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Jansen EC, Burgess HJ, Chervin RD, Dolinoy D, Téllez-Rojo MM, Cantoral A, Olascoaga-Torres L, Lee J, Dunietz GL, O’Brien LM, Peterson KE. Sleep duration and timing are prospectively linked with insulin resistance during late adolescence. Obesity (Silver Spring) 2023; 31:912-922. [PMID: 36847394 PMCID: PMC10033442 DOI: 10.1002/oby.23680] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 03/01/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate whether short sleep duration or later sleep timing is a risk factor for insulin resistance (IR) in late adolescence. METHODS Mexico City adolescents enrolled in a longitudinal birth cohort (ELEMENT) took part in two study visits during peri-puberty that occurred approximately 2 years apart. IR was assessed with serum glucose and insulin. Four groups were defined using puberty-specific cut points: no IR over the follow-up period, transition from normal to IR, transition from IR to normal, and IR at both time points. Baseline sleep assessments were measured with 7-day wrist actigraphy. Multinomial logistic regression models were used to evaluate associations between sleep duration and timing with homeostatic model assessment of insulin resistance categories, adjusting for age, sex, and baseline pubertal status. RESULTS Adolescents who were ≥ 1 hour below the sleep duration recommendations-for-age were 2.74 times more likely to develop IR (95% CI: 1.0-7.4). Similarly, adolescents who were in the latest category of sleep midpoint (>4:33 a.m.) were more likely than those with earliest midpoints (1 a.m.-3 a.m.) to develop IR (odds ratio = 2.63, 95% CI: 1.0-6.7). Changes in adiposity over follow-up did not mediate sleep and IR. CONCLUSIONS Insufficient sleep duration and late sleep timing were associated with development of IR over a 2-year period in late adolescence.
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Affiliation(s)
- Erica C. Jansen
- Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, MI
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Ronald D. Chervin
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI
| | - Dana Dolinoy
- Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, MI
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI
| | - Martha María Téllez-Rojo
- Center for Research on Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Libni Olascoaga-Torres
- Center for Research on Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Joyce Lee
- Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Galit Levi Dunietz
- Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, MI
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI
| | - Louise M. O’Brien
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI
| | - Karen E. Peterson
- Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, MI
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI
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Boman C, Bernhardsson S. Exploring needs, barriers, and facilitators for promoting physical activity for children with intellectual developmental disorders: A qualitative focus group study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023; 27:5-23. [PMID: 35128986 PMCID: PMC9940129 DOI: 10.1177/17446295211064368] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Many children with intellectual developmental disorders are insufficiently physically active and do not reach recommendations for physical activity. Pediatric healthcare providers play a key role in addressing these children's needs, including promoting interventions for physical activity. AIM To explore pediatric healthcare providers' perceived needs, barriers, and facilitators for promoting physical activity for children with intellectual developmental disorders. METHODS Semi-structured focus groups, analyzed using qualitative content analysis. Sixteen healthcare providers participated. RESULTS Main findings are the importance of parental support and engagement, need for structure, and stakeholder collaboration to bridge the gap between pediatric organizations and external stakeholders. CONCLUSION The study highlights the need for developing and implementing strategies to promote physical activity for children with intellectual developmental disorders in pediatric health care, and for producing guidelines regarding physical activity interventions for this vulnerable group.
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Affiliation(s)
- Charlotte Boman
- Centre for physical activity, Region Västra Götaland, Gothenburg, Sweden
- Department of Health and Rehabilitation, Unit of Physiotherapy, Sahlgrenska Academy, Institute of Neuroscience and Physiology, 3570University of Gothenburg, Gothenburg, Sweden
| | - Susanne Bernhardsson
- Department of Health and Rehabilitation, Unit of Physiotherapy, Sahlgrenska Academy, Institute of Neuroscience and Physiology, 3570University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
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Pezoa-Fuentes P, Cossio-Bolaños M, Urra-Albornoz C, Alvear-Vasquez F, Lazari E, Urzua-Alul L, de Campos LFCC, Gomez-Campos R. Fat-free mass and maturity status are determinants of physical fitness performance in schoolchildren and adolescents. J Pediatr (Rio J) 2023; 99:38-44. [PMID: 35675864 PMCID: PMC9875270 DOI: 10.1016/j.jped.2022.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/17/2022] [Accepted: 04/29/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES The objective of the study was to verify whether (FFM), maturity status (MS) and chronological age (CA) are determinants of physical fitness performance, and to analyze FFM and physical performance aligned by CA and MS in children and adolescents. METHODS A descriptive correlational study was carried out in 863 schoolchildren. Weight, height, and waist circumference (WC) were evaluated. Body mass index (BMI), FFM, fat mass (FM), MS (Age at peak height velocity, APHV) were calculated. The physical tests of velocity 20 m, agility 5 m x 10rep, and horizontal jump (HJ) were evaluated. RESULTS The APHV was estimated in boys at 14.0 ± 0.36APHV and in girls at 11.96 ± 0.49APHV. The relationships between CA and APHV with FFM was r = 0.80 in boys and r = 0.44 to 0.45 in girls. The relationships between FFM and physical tests in boys were [HJ (r = 0.70), agility 5m x 10rep (r = -0.68), velocity (r = -0.61)] and in girls [HJ (r = 0.42), agility 5m x 10rep (r = -0.52), velocity (r = -0.20)]. The differences in FFM and physical fitness tests were more pronounced when aligned by APHV than by CA. CONCLUSION It was verified that both FFM, CA, and APHV are determinants of physical fitness performance. In addition, the APHV should be introduced in physical education as a means of ranking physical performance among schoolchildren.
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Affiliation(s)
- Paz Pezoa-Fuentes
- Programa de Doctorado en Ciencias de la Actividad Física, Universidad Católica del Maule, Talca, Chile
| | - Marco Cossio-Bolaños
- Programa de Doctorado en Ciencias de la Actividad Física, Universidad Católica del Maule, Talca, Chile
| | - Camilo Urra-Albornoz
- Programa de Doctorado en Ciencias de la Actividad Física, Universidad Católica del Maule, Talca, Chile
| | | | - Evandro Lazari
- Facultade de Ciencias Aplicadas, Universidad Estadual de Campinas, São Paulo, SP, Brazil
| | - Luis Urzua-Alul
- Escuela de Kinesiología, Facultad de Ciencias de la Salud, Universidad Santo Tomás, Chile
| | | | - Rossana Gomez-Campos
- Departamento de Diversidad e Inclusividad Educativa, Universidad Católica del Maule, Talca, Chile.
