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Ma X, Tian M, Liu J, Tong L, Ding W. Impact of high fat and low lean mass phenotype on bone mineral content: A cross-sectional study of Chinese adolescent population. Bone 2024; 186:117170. [PMID: 38880171 DOI: 10.1016/j.bone.2024.117170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/30/2024] [Accepted: 06/13/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND AND OBJECTIVE Research on body composition phenotypes and bone health in adolescents is limited. Hence, this study aimed to analyze the relationship between different body composition phenotypes, bone mineral content, and bone metabolism markers in Chinese adolescents. METHODS In this cross-sectional study, 1852 adolescents aged 12 to 18 years were selected from six schools in Yinchuan City between 2017 and 2020 using stratified cluster random sampling. The participant's body composition and bone mineral content (BMC) were measured using bioelectrical impedance analysis (BIA). Serum bone metabolic markers (OC, CTX, and Ca) were measured. Based on their FMI and LMI, individuals were categorized into four body composition phenotypes: low fat mass-low lean mass (LFMI-LLMI), low fat mass-high lean mass (LFMI-HLMI), high fat mass-high lean mass (HFMI-HLMI), high fat mass-low lean mass (HFMI-LLMI). RESULTS There was a statistically significant difference between the four different body composition phenotypes with BMC, CTX and Ca in boys (all P < 0.05), similar conclusions were found in girls, except the OC and CTX. After adjusting for age, gender, smoking, drinking, and others, compared with the LFMI-HLMI reference group, the two high FMI groups (HFMI-LLMI and HFMI-HLMI) had a greater negative correlation with BMC, while the low BMC risk of the HFMI-LLMI group was the highest (OR = 33.28; 95%CI: 11.12-99.63; P < 0.001). The correlation between BMC of different body composition phenotypes in boys was greater than that in girls. HFMI-HLMI is a risk phenotype negatively associated with Ca content (β = -0.12; 95%CI: -0.19 to -0.04; P < 0.05). Regardless of body composition level, BMC was always negatively correlated with fat mass (LLMI: β = -0.27; 95%CI: -0.32-0.21; HLMI: β = -0.52, 95%CI: -0.65-0.40) and positively correlated with lean mass (LFMI: β =0.24; 95%CI: 0.20-0.28; HFMI: β =0.23, 95%CI:0.13-0.33) (all P < 0.001). The fat mass showed different correlations with OC and CTX in girls and boys based on LLMI or HLMI (all P < 0.05). CONCLUSION HFMI-LLMI is a risk phenotype of low BMC in Chinese adolescents, and the relationship between fat mass and bone metabolism markers is affected by lean body mass and gender.
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Affiliation(s)
- Xiaoyan Ma
- School of Public Health, Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan 750004, China
| | - Mei Tian
- School of Public Health, Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan 750004, China
| | - Jianxi Liu
- School of Public Health, Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan 750004, China
| | - Lingling Tong
- School of Public Health, Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan 750004, China
| | - Wenqing Ding
- School of Public Health, Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan 750004, China.
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Bouton S, Chevallier C, Cissé AH, Heude B, Jacquet PO. Metabolic trade-offs in childhood: Exploring the relationship between language development and body growth. Dev Sci 2024:e13493. [PMID: 38497570 DOI: 10.1111/desc.13493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/19/2024]
Abstract
During human childhood, brain development and body growth compete for limited metabolic resources, resulting in a trade-off where energy allocated to brain development can decrease as body growth accelerates. This preregistered study explores the relationship between language skills, serving as a proxy for brain development, and body mass index at three distinct developmental stages, representing different phases of body growth. Longitudinal data from 2002 children in the EDEN mother-child cohort were analyzed using structural equation modeling. Our findings reveal a compelling pattern of associations: girls with a delayed adiposity rebound, signaling slower growth rate, demonstrated better language proficiency at ages 5-6. Importantly, this correlation appears to be specific to language skills and does not extend to nonverbal cognitive abilities. Exploratory analyses show that early environmental factors contributing to enhanced cognitive development, such as higher parental socio-economic status and increased cognitive stimulation, are positively associated with both language skills and the timing of adiposity rebound in girls. Overall, our findings lend support to the existence of an energy allocation trade-off mechanism that appears to prioritize language function over body growth investment in girls.
