatory cytokine, growth factor and counterregulatory responses to exercise in children with type 1 diabetes and healthy controls

In children with type 1 diabetes (T1DM), altered adaptive responses to exercise (secretion of growth factors, inflammatory cytokines, and glucoregulatory mediators) may have potential implications in growth and development, early onset of disease complications, and incidence of hypoglycemia. We therefore measured a broad spectrum of exercise responses in 12 children with T1DM (seven males and five females) and 12 controls (six males / six females) aged 11-15 yr, during a 30-min exercise challenge @ 80% VO(2)max. Euglycemia was strictly controlled during exercise, and in diabetic patients a basal rate of i.v. insulin was allowed to maintain baseline insulin concentrations. Throughout the experiment, interleukin-6 (IL-6) concentrations (pg/mL) were markedly higher in T1DM vs. controls (preexercise: 5.0+/-1.3 vs. 1.9+/-0.6, p<0.02; end-exercise 5.3+/-1.2 vs. 2.7+/-1.0, p<0.05; 30-min postexercise: 8.2+/-2.2 vs. 3.9+/-0.8, p<0.05). A similar pattern was also observed with norepinephrine. Growth hormone (GH) concentration was similar in both groups at baseline and end-exercise, but in T1DM the exercise-induced GH remained significantly elevated 30 min after exercise (9.2+/-2.2 vs. 3.1+/-0.9 ng/L, p<0.01). The exercise-induced increase in glucagon elicited by exercise in controls was similar to that previously observed in healthy adults (10+/-3 pg/mL); however, it was significantly blunted in T1DM children (2+/-2 pg/mL, p<0.05). In conclusion, T1DM children displayed significant alterations in multiple aspects of their adaptive response to intense exercise.

Reduced exercise-associated response of the GH-IGF-I axis and catecholamines in obese children and adolescents

Obesity blunts catecholamine and growth hormone (GH) responses to exercise in adults, but the effect of obesity on these exercise-associated hormonal responses in children is unclear. Therefore, the aim of the present study was to asses the effect of childhood obesity on the counterregulatory hormonal response to acute exercise. Twenty-five obese children (Ob; body mass index > 95%), and 25 age, gender, and maturity-matched normal-weight controls (NW) participated in the study. Exercise consisted of ten 2-min bouts of constant-cycle ergometry above the anaerobic threshold, with 1-min rest intervals between each bout. Pre-, post-, and 120-min postexercise blood samples were collected for circulating components of the GH-IGF-I axis and catecholamines. There were no differences in peak exercise heart rate, serum lactate, and peak O2 uptake normalized to lean body mass between the groups. Obesity attenuated the GH response to exercise (8.9 +/- 1.1 vs. 3.4 +/- 0.7 ng/ml in NW and Ob participants, respectively; P < 0.02). No significant differences in the response to exercise were found for other components of the GH-IGF-I axis. Obesity attenuated the catecholamine response to exercise (epinephrine: 52.5 +/- 12.7 vs. 18.7 +/- 3.7 pg/ml, P < 0.02; norepinephrine: 479.5 +/- 109.9 vs. 218.0 +/- 26.0 pg/ml, P < 0.04; dopamine: 17.2 +/- 2.9 vs. 3.5 +/- 1.9 pg/ml, P < 0.006 in NW and Ob, respectively). Insulin levels were significantly higher in the obese children and dropped significantly after exercise in both groups. Despite the elevated insulin levels and the blunted counterregulatory response, none of the participants developed hypoglycemia. Childhood obesity was associated with attenuated GH and catecholamine response to acute exercise. These abnormalities were compensated for, so that exercise was not associated with hypoglycemia, despite increased insulin levels in obese children.