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Bernhardsson S, Boman C, Lundqvist S, Arvidsson D, Börjesson M, Larsson MEH, Lundh H, Melin K, Nilsen P, Lauruschkus K. Implementation of physical activity on prescription for children with obesity in paediatric health care (IMPA): protocol for a feasibility and evaluation study using quantitative and qualitative methods. Pilot Feasibility Stud 2022; 8:117. [PMID: 35650617 PMCID: PMC9158137 DOI: 10.1186/s40814-022-01075-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical inactivity is a main cause of childhood obesity which tracks into adulthood obesity, making it important to address early in life. Physical activity on prescription (PAP) is an evidence-based intervention that has shown good effect on physical activity levels in adults, but has not been evaluated in children with obesity. This project aims to evaluate the prerequisites, determinants, and feasibility of implementing PAP adapted to children with obesity and to explore children's, parents', and healthcare providers' experiences of PAP. METHODS In the first phase of the project, healthcare providers and managers from 26 paediatric clinics in Region Västra Götaland, Sweden, will be invited to participate in a web-based survey and a subset of this sample for a focus group study. Findings from these two data collections will form the basis for adaptation of PAP to the target group and context. In a second phase, this adapted PAP intervention will be evaluated in a clinical study in a sample of approximately 60 children with obesity (ISO-BMI > 30) between 6 and 12 years of age and one of their parents/legal guardians. Implementation process and clinical outcomes will be assessed pre- and post-intervention and at 8 and 12 months' follow-up. Implementation outcomes are the four core constructs of the Normalization Process Theory; coherence, cognitive participation, collective action, and reflexive monitoring; and appropriateness, acceptability, and feasibility of the PAP intervention. Additional implementation process outcomes are recruitment and attrition rates, intervention fidelity, dose, and adherence. Clinical outcomes are physical activity pattern, BMI, metabolic risk factors, health-related quality of life, sleep, and self-efficacy and motivation for physical activity. Lastly, we will explore the perspectives of children and parents in semi-structured interviews. Design and analysis of the included studies are guided by the Normalization Process Theory. DISCUSSION This project will provide new knowledge regarding the feasibility of PAP for children with obesity and about whether and how an evidence-based intervention can be fitted and adapted to new contexts and populations. The results may inform a larger scale trial and future implementation and may enhance the role of PAP in the management of obesity in paediatric health care in Sweden. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04847271 , registered 14 April 2021.
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Affiliation(s)
- Susanne Bernhardsson
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden. .,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Charlotte Boman
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Centre for Physical Activity, Gothenburg, Sweden
| | - Stefan Lundqvist
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden.,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Centre for Physical Activity, Gothenburg, Sweden
| | - Daniel Arvidsson
- Department of Food and Nutrition and Sport Science, Faculty of Education, Center for Health and Performance, University of Gothenburg, Gothenburg, Sweden
| | - Mats Börjesson
- Department of Molecular and Clinical Medicine & Center for Health and Performance, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria E H Larsson
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden.,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hannah Lundh
- Region Västra Götaland, Centre for Physical Activity, Gothenburg, Sweden.,School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Melin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Child and Adolescent Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Nilsen
- Division of Health and Society, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Katarina Lauruschkus
- Faculty of Medicine, Institution of Health Sciences, Lund University, Lund, Sweden
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Relative Importance of Physical Activity and Body Composition on Insulin Resistance in Older Adult Population. TOPICS IN GERIATRIC REHABILITATION 2022. [DOI: 10.1097/tgr.0000000000000358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Waist Circumference Is Not Associated with Impaired Fasting Blood Glucose in a Sample of Mexican Children and Teenagers: Results from a State Screening Program. CHILDREN-BASEL 2021; 8:children8030172. [PMID: 33668305 PMCID: PMC7996355 DOI: 10.3390/children8030172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 11/16/2022]
Abstract
A high waist circumference (WC) is used as a risk factor for impaired fasting blood glucose (IFG) in adults. This association is less studied in children and teenagers. The purpose of this study was to analyze the association between having a high WC and IFG by sex and age in a sample of Mexican children and teenagers. We analyzed the data of 12979 participants aged 5 to 17 years to calculate percentile references for uncorrected WC, corrected for height (WC/HT) and by height squared (WC/HT2) with quantile regression. A subsample of 2309 participants with fasting blood glucose samples (FBG), WC, WC/HT and WC/HT2 values was analyzed with logistic regression. A high WC, WC/HT, and WC/HT2 were considered at the sex- and age-specific 90th percentile from the subsample. The IFG was considered as FBG ≥100 mg/dL. Having a high WC, WC/HT, nor WC/HT2 was not significantly associated with IFG for either sex and age group (all p > 0.05). A high WC, either on its uncorrected or corrected for height values, was not an important assessment for predicting IFG in a sample of Mexican children and teenagers. This study provides percentile reference values specific for sex and age.