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Affiliation(s)
- Sophie Bouton
- Institut Pasteur, Université Paris Cité, Inserm, Institut de l'Audition, Paris, France
- Laboratoire de Sciences Cognitives et Psycholinguistique, Ecole Normale Supérieure, Université PSL, INSERM, Paris, France
| | - Coralie Chevallier
- LNC2, Département d'études cognitives, Ecole Normale Supérieure, Université PSL, INSERM, Paris, France
| | - Aminata Hallimat Cissé
- INSERM UMR 1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Developmental Origins of Health and Disease (ORCHAD) Team, Paris Descartes University, Villejuif, France
| | - Barbara Heude
- INSERM UMR 1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Developmental Origins of Health and Disease (ORCHAD) Team, Paris Descartes University, Villejuif, France
| | - Pierre O Jacquet
- LNC2, Département d'études cognitives, Ecole Normale Supérieure, Université PSL, INSERM, Paris, France
- Centre de recherche en épidémiologie et santé des populations, Inserm U1018, université Paris-Saclay, université Versailles Saint-Quentin, Paris, France
- Institut du Psychotraumatisme de l'Enfant et de l'Adolescent, Conseil Départemental Yvelines et Hauts-de-Seine et Centre Hospitalier des Versailles, Versailles, France
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Waterfield S, Richardson TG, Davey Smith G, O’Keeffe LM, Bell JA. Life course effects of genetic susceptibility to higher body size on body fat and lean mass: prospective cohort study. Int J Epidemiol 2023; 52:1377-1387. [PMID: 36952292 PMCID: PMC10555894 DOI: 10.1093/ije/dyad029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 02/27/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND/OBJECTIVES Different genetic variants are associated with larger body size in childhood vs adulthood. Whether and when these variants predominantly influence adiposity are unknown. We examined how genetic variants influence total body fat and total lean mass trajectories. METHODS Data were from the Avon Longitudinal Study of Parents and Children birth cohort (N = 6926). Sex-specific genetic risk scores (GRS) for childhood and adulthood body size were generated, and dual-energy X-ray absorptiometry scans measured body fat and lean mass six times between the ages of 9 and 25 years. Multilevel linear spline models examined associations of GRS with fat and lean mass trajectories. RESULTS In males, the sex-specific childhood and adulthood GRS were associated with similar differences in fat mass from 9 to 18 years; 8.3% [95% confidence interval (CI) 5.1, 11.6] and 7.5% (95% CI 4.3, 10.8) higher fat mass at 18 years per standard deviation (SD) higher childhood and adulthood GRS, respectively. In males, the sex-combined childhood GRS had stronger effects at ages 9 to 15 than the sex-combined adulthood GRS. In females, associations for the sex-specific childhood GRS were almost 2-fold stronger than the adulthood GRS from 9 to 18 years: 10.5% (95% CI 8.5, 12.4) higher fat mass at 9 years per SD higher childhood GRS compared with 5.1% (95% CI 3.2, 6.9) per-SD higher adulthood GRS. In females, the sex-combined GRS had similar effects, with slightly larger effect estimates. Lean mass effect sizes were much smaller. CONCLUSIONS Genetic variants for body size are more strongly associated with adiposity than with lean mass. Sex-combined childhood variants are more strongly associated with increased adiposity until early adulthood. This may inform future studies that use genetics to investigate the causes and impact of adiposity at different life stages.
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Affiliation(s)
- Scott Waterfield
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Cancer Research UK Integrative Cancer Epidemiology Programme, University of Bristol, Bristol, UK
| | - Tom G Richardson
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Linda M O’Keeffe
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- School of Public Health, University College Cork, Cork, Ireland
| | - Joshua A Bell
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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O'Keeffe LM, Tilling K, Bell JA, Walsh PT, Lee MA, Lawlor DA, Davey Smith G, Kearney PM. Sex-specific trajectories of molecular cardiometabolic traits from childhood to young adulthood. Heart 2023; 109:674-685. [PMID: 36914250 PMCID: PMC10176380 DOI: 10.1136/heartjnl-2022-321347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/15/2022] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND The changes which typically occur in molecular causal risk factors and predictive biomarkers for cardiometabolic diseases across early life are not well characterised. METHODS We quantified sex-specific trajectories of 148 metabolic trait concentrations including various lipoprotein subclasses from age 7 years to 25 years. Data were from 7065 to 7626 offspring (11 702 to14 797 repeated measures) of the Avon Longitudinal Study of Parents and Children birth cohort study. Outcomes were quantified using nuclear magnetic resonance spectroscopy at 7, 15, 18 and 25 years. Sex-specific trajectories of each trait were modelled using linear spline multilevel models. RESULTS Females had higher very-low-density lipoprotein (VLDL) particle concentrations at 7 years. VLDL particle concentrations decreased from 7 years to 25 years with larger decreases in females, leading to lower VLDL particle concentrations at 25 years in females. For example, females had a 0.25 SD (95% CI 0.20 to 0.31) higher small VLDL particle concentration at 7 years; mean levels decreased by 0.06 SDs (95% CI -0.01 to 0.13) in males and 0.85 SDs (95% CI 0.79 to 0.90) in females from 7 years to 25 years, leading to 0.42 SDs (95% CI 0.35 to 0.48) lower small VLDL particle concentrations in females at 25 years. Females had lower high-density lipoprotein (HDL) particle concentrations at 7 years. HDL particle concentrations increased from 7 years to 25 years with larger increases among females leading to higher HDL particle concentrations in females at 25 years. CONCLUSION Childhood and adolescence are important periods for the emergence of sex differences in atherogenic lipids and predictive biomarkers for cardiometabolic disease, mostly to the detriment of males.