Exercise and circulating insulin-like growth factor I

Determinations of serum concentrations of total insulin-like growth factor I (tIGF-I) are important in the diagnosis, monitoring of treatment and safety evaluation of patients with growth disorders and/or metabolic disease. It is well established that tIGF-I status varies over time. Changes in tIGF-I levels in relation to an acute bout of exercise or repeated bouts, known as training, are likely to contribute to this variation. Serum tIGF-I has also been found to be of predictive value in growth prediction models employed before the start of growth hormone (GH) treatment. Furthermore, IGF-I generation tests have been suggested to be of value in the assessment of the growth response to GH administration in patients suspected of GH deficiency with or without some degree of GH insensitivity. This is discussed elsewhere in this issue. Recent progress in our understanding of growth hormone-dependent and -independent expression of the IGF1 gene in skeletal muscle and the role of sufficient energy intake during training for muscle and liver generation of IGF-I raises important questions regarding their relative contribution to the circulating pool of IGF-I. The present review is focused on circulating levels of tIGF-I in relation to a single bout of exercise or to a period of training. In addition, the expression of IGF-I locally in muscle in response to these stimuli will be discussed.

Effect of protein supplementation during a 6-mo strength and conditioning program on insulin-like growth factor I and markers of bone turnover in young adults

BACKGROUND

Exercise is beneficial for bone when adequate nutrition is provided. The role of protein consumption in bone health, however, is controversial.

OBJECTIVE

The objective was to ascertain the effect of high protein intake on insulin-like growth factor I (IGF-I) and markers of bone turnover during 6 mo of exercise training.

DESIGN

Fifty-one subjects aged 18-25 y (28 men, 23 women) received a protein supplement (42 g protein, 24 g carbohydrate, 2 g fat) or a carbohydrate supplement (70 g carbohydrate) twice daily. Exercise consisted of alternating resistance training and running 5 times/wk. Plasma concentrations of IGF-I, insulin-like growth factor-binding protein 3, serum bone alkaline phosphatase, and urinary N-telopeptide collagen crosslink (NTx) concentrations were measured at 0, 3, and 6 mo after 24 h without exercise and a 12-h fast.

RESULTS

Three-day diet records indicated no difference in energy intake between the groups. Average protein intakes after supplementation began in the protein and carbohydrate groups were 2.2 +/- 0.1 and 1.1 +/- 0.1 g/kg, respectively (P < 0.001). The increase in plasma IGF-I was greater in the protein group than in the carbohydrate group (time x supplement interaction, P = 0.01). There were no significant changes over time or significant differences by supplement in plasma insulin-like growth factor-binding protein 3 (44 and 40 kDa). Serum bone alkaline phosphatase increased significantly over time (P = 0.04) and tended to be higher in the protein group than in the carbohydrate group (P = 0.06). NTx concentrations changed over time (time and time squared; P < 0.01 for both) and were greater in the protein group than in the carbohydrate group (P = 0.04). Men had higher NTx concentrations than did women (74.6 +/- 3.4 and 60.0 +/- 3.8 nmol/mmol creatinine; P = 0.005).

CONCLUSION

Protein supplementation during a strength and conditioning program resulted in changes in IGF-I concentrations.

IL-6-induced skeletal muscle atrophy

Chronic, low-level elevation of circulating interleukin (IL)-6 is observed in disease states as well as in many outwardly healthy elderly individuals. Increased plasma IL-6 is also observed after intense, prolonged exercise. In the context of skeletal muscle, IL-6 has variously been reported to regulate carbohydrate and lipid metabolism, increase satellite cell proliferation, or cause muscle wasting. In the present study, we used a rodent local infusion model to deliver modest levels of IL-6, comparable to that present after exercise or with chronic low-level inflammation in the elderly, directly into a single target muscle in vivo. The aim of this study was to examine the direct effects of IL-6 on skeletal muscle in the absence of systemic changes in this cytokine. Data included cellular and molecular markers of cytokine and growth factor signaling (phosphorylation and mRNA content) as well as measurements to detect muscle atrophy. IL-6 infusion resulted in muscle atrophy characterized by a preferential loss of myofibrillar protein (-17%). IL-6 induced a decrease in the phosphorylation of ribosomal S6 kinase (-60%) and STAT5 (-33%), whereas that of STAT3 was increased approximately twofold. The changes seen in the IL-6-infused muscles suggest alterations in the balance of growth factor-related signaling in favor of a more catabolic profile. This suggests that downregulation of growth factor-mediated intracellular signaling may be a mechanism contributing to the development of muscle atrophy induced by elevated IL-6.