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Physical activity impacts insulin sensitivity post metabolic bariatric surgery in adolescents with severe obesity. Int J Obes (Lond) 2020; 44:1479-1486. [PMID: 32424268 PMCID: PMC7363050 DOI: 10.1038/s41366-020-0585-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 04/02/2020] [Accepted: 04/29/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES We hypothesized that physical activity (PA) improves insulin sensitivity in adolescents with severe obesity beyond that attributable to metabolic bariatric surgery (MBS). SUBJECTS/METHODS StepWatchTM monitors objectively measured PA in 88 participants in the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. Primary outcomes included absolute change in fasting insulin, HOMA-IR, and fasting glucose from pre-surgery (baseline) to 6, 12, 24, and 36 months post-MBS. SAS PROC TRAJ generated activity trajectories based on probability and individual participant step count trajectories. Linear regression models were used, adjusted for baseline value, visit, surgical procedure, sex, and percent change in BMI. Additional models adjusted for percent change in iliac waist circumference (IWC) or percent body fat (BF), measured by bio-impedance. RESULTS Two activity trajectories were identified: more active (MA, n = 13) and less active (LA, n = 75). MA baseline mean daily step count was >6000, increasing to >9000 at 2 years. LA mean daily step count remained at ~4000. Few participants recorded moderate step activity (cadence >80 steps/minute). Still, fasting insulin and HOMA-IR differed in association with activity trajectoy. MA was associated with a greater absolute decrease in fasting insulin (-7.8 μU/ml [95% CI: (-11.8, -3.7)], p ≤ 0.001) and a greater decrease in HOMA-IR (-1.9 [95% CI: (-3.0, -0.7)], p = 0.001), when adjusted for percent change in BMI. The significant independent effect of MA remained when adjusted for percent change in IWC or percent BF. Clinically, 100% of MA trajectory participants normalized fasting insulin, HOMA-IR, and fasting glucose by 6 months and normalization remained throughout the 36 months follow up. In contrast, 76.3 and 65.8% of LA trajectory participants normalized fasting insulin and HOMA-IR, respectively, by 12 months with 28.6% of both remaining normalized at 36 months. CONCLUSIONS PA is independently associated with improved insulin sensitivity beyond that attributable to MBS in adolescents with severe obesity.
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Abstract
In insulin resistance, alterations occur in the signalling pathways that modulate glucose uptake into cells, especially skeletal muscle cells, resulting in impaired glucose homeostasis. Glucose uptake into cells is controlled by a number of pathways, some of which are insulin-dependent. During exercise glucose uptake can occur independently of insulin regulation, and hence research into the effects of exercise on insulin resistance must be clearly defined to reflect whether glucose uptake has been enhanced as a result of the utilisation of these insulin-independent pathways, or whether exercise directly affects insulin resistance in cells. Research into the benefits of exercise for insulin resistance is also problematic in the need to clarify whether it is the exercise itself, or the visceral fat/weight loss that has resulted from the exercise, that has led to improved insulin sensitivity. The research presents a promising picture for the benefits of exercise in insulin resistance.
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Affiliation(s)
- Stephney Whillier
- Faculty of Science and Engineering, Macquarie University, Sydney, NSW, Australia.
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Bruggink SM, Shomaker LB, Kelly NR, Drinkard BE, Chen KY, Brychta RJ, Cassidy O, Demidowich AP, Brady SM, Tanofsky-Kraff M, Yanovski JA. Insulin Sensitivity, Depression/Anxiety, and Physical Fitness in At-Risk Adolescents. Sports Med Int Open 2019; 3:E40-E47. [PMID: 31214645 PMCID: PMC6579727 DOI: 10.1055/a-0889-8653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/14/2019] [Accepted: 03/25/2019] [Indexed: 12/20/2022] Open
Abstract
Poor physical fitness contributes to the early progression of cardiometabolic disease, yet the physiological and psychological factors underpinning poor fitness in at-risk adolescents are not well understood. In this study, we sought to determine the relationship of physical fitness with two developmental phenomena of adolescence, insulin resistance and depression/anxiety symptoms among at-risk youth. We conducted secondary data analyses of 241 overweight or obese adolescents (12-17 years), drawn from two study cohorts. Insulin sensitivity index was derived from oral glucose tolerance tests. Adolescents self-reported depressive symptoms and anxiety symptoms on validated surveys. A walk/run test was administered to determine perceived exertion and physical fitness (distance traveled). Insulin sensitivity was positively associated with walk/run distance ( b =0.16, P< 0.01), even after accounting for all covariates. Anxiety symptoms were inversely related to perceived exertion ( b =-0.11, P< 0.05), adjusting for covariates. These findings suggest that insulin resistance and anxiety symptoms are associated with different dimensions of physical fitness in overweight or obese adolescents and could both potentially contribute to declining fitness and worsening metabolic outcomes in at-risk youth.
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Affiliation(s)
- Stephanie M. Bruggink
- Human Development & Family Studies, Colorado State University College of Health and Human Sciences, Fort Collins, Colorado, United States
| | - Lauren Berger Shomaker
- Human Development & Family Studies, Colorado State University College of Health and Human Sciences, Fort Collins, Colorado, United States
| | - Nichole R. Kelly
- Counseling Psychology and Human Services and the Prevention Science Institute, College of Education, University of Oregon, Eugene, Oregon, United States
- Section on Growth and Obesity, Division of Intramural Research, National Institute of Child Health and Human Development, Bethesda, Maryland, United States
- Uniformed Services University of the Health Sciences, Medical and Clinical Psychology, Bethesda, Maryland, United States
| | - Bart E. Drinkard
- Rehabilitation Medicine Department, Mark O Hatfield Clinical Research Center, Bethesda, Maryland, United States
| | - Kong Y. Chen
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, Maryland, United States
| | - Robert J. Brychta
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, Maryland, United States
| | - Omni Cassidy
- Section on Growth and Obesity, Division of Intramural Research, National Institute of Child Health and Human Development, Bethesda, Maryland, United States
- Uniformed Services University of the Health Sciences, Medical and Clinical Psychology, Bethesda, Maryland, United States
| | - Andrew P. Demidowich
- Section on Growth and Obesity, Division of Intramural Research, National Institute of Child Health and Human Development, Bethesda, Maryland, United States
| | - Sheila M. Brady
- Section on Growth and Obesity, Division of Intramural Research, National Institute of Child Health and Human Development, Bethesda, Maryland, United States
| | - Marian Tanofsky-Kraff
- Section on Growth and Obesity, Division of Intramural Research, National Institute of Child Health and Human Development, Bethesda, Maryland, United States