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Affiliation(s)
- Linda M O'Keeffe
- School of Public Health, University College Cork, Cork, Ireland
- MRC Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate Tilling
- MRC Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joshua A Bell
- MRC Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Patrick T Walsh
- School of Public Health, University College Cork, Cork, Ireland
| | - Matthew A Lee
- MRC Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Henne SK, Nöthen MM, Heilmann-Heimbach S. Male-pattern hair loss: Comprehensive identification of the associated genes as a basis for understanding pathophysiology. MED GENET-BERLIN 2023; 35:3-14. [PMID: 38835416 PMCID: PMC10842561 DOI: 10.1515/medgen-2023-2003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Male-pattern hair loss (MPHL) is a highly heritable and prevalent condition that is characterized by progressive hair loss from the frontotemporal and vertex scalp. This androgen-dependent hair loss may commence during puberty, and up to 80 % of European men experience some degree of MPHL during their lifetime. Current treatment options for MPHL have limited efficacy, and improved understanding of the underlying biological causes is required to facilitate novel therapeutic approaches. To date, molecular genetic studies have identified 389 associated genomic regions, have implicated numerous genes in these regions, and suggested pathways that are likely to contribute to key pathophysiological mechanisms in MPHL. This review provides an overview of the current status of MPHL genetic research. We discuss the most significant achievements, current challenges, and anticipated developments in the field, as well as their potential to advance our understanding of hair (loss) biology, and to improve hair loss prediction and treatment.
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Affiliation(s)
- Sabrina K Henne
- University Hospital of Bonn & University of Bonn Institute of Human Genetics Bonn Germany
| | - Markus M Nöthen
- University Hospital of Bonn & University of Bonn Institute of Human Genetics Bonn Germany
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O'Keeffe LM, Yelverton CA, Bartels HC, O'Neill KN, McDonnell C, McAuliffe FM. Application of multilevel linear spline models for analysis of growth trajectories in a cohort with repeat antenatal and postnatal measures of growth: a prospective cohort study. BMJ Open 2023; 13:e065701. [PMID: 36972957 PMCID: PMC10069489 DOI: 10.1136/bmjopen-2022-065701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVES To model trajectories of antenatal and postnatal growth using linear spline multilevel models. DESIGN Prospective cohort study. SETTING Maternity hospital in Dublin, Ireland. PARTICIPANTS 720-759 mother-child pairs from the ROLO study (initially a randomised control trial of a low glycaemic index diet in pregnancy to prevent recurrence of macrosomia [birth weight >4 kg]). PRIMARY OUTCOMES Trajectories of growth from 20 weeks gestation (abdominal circumference [AC], head circumference [HC] and weight) or birth (length/height) to 5 years. RESULTS Over 50% of women had third-level education and 90% were of white ethnicity. Women were a mean (SD) age of 32 years (4.2) at recruitment. The best fitting model for AC, HC and weight included a model with 5 linear spline periods. The best fitting models for length/height included a model with 3 linear spline periods from birth to 6 months, 6 months to 2 years and 2 years to 5 years. Comparison of observed and predicted values for each model demonstrated good model fit. For all growth measures, growth rates were generally fastest in pregnancy or immediately post partum (for length/height), with rates of growth slowing after birth and becoming slower still as infancy and childhood progressed. CONCLUSION We demonstrate the application of multilevel linear spline models for examining growth trajectories when both antenatal and postnatal measures of growth are available. The approach may be useful for cohort studies or randomised control trials with repeat prospective assessments of growth.