Effects of exercise on gene expression in human peripheral blood mononuclear cells

Exercise leads to increases in circulating levels of peripheral blood mononuclear cells (PBMCs) and to a simultaneous, seemingly paradoxical increase in both pro- and anti-inflammatory mediators. Whether this is paralleled by changes in gene expression within the circulating population of PBMCs is not fully understood. Fifteen healthy men (18–30 yr old) performed 30 min of constant work rate cycle ergometry (∼80% peak O2 uptake). Blood samples were obtained preexercise (Pre), end-exercise (End-Ex), and 60 min into recovery (Recovery), and gene expression was measured using microarray analysis (Affymetrix GeneChips). Significant differential gene expression was defined with a posterior probability of differential expression of 0.99 and a Bayesian P value of 0.005. Significant changes were observed from Pre to End-Ex in 311 genes, from End-Ex to Recovery in 552 genes, and from Pre to Recovery in 293 genes. Pre to End-Ex upregulation of PBMC genes related to stress and inflammation [e.g., heat shock protein 70 (3.70-fold) and dual-specificity phosphatase-1 (4.45-fold)] was followed by a return of these genes to baseline by Recovery. The gene for interleukin-1 receptor antagonist (an anti-inflammatory mediator) increased between End-Ex and Recovery (1.52-fold). Chemokine genes associated with inflammatory diseases [macrophage inflammatory protein-1α (1.84-fold) and -1β (2.88-fold), and regulation-on-activation, normal T cell expressed and secreted (1.34-fold)] were upregulated but returned to baseline by Recovery. Exercise also upregulated growth and repair genes such as epiregulin (3.50-fold), platelet-derived growth factor (1.55-fold), and hypoxia-inducible factor-I (2.40-fold). A single bout of heavy exercise substantially alters PBMC gene expression characterized in many cases by a brisk activation and deactivation of genes associated with stress, inflammation, and tissue repair.

Gender differences in TNF-alpha levels among obese vs nonobese Latino children

OBJECTIVE

To examine the relationships between TNF-alpha, obesity, and insulin resistance among prepubescent children.

DESIGN

Cross-sectional study.

SETTING AND SUBJECTS

Data were collected from 112 nondiabetic Latino schoolchildren from public schools in three South Florida communities. Of the enrolled participants, 43.8% were obese (BMI 95th percentile) and 51.8% presented with a family history of type 2 diabetes mellitus (T2DM). With one exception, all demonstrated normal glucose tolerance.

INTERVENTIONS

Plasma TNF-alpha levels were determined with enzyme-linked immunosorbance assay (ELISA). Homeostasis model assessment (HOMA-IR) was calculated as an index of insulin resistance. Mean levels of TNF-alpha among obese vs nonobese children were compared with a one-way analysis of variance with two groups, and the association between TNF-alpha and HOMA-IR was assessed with a Pearson's correlation.

RESULTS

Higher circulating TNF-alpha levels were revealed among nonobese vs obese children. Nonobese girls demonstrated higher TNF-alpha levels than obese girls, whereas there were no significant differences for boys. There were no significant differences after stratifying for family history of T2DM. There was a modest relationship between increased TNF-alpha levels and decreased insulin resistance.

CONCLUSIONS

The observed elevated circulating TNF-alpha concentrations among leaner participants may reflect an inflammatory process that has been associated with higher levels of physical fitness in both adults and prepubescent children. This effect may remain stronger for prepubescent girls, and the mechanism may be attenuated by the hormonal changes that occur with the onset of puberty.

Exercise, stress, and inflammation in the growing child: from the bench to the playground

PURPOSE OF REVIEW

It is becoming increasingly clear that physical activity in children plays a critical role in growth and development, therapy for certain chronic diseases and disabilities, and in the pediatric origins of a variety of bone, metabolic, and cardiovascular diseases. New mechanistic insights have created the opportunity for a phase shift in understanding of the links between exercise and health in the context of the growing child.