- Uniformed Services University of the Health Sciences, Medical and Clinical Psychology, Bethesda, Maryland, United States
| | - Jack A. Yanovski
- Section on Growth and Obesity, Division of Intramural Research, National Institute of Child Health and Human Development, Bethesda, Maryland, United States
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Shomaker LB, Gulley L, Hilkin AM, Clark E, Annameier S, Rao S, Rockette-Wagner B, Kriska A, Wright KP, Stice E, Nadeau KJ, Kelsey MM. Design of a randomized controlled trial to decrease depression and improve insulin sensitivity in adolescents: Mood and INsulin sensitivity to prevent Diabetes (MIND). Contemp Clin Trials 2018; 75:19-28. [PMID: 30342256 PMCID: PMC6249074 DOI: 10.1016/j.cct.2018.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/09/2018] [Accepted: 10/16/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depressive symptoms often manifest in adolescence and predict worsening insulin sensitivity, a key precursor in the path to β-cell failure and type 2 diabetes (T2D). OBJECTIVE To assess the efficacy of a six-week cognitive-behavioral group versus six-week health education group for improving insulin sensitivity and preserving β-cell function in adolescent girls at-risk for T2D with depressive symptoms and evaluate mechanisms underlying the association between depression and insulin dynamics. DESIGN Randomized controlled trial of N = 150 12-17-year-old girls with overweight/obesity (body mass index [BMI; kg/m2] ≥85th percentile), elevated depressive symptoms (Center for Epidemiologic Studies-Depression Scale [CES-D] total score > 20), and diabetes family history. METHODS Girls at-risk for T2D with elevated depressive symptoms are recruited from the Denver-metropolitan area and randomized to participate in one of two six-week interventions. The cognitive-behavioral group is a depression prevention program involving psycho-education, restructuring negative thoughts, and behavioral activation. The health education group is a didactic control that provides knowledge about healthy living. Participants are assessed at baseline, immediate post-intervention, and one-year follow-up. Primary outcomes are insulin sensitivity and β-cell function from oral glucose tolerance tests. Secondary outcomes are disinhibited eating, physical activity, sleep, and cortisol. SUMMARY Results from this adequately powered randomized controlled trial will determine whether decreasing depressive symptoms with a behavioral health program preventatively alters insulin sensitivity and β-cell function trajectories in adolescents at-risk for T2D. Results from the MIND Project will add to knowledge of the contribution of depressive symptoms to T2D risk.
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Affiliation(s)
- Lauren B Shomaker
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, Fort Collins, CO 80523, United States; Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States; Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, United States.
| | - Lauren Gulley
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, Fort Collins, CO 80523, United States; Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
| | - Allison M Hilkin
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
| | - Emma Clark
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, Fort Collins, CO 80523, United States
| | - Shelly Annameier
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, Fort Collins, CO 80523, United States
| | - Sangeeta Rao
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Bonny Rockette-Wagner
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrea Kriska
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kenneth P Wright
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Eric Stice
- Oregon Research Institute, Eugene, OR, United States
| | - Kristen J Nadeau
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
| | - Megan M Kelsey
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
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Ávila-Curiel A, Galindo-Gómez C, Juárez-Martínez L, Osorio-Victoria ML. [Metabolic syndrome in children aged 6 to 12 years with obesity in public schools of seven municipalities in the State of Mexico]. SALUD PUBLICA DE MEXICO 2018; 60:395-403. [PMID: 30137941 DOI: 10.21149/8470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 12/07/2017] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of Metabolic Syndrome (MS), its components and its association with obesity and cardiovascular risk in school age children. MATERIALS AND METHODS A cross-sectional study of 1,017 children from 6 to 12 years of age. Anthropometric information, blood pressure, glucose, insulin, cholesterol, HDLc, LDLc and triglycerides were collected. The presence of MS and its components were determined by criteria of Cook et. al. (2003), modified for children and adolescents. In the analysis, the children were grouped by aged group of 6 to 9 and 10 to 12 years. The association between MS, obesity and cardiovascular risk was estimated using Student's t-test and Mann-Whitney U test, Chi-square test and logistic regression. RESULTS The MS was present with 54.6% in obese children. Obesity was the characteristic of greater association to suffer from MS with an OR=8.62 p<0.001. CONCLUSIONS MS is high among children with obesity, and is mostly associated with insulin resistance and atherogenic risk.
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Affiliation(s)
- Abelardo Ávila-Curiel
- Dirección de Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Ciudad de México, México
| | - Carlos Galindo-Gómez
- Dirección de Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Ciudad de México, México
| | - Liliana Juárez-Martínez
- Dirección de Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Ciudad de México, México
| | - Mario Luis Osorio-Victoria
- Dirección de Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Ciudad de México, México
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Park JS, Lee H, Choi BW, Ro S, Lee D, Na JE, Hong JH, Lee JS, Kim BW, Ko YG. An MG53-IRS1-interaction disruptor ameliorates insulin resistance. Exp Mol Med 2018; 50:1-12. [PMID: 29884820 PMCID: PMC5994830 DOI: 10.1038/s12276-018-0099-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/08/2018] [Accepted: 03/16/2018] [Indexed: 12/24/2022] Open
Abstract
Mitsugumin 53 (MG53) is an E3 ligase that induces insulin receptor substrate-1 (IRS-1) ubiquitination and degradation in skeletal muscle. We previously demonstrated that the pharmaceutical disruption of the MG53-IRS-1 interaction improves insulin sensitivity by abrogating IRS-1 ubiquitination and increasing IRS-1 levels in C2C12 myotubes. Here, we developed a novel MG53-IRS-1 interaction disruptor (MID-00935) that ameliorates insulin resistance in diet-induced obese (DIO) mice. MID-00935 disrupted the molecular interaction of MG53 and IRS-1, abrogated MG53-induced IRS-1 ubiquitination and degradation and improved insulin signaling in C2C12 myotubes. Oral administration of MID-00935 increased insulin-induced IRS-1, Akt, and Erk phosphorylation via increasing IRS-1 levels in the skeletal muscle of DIO mice. In DIO mice, MID-00935 treatment lowered fasting blood glucose levels and improved glucose disposal in glucose and insulin tolerance tests. These results suggest that MID-00935 may be a potential muscle-targeting drug candidate for treating insulin resistance.
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Affiliation(s)
- Jun Sub Park
- Division of Life Sciences, Korea University, Seoul, Korea.,Tunneling Nanotube Research Center, Korea University, Seoul, Korea
| | - Hyun Lee
- Division of Life Sciences, Korea University, Seoul, Korea.,Tunneling Nanotube Research Center, Korea University, Seoul, Korea
| | - Bo Woon Choi
- Division of Life Sciences, Korea University, Seoul, Korea.,Tunneling Nanotube Research Center, Korea University, Seoul, Korea
| | - Seonggu Ro
- CrystalGenomics, Inc., Seongnam-si, Gyeonggi-do, Korea
| | - Doyoung Lee
- CrystalGenomics, Inc., Seongnam-si, Gyeonggi-do, Korea
| | - Jeong Eun Na
- CrystalGenomics, Inc., Seongnam-si, Gyeonggi-do, Korea
| | - Jeoung-Ho Hong
- Division of Life Sciences, Korea University, Seoul, Korea.,Tunneling Nanotube Research Center, Korea University, Seoul, Korea
| | - Jae-Seon Lee
- Department of Molecular Medicine, College of Medicine, INHA University, Incheon, Korea
| | - Bong-Woo Kim
- Division of Life Sciences, Korea University, Seoul, Korea. .,Tunneling Nanotube Research Center, Korea University, Seoul, Korea.
| | - Young-Gyu Ko
- Division of Life Sciences, Korea University, Seoul, Korea. .,Tunneling Nanotube Research Center, Korea University, Seoul, Korea.
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13
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Vilchis-Gil J, Klünder-Klünder M, Flores-Huerta S. Effect on the Metabolic Biomarkers in Schoolchildren After a Comprehensive Intervention Using Electronic Media and In-Person Sessions to Change Lifestyles: Community Trial. J Med Internet Res 2018; 20:e44. [PMID: 29402762 PMCID: PMC5818679 DOI: 10.2196/jmir.9052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/07/2017] [Accepted: 12/01/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Obesity is a chronic low-intensity state of inflammation with metabolic alterations that, when acquired during childhood, lead to severe illness in adults. Encouraging healthy eating habits and physical activity is the basis for preventing and treating obesity and its complications. OBJECTIVE To evaluate how a comprehensive intervention promoting healthy eating habits and physical activities in schools affects children's metabolic biomarkers. METHODS Of four Mexico City primary schools in this study, two groups of children that were recruited at their schools were assigned to a 12-month intervention group (IG) and the other two were assigned to control groups (CGs). The intervention had two components: (1) parents/schoolchildren attended in-person educational sessions promoting healthy eating and physical activity habits, and were provided printed information; and (2) parents were able to seek information through a website, and also received brief weekly mobile phone text messages. Anthropometric measurements and fasting blood samples were taken from both groups of children at baseline and again after 12 months. RESULTS The study involved 187 children in the IG and 128 in the CG. Regardless of each child's nutritional status at the beginning of the study, the intervention improved metabolic parameters; the IG showed a negative effect on glucose concentrations (-1.83; CI 95% -3.06 to -0.60), low-density lipoprotein-cholesterol (-2.59; CI 95% -5.12 to -0.06), insulin (-0.84; CI 95% -1.31 to -0.37), and homeostasis model to assess the insulin resistance index (HOMA-IR; -0.21; CI 95% -0.32 to -0.09) in comparison to the CG. HOMA-IR improved in children who had higher than baseline body mass index z-scores. CONCLUSIONS Intervention through multiple components that promoted healthier eating and physical activity habits improved the metabolic parameters of the children in the study after one year, regardless of their nutritional status.
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Affiliation(s)
- Jenny Vilchis-Gil
- Community Health Research Department, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Miguel Klünder-Klünder
- Community Health Research Department, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
- Research Committee, Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Ciudad de México, Mexico
| | - Samuel Flores-Huerta
- Community Health Research Department, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
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14
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Shomaker LB, Kelly NR, Radin RM, Cassidy OL, Shank LM, Brady SM, Demidowich AP, Olsen CH, Chen KY, Stice E, Tanofsky-Kraff M, Yanovski JA. Prevention of insulin resistance in adolescents at risk for type 2 diabetes with depressive symptoms: 1-year follow-up of a randomized trial. Depress Anxiety 2017; 34:866-876. [PMID: 28370947 PMCID: PMC5623599 DOI: 10.1002/da.22617] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 01/24/2017] [Accepted: 02/07/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Depression is associated with poor insulin sensitivity. We evaluated the long-term effects of a cognitive behavioral therapy (CBT) program for prevention of depression on insulin sensitivity in adolescents at risk for type 2 diabetes (T2D) with depressive symptoms. METHODS One-hundred nineteen adolescent females with overweight/obesity, T2D family history, and mild-to-moderate depressive symptoms were randomized to a 6-week CBT group (n = 61) or 6-week health education (HE) control group (n = 58). At baseline, posttreatment, and 1 year, depressive symptoms were assessed, and whole body insulin sensitivity (WBISI) was estimated from oral glucose tolerance tests. Dual energy X-ray absorptiometry assessed fat mass at baseline and 1 year. Primary outcomes were 1-year changes in depression and insulin sensitivity, adjusting for adiposity and other relevant covariates. Secondary outcomes were fasting and 2-hr insulin and glucose. We also evaluated the moderating effect of baseline depressive symptom severity. RESULTS Depressive symptoms decreased in both groups (P < .001). Insulin sensitivity was stable in CBT and HE (ΔWBISI: .1 vs. .3) and did not differ between groups (P = .63). However, among girls with greater (moderate) baseline depressive symptoms (N = 78), those in CBT developed lower 2-hr insulin than those in HE (Δ-16 vs. 16 μIU/mL, P < .05). Additional metabolic benefits of CBT were seen for this subgroup in post hoc analyses of posttreatment to 1-year change. CONCLUSIONS Adolescent females at risk for T2D decreased depressive symptoms and stabilized insulin sensitivity 1 year following brief CBT or HE. Further studies are required to determine if adolescents with moderate depression show metabolic benefits after CBT.