RECENT FINDINGS

Exercise even in healthy children profoundly alters stress, immune, and inflammatory mediators including peripheral blood mononuclear cells and circulating pro- and anti-inflammatory cytokines (like interleukin-6). Moreover, exercise even in healthy adults stimulates the production of reactive oxygen species (ROS) and mediators that attenuate them. Oxidative stress, in turn, alters growth and stress mediators. Both ROS and stress/inflammatory factors interact with powerful growth mediators like growth hormone and insulinlike growth factor-I. These findings suggest specific ways in which the balance between pro- and anti-inflammatory, catabolic, and anabolic factors associated with exercise can influence health and growth in children.

SUMMARY

To address the current epidemic of physical inactivity and obesity in children and to optimize the therapeutic effects of exercise in children with disease and disability will require real changes in environments (eg, schools and playgrounds); innovative approaches to rehabilitation of children with chronic disease and disability; and enlightened training of child health professionals. Identifying novel exercise mechanisms involving stress, inflammation, and growth factors will help guide these efforts.

IGF-I system responses during 12 weeks of resistance training in end-stage renal disease patients

OBJECTIVE

To examine the hypothesis that 12 weeks of resistance training would alter circulating concentrations of IGF-I system components in end-stage renal disease (ESRD) patients.

DESIGN

Ten ESRD patients underwent 12 weeks of resistance training after a 6 week control period and had morning fasted blood drawn on four occasions (weeks - 6, 0, 6, 12). Immunoassays were performed for serum total and free IGF-I, IGF binding proteins (IGFBPs) 2 and 3, and the acid labile subunit (ALS). Immunoaffinity depletion of ALS-based complexes allowed measurement of non-ternary (i.e., binary) IGF-I and IGFBP-3.

RESULTS

Significant improvements in strength and functional performance were observed. All IGF-I measures were stable during the control period and no changes were observed for the first 6 weeks of resistance training. At week 12, total IGF-I (-15.4+/-28.9%), ternary IGF-I (-16.4+/-36.7%), and the IGF-I/IGFBP-3 ratio had significantly (p < or = 0.05) declined from week 0 values. No changes were observed for free IGF-I, IGFBPs 2 and 3, or the acid labile subunit. The proportion of IGF-I in ternary ( approximately 76.3+/-6.8%), non-ternary ( approximately 22.5+/-6.6%), and free ( approximately 1.2+/-0.5%) forms remained constant throughout the training.

CONCLUSIONS

12 weeks of resistance training in ESRD patients induced a decline in total IGF-I, but did not alter the proportion of IGF-I circulating in free, ternary or non-ternary molecular complexes. The decline in IGF-I occurs in the presence of positive training adaptations on physical performance and we conclude that this response pattern appears to be reflective of favorable neuromuscular anabolic adaptations.

Cytokines and Growth Factors during and after a Wrestling Season in Adolescent Boys

PURPOSE

Brief periods of aerobic exercise training lead to reductions, rather then the expected increases in circulating IGF-I. We hypothesized that intense exercise training in adolescents initially leads to simultaneous increases in proinflammatory cytokines and decreases in activity of the GH/IGF-I axis; and that as exercise training proceeds, levels of proinflammatory cytokines become reduced, and a rebound in IGF-I ensues leading to the higher IGF-I levels.

METHOD

To test this, we evaluated the GH/IGF-I axis and levels of inflammatory cytokines (IL-6, TNF-alpha, IL-1beta, IL-1ra), body composition, and fitness in 13 healthy adolescent boys (mean age 15.9 +/- 0.3 yr) over the course of a high-school wrestling season. Subjects were tested preseason, midseason (6 wk), peak season (12-14 wk), and 4 wk postseason.

RESULTS

No significant weight loss was noted throughout the season. During the wrestling season (mid and peak) both total (P < 0.046) and free (P < 0.002) IGF-I levels decreased, whereas proinflammatory cytokines (IL-1ra, P < 0.005; IGFBP-1, P < 0.013; and IGFBP-2, P < 0.025) increased. GHBP (P < 0.018) levels also decreased during the season. In the postseason, there were significant increases in GHBP, and free and total IGF-I, whereas proinflammatory cytokines decreased.