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Affiliation(s)
- Lauren B. Shomaker
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH),Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS),Department of Human Development and Family Studies and Colorado School of Public Health, Colorado State University
| | - Nichole R. Kelly
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH),Department of Counseling Psychology and Human Services and the Prevention Science Institute, College of Education, University of Oregon
| | - Rachel M. Radin
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH),Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS)
| | - Omni L. Cassidy
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH),Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS)
| | - Lisa M. Shank
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH),Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS)
| | - Sheila M. Brady
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH)
| | - Andrew P. Demidowich
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH)
| | - Cara H. Olsen
- Biostatistics, Department of Preventive Medicine, Uniformed Services University of the Health Sciences
| | - Kong Y. Chen
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, NIH
| | | | - Marian Tanofsky-Kraff
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH),Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS)
| | - Jack A. Yanovski
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH)
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15
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Bird SR, Hawley JA. Update on the effects of physical activity on insulin sensitivity in humans. BMJ Open Sport Exerc Med 2017; 2:e000143. [PMID: 28879026 PMCID: PMC5569266 DOI: 10.1136/bmjsem-2016-000143] [Citation(s) in RCA: 289] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2016] [Indexed: 01/04/2023] Open
Abstract
PURPOSE AND METHODS This review presents established knowledge on the effects of physical activity (PA) on whole-body insulin sensitivity (SI) and summarises the findings of recent (2013-2016) studies. DISCUSSION AND CONCLUSIONS Recent studies provide further evidence to support the notion that regular PA reduces the risk of insulin resistance, metabolic syndrome and type 2 diabetes, and SI improves when individuals comply with exercise and/or PA guidelines. Many studies indicate a dose response, with higher energy expenditures and higher exercise intensities, including high intensity interval training (HIIT), producing greater benefits on whole-body SI, although these findings are not unanimous. Aerobic exercise interventions can improve SI without an associated increase in cardiorespiratory fitness as measured by maximal or peak oxygen consumption. Both aerobic and resistance exercise can induce improvements in glycaemic regulation, with some suggestions that exercise regimens including both may be more efficacious than either exercise mode alone. Some studies report exercise-induced benefits to SI that are independent of habitual diet and weight loss, while others indicate an association with fat reduction, hence the debate over the relative importance of PA and weight loss continues. During exercise, muscle contraction stimulated improvements in SI are associated with increases in AMPK activity, which deactivates TCB1D1, promoting GLUT4 translocation to the cell membrane and thereby increasing glucose uptake. Postexercise, increases in Akt deactivate TCB1D4 and thereby increase GLUT4 translocation to the cell membrane. The reduction in intramuscular saturated fatty acids and concomitant reductions in ceramides, but not diacylglycerols, provide a potential link between intramuscular lipid content and SI. Increased skeletal muscle capillarisation provides another independent adaptation through which SI is improved, as does enhanced β cell activity. Recent studies are combining exercise interventions with dietary and feeding manipulations to investigate the potential for augmenting the exercise-induced improvements in SI and glycaemic control.
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Affiliation(s)
- Stephen R Bird
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - John A Hawley
- Mary MaKillop Institute for Health Research, Centre for Exercise and Nutrition, Australian Catholic University, Melbourne, Victoria, Australia.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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16
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Physical Activity Throughout Adolescence and Hba1c in Early Adulthood: Birth Cohort Study. J Phys Act Health 2017; 14:375-381. [PMID: 28169566 DOI: 10.1123/jpah.2016-0245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Physical inactivity is responsible for 7% of diabetes deaths worldwide, but little is known whether low levels of physical activity (PA) during adolescence increase the risk of diabetes in early adulthood. We evaluated the cross-sectional and longitudinal associations between PA throughout adolescence and HbA1c concentration in early adulthood. METHODS HbA1c was measured by high performance liquid chromatography. PA was assessed by self-report at the ages of 11, 15, and 18 years and by accelerometry at the ages of 13 (subsample) and 18 years. The loss percentages of follow up were 12.5% at 11 years, 14.4% at 15 years, and 18.7% at 18 years. RESULTS At 18 years, boys showed higher HbA1c than girls. At age 18 years, accelerometrybased PA at 18 years was inversely related to HbA1c levels in boys. Self-reported leisure-time PA at ages 11, 15, and 18 were unrelated to HbA1c in both genders. PA at 13 years of age was unrelated to HbA1c among both genders. In trajectory analysis, PA and accelerometer PA trajectories were not associated with later HbA1c. CONCLUSIONS Objectively measured PA at 18 years was cross-sectionally inversely associated with HbA1c in boys only. No prospective associations were identified.
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17
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Metcalf BS, Hosking J, Henley WE, Jeffery AN, Mostazir M, Voss LD, Wilkin TJ. Physical activity attenuates the mid-adolescent peak in insulin resistance but by late adolescence the effect is lost: a longitudinal study with annual measures from 9-16 years (EarlyBird 66). Diabetologia 2015; 58:2699-708. [PMID: 26264061 DOI: 10.1007/s00125-015-3714-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/10/2015] [Indexed: 11/25/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to test whether the mid-adolescent peak in insulin resistance (IR) and trends in other metabolic markers are influenced by long-term exposure to physical activity. METHODS Physical activity (7 day ActiGraph accelerometry), HOMA-IR and other metabolic markers (glucose, fasting insulin, HbA1c, lipids and BP) were measured annually from age 9 years to 16 years in 300 children (151 boys) from the EarlyBird study in Plymouth, UK. The activity level of each child was characterised, with 95% reliability, by averaging their eight annual physical activity measures. Age-related trends in IR and metabolic health were analysed by multi-level modelling, with physical activity as the exposure measure (categorical and continuous) and body fat percentage (assessed by dual-energy X-ray absorptiometry) and pubertal status (according to age at peak height velocity and Tanner stage) as covariates. RESULTS The peak in IR at age 12-13 years was 17% lower (p < 0.001) in the more active adolescents independently of body fat percentage and pubertal status. However, this difference diminished progressively over the next 3 years and had disappeared completely by the age of 16 years (e.g. difference was -14% at 14 years, -8% at 15 years and +1% at 16 years; 'physical activity × age(2), interaction, p < 0.01). Triacylglycerol levels in girls (-9.7%, p = 0.05) and diastolic blood pressure in boys (-1.20 mmHg, p = 0.03) tended to be lower throughout adolescence in the more active group. CONCLUSIONS/INTERPRETATION Our finding that physical activity attenuates IR during mid-adolescence may be clinically important. It remains to be established whether the temporary attenuation in IR during this period has implications for the development of diabetes in adolescence and for future metabolic health generally.