CONCLUSIONS

An initial catabolic-type hormonal response occurs with intense exercise training in adolescents. This is followed by a rebound in circulating growth factors when the period of heavy training ceases.

Effect of intense wrestling exercise on leucocytes and adhesion molecules in adolescent boys

BACKGROUND

In adults, exercise is a powerful and natural stimulator of immune cells and adhesion molecules. Far less is known about exercise responses during childhood and adolescence and whether or not exercise in "real life" activities of healthy adolescents influences immune responses.

OBJECTIVE

To determine if strenuous exercise leads to significant changes in leucocyte number and adhesion molecule expression in adolescent boys.

METHODS

Eleven healthy, high school boys, aged 14-18.5 years, performed a single, typical, 1.5 hour wrestling practice session. Blood was sampled before and after the session. Flow cytometry was used to evaluate changes in immune responses.

RESULTS

The exercise led to significant (p<0.05) and robust increases in granulocytes, monocytes, and all lymphocyte subpopulations. The most significant changes were observed for natural killer cells (p<0.0005). The number of T cytotoxic and T helper cells expressing CD62L increased significantly (p<0.002 and p<0.0005 respectively), as did the number of T cytotoxic and T helper cells not expressing CD62L (p<0.003 and p<0.009 respectively). The density of CD62L on lymphocytes decreased significantly with exercise (p<0.0005), whereas CD11a (p<0.01) and CD54 (p<0.01) increased.

CONCLUSIONS

The data show that an intense wrestling bout in adolescent boys leads to profound stimulation of the immune system. The role of these common changes in overall immune status and the development of the immune and haemopoietic systems has yet to be determined.

Negative energy balance plays a major role in the IGF-I response to exercise training

Circulating IGF-I is correlated with fitness, but results of prospective exercise training studies have been inconsistent, showing both increases and decreases in IGF-I. We hypothesized that energy balance, often not accounted for, is a regulating variable such that training plus an energy intake deficit would cause a reduction in IGF-I, whereas training plus energy intake excess would lead to an increased IGF-I. To test this, 19 young, healthy men completed a 7-day strenuous exercise program in which they were randomly assigned to either a positive energy balance [overfed (OF), n = 10] or negative energy balance [underfed (UF), n = 9] group. IGF-I (free and total), insulin, and IGF-binding protein-1 were measured before, during, and 1 wk after the training. Weight decreased in the UF subjects and increased in the OF subjects. Free and total IGF-I decreased substantially in the UF group (P < 0.0005 for both), but, in the OF group, IGF-I remained unchanged. The UF group also demonstrated an increase in IGF-binding protein-1 (P < 0.027), whereas glucose levels decreased (P < 0.0005). In contrast, insulin was reduced in both the OF and UF exercise-training groups (P < 0.044). Finally, within 7 days of the cessation of the diet and training regimen, IGF-I and IGF-binding protein-1 in the UF group returned to preintervention levels. We conclude that energy balance during periods of exercise training influences circulating IGF-I and related growth mediators. Exercise-associated mechanisms may inhibit increases in IGF-I early in the course of a training protocol, even in overfed subjects.

Antioxidants attenuate the plasma cytokine response to exercise in humans

Exercise increases plasma TNF-alpha, IL-1beta, and IL-6, yet the stimuli and sources of TNF-alpha and IL-1beta remain largely unknown. We tested the role of oxidative stress and the potential contribution of monocytes in this cytokine (especially IL-1beta) response in previously untrained individuals. Six healthy nonathletes performed two 45-min bicycle exercise sessions at 70% of Vo(2 max) before and after a combination of antioxidants (vitamins E, A, and C for 60 days; allopurinol for 15 days; and N-acetylcysteine for 3 days). Blood was drawn at baseline, end-exercise, and 30 and 120 min postexercise. Plasma cytokines were determined by ELISA and monocyte intracellular cytokine level by flow cytometry. Before antioxidants, TNF-alpha increased by 60%, IL-1beta by threefold, and IL-6 by sixfold secondary to exercise (P < 0.05). After antioxidants, plasma IL-1beta became undetectable, the TNF-alpha response to exercise was abolished, and the IL-6 response was significantly blunted (P < 0.05). Exercise did not increase the percentage of monocytes producing the cytokines or their mean fluorescence intensity. We conclude that in untrained humans oxidative stress is a major stimulus for exercise-induced cytokine production and that monocytes play no role in this process.