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Affiliation(s)
- Brad S Metcalf
- Institute of Health Research, University of Exeter Medical School, Exeter, UK.
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Joanne Hosking
- Department of Endocrinology and Metabolism, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - William E Henley
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Alison N Jeffery
- Department of Endocrinology and Metabolism, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Mohammod Mostazir
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Linda D Voss
- Department of Endocrinology and Metabolism, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Terence J Wilkin
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
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18
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Andersen K, Rasmussen F, Held C, Neovius M, Tynelius P, Sundström J. Exercise capacity and muscle strength and risk of vascular disease and arrhythmia in 1.1 million young Swedish men: cohort study. BMJ 2015; 351:h4543. [PMID: 26378015 PMCID: PMC4768156 DOI: 10.1136/bmj.h4543] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the associations of exercise capacity and muscle strength in late adolescence with risk of vascular disease and arrhythmia. DESIGN Cohort study. SETTING General population in Sweden. PARTICIPANTS 1.1 million men who participated in mandatory military conscription between 1 August 1972 and 31 December 1995, at a median age of 18.2 years. Participants were followed until 31 December 2010. MAIN OUTCOMES Associations between exercise capacity and muscle strength with risk of vascular disease and subgroups (ischaemic heart disease, heart failure, stroke, and cardiovascular death) and risk of arrhythmia and subgroups (atrial fibrillation or flutter, bradyarrhythmia, supraventricular tachycardia, and ventricular arrhythmia or sudden cardiac death). Maximum exercise capacity was estimated by the ergometer bicycle test, and muscle strength was measured as handgrip strength by a hand dynamometer. High exercise capacity or muscle strength was deemed as above the median level. RESULTS During a median follow-up of 26.3 years, 26 088 vascular disease events and 17 312 arrhythmia events were recorded. Exercise capacity was inversely associated with risk of vascular disease and its subgroups. Muscle strength was also inversely associated with vascular disease risk, driven by associations of higher muscle strength with lower risk of heart failure and cardiovascular death. Exercise capacity had a U shaped association with risk of arrhythmia, driven by a direct association with risk of atrial fibrillation and a U shaped association with bradyarrhythmia. Higher muscle strength was associated with lower risk of arrhythmia (specifically, lower risk of bradyarrhythmia and ventricular arrhythmia). The combination of high exercise capacity and high muscle strength was associated with a hazard ratio of 0.67 (95% confidence interval 0.65 to 0.70) for vascular events and 0.92 (0.88 to 0.97) for arrhythmia compared with the combination of low exercise capacity and low muscle strength. CONCLUSIONS Exercise capacity and muscle strength in late adolescence are independently and jointly associated with long term risk of vascular disease and arrhythmia. The health benefit of lower risk of vascular events with higher exercise capacity was not outweighed by higher risk of arrhythmia.
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Affiliation(s)
- Kasper Andersen
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University Hospital, Uppsala, SE-751 85, Sweden
| | - Finn Rasmussen
- Child and Adolescent Public Health Epidemiology Unit, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Claes Held
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University Hospital, Uppsala, SE-751 85, Sweden
| | - Martin Neovius
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Per Tynelius
- Child and Adolescent Public Health Epidemiology Unit, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Johan Sundström
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University Hospital, Uppsala, SE-751 85, Sweden
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19
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Marlais M, Coward RJ. Paediatrics, insulin resistance and the kidney. Pediatr Nephrol 2015; 30:1217-24. [PMID: 25060762 DOI: 10.1007/s00467-014-2890-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 04/05/2014] [Accepted: 04/15/2014] [Indexed: 12/12/2022]
Abstract
Systemic insulin resistance is becoming more prevalent in the young due to modern lifestyles predisposing to the metabolic syndrome and obesity. There is also evidence that there are critical insulin-resistant phases for the developing child, including puberty, and that renal disease per se causes systemic insulin resistance. This review considers the factors that render children insulin resistant, as well as the accumulating evidence that the kidney is an insulin-responsive organ and could be affected by insulin resistance.
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Affiliation(s)
- Matko Marlais
- Institute of Child Health, University College London, London, United Kingdom
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20
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Slater ME, Ross JA, Kelly AS, Dengel DR, Hodges JS, Sinaiko AR, Moran A, Lee J, Perkins JL, Chow LS, Baker KS, Steinberger J. Physical activity and cardiovascular risk factors in childhood cancer survivors. Pediatr Blood Cancer 2015; 62:305-310. [PMID: 25327738 PMCID: PMC4402091 DOI: 10.1002/pbc.25276] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 08/19/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Childhood cancer survivors (CCS) are at high risk of developing treatment-related late effects, including cardiovascular disease and diabetes. Late effects can be exacerbated by low physical activity (PA) levels. Relationships between PA and cardiovascular risk factors during childhood have not been well described in CCS. PROCEDURE PA and cardiovascular risk factors were measured cross-sectionally in 319 CCS and 208 sibling controls aged 9-18 years. Comparisons between CCS and controls and associations of outcomes with PA (dichotomized at 60 min/day or treated as continuous) were performed with linear regression. RESULTS Among CCS, the high PA group had lower percent fat mass (24.4% vs. 29.8%, P < 0.0001), abdominal subcutaneous fat (67.9 vs. 97.3 cm3 , P = 0.0004), and abdominal visceral fat (20.0 vs. 24.9 cm3 , P = 0.007) and greater lean body mass (41.3 vs. 39.5 kg, P = 0.009) than the low PA group. Comparing CCS to controls, differences in waist circumference (Pinteraction = 0.04), percent fat mass (Pinteraction = 0.04), and abdominal subcutaneous (Pinteraction = 0.02) and visceral (Pinteraction = 0.004) fat between low and high PA groups were greater in CCS than controls, possibly due to greater overall adiposity in CCS. CONCLUSIONS High PA in CCS resulted in an improved cardiovascular profile, consisting primarily of lower fat mass and greater lean mass, similar to that observed in controls. This suggests interventions directed to increase PA in CCS may reduce the risk of future cardiovascular disease. Pediatr Blood Cancer 2015;62:305-310. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
| | | | | | | | | | | | | | - Jill Lee
- University of Minnesota, Minneapolis, Minnesota
| | - Joanna L. Perkins
- Children’s Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | | | - K. Scott Baker
- Fred Hutchinson Cancer Research Center, Seattle, Washington
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21
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Abstract
Diseases once associated with older adulthood, type 2 diabetes and cardiovascular disease, are increasingly diagnosed in children and adolescents. Interventions designed to assist adults in modifying dietary and physical activity habits have been shown to help prevent the development of type 2 diabetes and cardiovascular disease in adults. Given the unfortunate rise in both of these diseases in pediatric populations, it is increasingly important to begin prevention efforts in childhood or prenatally. There is strong empirical support for utilizing lifestyle interventions to prevent these diseases in adults; it is not clear whether the same holds true for pediatric populations. The present review examines lifestyle management efforts to prevent type 2 diabetes and cardiovascular disease in children across socioecological levels. Recommendations are made for expanding the traditional focus of lifestyle interventions from dietary and physical activity behaviors to target additional risks for these diseases such as smoking and depression in youth.
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Affiliation(s)
- Dorothy J. Van Buren
- Department of Psychiatry, Washington University School of Medicine, Campus Box 8134, 660 South Euclid, St. Louis, MO 63110 USA
| | - Tiffany L. Tibbs
- School of Advanced Studies and College of Social Sciences, University of Phoenix, 3157 E. Elwood St., Phoenix, AZ 85034 USA
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22
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Health behaviour in children and adolescents with type 1 diabetes compared to a representative reference population. PLoS One 2014; 9:e112083. [PMID: 25384048 PMCID: PMC4226508 DOI: 10.1371/journal.pone.0112083] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 10/13/2014] [Indexed: 12/30/2022] Open
Abstract
Objective We provide a population-based overview of health behaviours of children and adolescents with type 1 diabetes in comparison to the general population, and analyse their relevance for glycaemic control and self-rated health status. Methods Data from questionnaires of 11- to 17-year-old children and adolescents with diabetes (n = 629) were compared to a representative sample (n = 6,813). Results Children and adolescents with type 1 diabetes had a significantly increased odds of infrequent physical activity (adjusted OR 1.56), short overall duration of physical activity per week (OR 1.55, difference -1.3 hours/week), and high daily computer use (OR 2.51). They had a lower odds of active and passive smoking (OR 0.31 and OR 0.29), and high daily television time (OR 0.68). The odds of an at least good and excellent self-rated health status was increased with intense physical activity, and decreased with active smoking and prolonged daily use of computer and television. Active smoking and prolonged daily use of computer were associated with higher HbA1c. Conclusions Children and adolescents with type 1 diabetes showed a different profile of health behaviour. Their overall health may improve if their education stresses specifically frequent physical activity with longer overall duration and less frequent television or computer use.
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23
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Abstract
Behavioral contributions to the pathogenesis of prediabetes and Type 2 diabetes (T2D) include lifestyle behaviors including dietary intake, exercise, sedentariness, sleep, and stress. The purpose of this paper is to review evidence for the metabolic pathways by which the behavior is linked to T2D. Evidence for interventions, which change each of the lifestyle behaviors, is discussed. The article will close with a brief discussion on how new technologies may provide opportunities to better understand relationships between moment-to-moment fluctuations in behaviors and diabetes pathogenesis, as well as provide opportunities to personalize and adapt interventions to achieve successful behavior change and maintenance of that change. Especially promising are new technologies, which assist in tracking lifestyle behaviors along with clinical and metabolic outcomes.
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Affiliation(s)
- Donna Spruijt-Metz
- Center for Economic and Social Research, University of Southern California, 12015 Waterfront Drive, Playa Vista, CA, 90094-2536, USA,
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24
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Vegetarian diet-induced increase in linoleic acid in serum phospholipids is associated with improved insulin sensitivity in subjects with type 2 diabetes. Nutr Diabetes 2013; 3:e75. [PMID: 23775014 PMCID: PMC3697401 DOI: 10.1038/nutd.2013.12] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND AIMS: Fatty acids are important cellular constituents that may affect many metabolic processes relevant for the development of diabetes and its complications. We showed previously that vegetarian diet leads to greater increase in metabolic clearance rate of glucose (MCR) than conventional hypocaloric diet. The aim of this secondary analysis was to explore the role of changes in fatty acid composition of serum phospholipids in diet- and exercise-induced changes in MCR in subjects with type 2 diabetes (T2D). METHODS: Subjects with T2D (n=74) were randomly assigned into a vegetarian group (VG, n=37) following vegetarian diet or a control group (CG, n=37) following a conventional diet. Both diets were calorie restricted (−500 kcal day–1). Participants were examined at baseline, 12 weeks of diet intervention and 24 weeks (subsequent 12 weeks of diet were combined with aerobic exercise). The fatty acid composition of serum phospholipids was measured by gas liquid chromatography. MCR was measured by hyperinsulinemic isoglycemic clamp. Visceral fat (VF) was measured by magnetic resonance imaging. RESULTS: Linoleic acid (LA; 18:2n6) increased in VG (P=0.04), whereas it decreased in CG (P=0.04) in response to dietary interventions. It did not change significantly after the addition of exercise in either group (group × time P<0.001). In VG, changes in 18:2n6 correlated positively with changes in MCR (r=+0.22; P=0.04) and negatively with changes in VF (r=−0.43; P=0.01). After adjustment for changes in body mass index, the association between 18:2n6 and MCR was no longer significant. The addition of exercise resulted in greater changes of phospholipid fatty acids composition in VG than in CG. CONCLUSION: We demonstrated that the insulin-sensitizing effect of a vegetarian diet might be related to the increased proportion of LA in serum phospholipids.
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