Effect of water polo practice on cytokines, growth mediators, and leukocytes in girls

PURPOSE

The effects of exercise on growth and development are mediated through a complex interaction between the endocrine, immune, and nervous systems. Very little is known about how these systems respond to exercise in children or adolescents. Moreover, there are few studies that have examined growth factors, inflammatory cytokines, and leukocyte responses to "real-life" or field exercise solely in girls. Thus, the goal of the present study was to determine the acute exercise-induced alterations in the growth hormone --> insulin-like growth factor-I axis, inflammatory cytokines, and certain aspects of immune function in a group of adolescent girls after a typical water polo practice.

METHODS

Ten, healthy, high-school female subjects, 14-16 yr old, performed a single, typical, 1.5-h water polo practice session. Blood was sampled before and after the session.

RESULTS

The exercise resulted in an increase in HR (from 82 +/- 2 to 161 +/- 5 beats.min(-1) at 30 min, P < 1.4.10(-6) ), as well as in circulating lactate levels (375 +/- 66%, P < 0.0005). Significant increases where noted in circulating IL-6 (396 +/- 162%, P < 0.005) and IL-1ra (71 +/- 20%, P < 0.015). A substantial increase in the level of IGFBP-1 (1344 +/- 344%, P < 0.001) was also observed. Interestingly, TNF-alpha levels decreased after the exercise (-10.4 +/- 3.8%, P < 0.04) as did insulin (55 +/- 12%, P < 0.005). The exercise led to significant increases in granulocytes, monocytes, and lymphocytes. The exercise significantly influenced adhesion molecules (such as CD62L and CD54), which has not been previously studied in adolescent girls.

CONCLUSIONS

These data demonstrate that an intense "real-life" exercise bout in adolescent females leads to profound increases in inflammatory cytokines and reductions in anabolic mediators with substantial alterations in white blood cell subpopulations and adhesion molecules. The role of these frequent, almost daily immune and cytokine changes on growth and development have yet to be determined.

Adipocytokines, body composition, and fitness in children

Recent evidence suggests a role for adipose derived cytokines (adipocytokines) such as tumor necrosis factor-alpha (TNF-alpha), IL-6, and the recently discovered adiponectin in the mechanism of impaired glucose regulation and atherosclerosis in adults. However, the relationship between adipocytokines and body composition, fasting insulin, and fitness is virtually unknown children. Fasting blood sampling was performed in 30 healthy, predominately Hispanic- and Asian-American children (16 boys, mean age 12.7 +/- 0.1 y old) from a lower socioeconomic area in Los Angeles. Adiposity was measured by dual x-ray absorptiometry (DEXA); and peak oxygen uptake using cycle ergometry. Adiponectin (mean 10.8 +/- 0.8 micro g/mL) was inversely correlated with body mass index (BMI, as percentile by age) (r = -0.48, p = 0.011) and fat mass (r = -0.43, p = 0.03). In contrast, TNF-alpha and IL-6 were both positively correlated with BMI and fat mass. Adiponectin was inversely correlated with fasting insulin (r = -0.52, p = 0.006), but no correlations were found for insulin and either TNF-alpha or IL-6. Adiponectin was correlated with HDL (r = 0.448, p = 0.019). Paradoxically, peak oxygen consumption (an indicator of fitness) was negatively correlated with adiponectin levels (r = -0.471, p = 0.013) and positively correlated with TNF-alpha (r = 0.560, p = 0.002). In children, adipocytokines are correlated with fat mass, insulin sensitivity, and cardiovascular risk factors in a manner that is qualitatively similar to relationships recently observed in adults. In more obese children, the mass of fat tissue may attenuate potentially positive effects of fitness on circulating levels of adiponectin and TNF-alpha. The novel data on adiponectin suggest that deleterious dysregulation of adipocytokines associated with obesity may occur relatively early in life.