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Affiliation(s)
- Linda M O'Keeffe
- School of Public Health, University College Cork, Cork, Ireland
- MRC Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol Medical School, Bristol, UK
| | - Cara A Yelverton
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, Dublin, Ireland
| | - Helena C Bartels
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, Dublin, Ireland
| | - Kate N O'Neill
- School of Public Health, University College Cork, Cork, Ireland
| | - Ciara McDonnell
- Department of Paediatric Endocrinology & Diabetes, Children's Health Ireland at Temple Street, Dublin, Ireland
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, Dublin, Ireland
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A Cross-Sectional Investigation of Preadolescent Cardiometabolic Health: Associations with Fitness, Physical Activity, Sedentary Behavior, Nutrition, and Sleep. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020336. [PMID: 36832464 PMCID: PMC9955686 DOI: 10.3390/children10020336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Cardiometabolic disease (CMD) risk often begins early in life. Healthy lifestyle behaviors can mitigate risk, but the optimal combination of behaviors has not been determined. This cross-sectional study simultaneously examined the associations between lifestyle factors (fitness, activity behaviors, and dietary patterns) and CMD risk in preadolescent children. METHODS 1480 New Zealand children aged 8-10 years were recruited. Participants included 316 preadolescents (50% female, age: 9.5 ± 1.1 years, BMI: 17.9 ± 3.3 kg/m2). Fitness (cardiorespiratory fitness [CRF], muscular fitness), activity behaviors (physical activity, sedentary, sleep), and dietary patterns were measured. Factor analysis was used to derive a CMD risk score from 13 variables (adiposity, peripheral and central hemodynamics, glycemic control, and blood lipids). RESULTS Only CRF (β = -0.45, p < 0.001) and sedentary time (β = 0.12, p = 0.019) were associated with the CMD risk score in the adjusted multivariable analysis. CRF was found to be nonlinear (VO2 max ≤ ≈42 mL/kg/min associated with higher CMD risk score), and thus a CRF polynomial term was added, which was also associated (β = 0.19, p < 0.001) with the CMD risk score. Significant associations were not found with sleep or dietary variables. CONCLUSION The findings indicate that increasing CRF and decreasing sedentary behavior may be important public health targets in preadolescent children.
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Bassols J, de Zegher F, Diaz M, Carreras-Badosa G, Garcia-Beltran C, Puerto-Carranza E, Oliver-Vila C, Casano P, Franco CA, Malpique R, López-Bermejo A, Ibáñez L. Effects of half-dose spiomet treatment in girls with early puberty and accelerated bone maturation: a multicenter, randomized, placebo-controlled study protocol. Trials 2023; 24:56. [PMID: 36694227 PMCID: PMC9873221 DOI: 10.1186/s13063-022-07050-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/23/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND A "mismatch" sequence of less prenatal weight gain and more postnatal weight gain may lead to ectopic lipid accumulation, and trigger the development of early adrenarche/pubarche and the activation of the gonadotropic axis resulting in early puberty and ending up in full-blown adolescent polycystic ovary syndrome (PCOS). In the present study, we assess whether a low-dose combination of generics that collectively reduce ectopic fat through different pathways can slow down the accelerated maturation in "mismatch" girls with early puberty. METHODS Randomized, placebo-controlled, multicenter, phase 2a, study in 64 girls [age, 8.0-9.3 years; birthweight (BW) for gestational age in lower tertile (-1.96< Z-score <-0.44), body mass index (BMI) in upper tertile (+0.44< Z-score < +1.96) and early progressive puberty (Tanner B2 at 7.7-9.0 years)]. Pharmacological intervention will be with a half-dose version of SPIOMET (mini-spiomet), a combination that reverts the PCOS phenotype in "mismatch" adolescents; mini-spiomet will contain spironolactone (25 mg/day, to raise brown adipose tissue activity), pioglitazone (3.75 mg/day, to raise adiponectin and insulin sensitivity), and metformin (425 mg/day, to raise AMPK activity and GDF15). Recruitment: 1 year; double-blind treatment: 1 year; open follow-up: 1 year; analyses and reporting: 1 year. INTERVENTIONS randomization (1:1) for placebo vs mini-spiomet. PRIMARY OUTCOME annualized bone age advancement (0-1 year) by BoneXpert; secondary outcomes: insulin, IGF-I, high-molecular-weight adiponectin (HMW-adip), sex hormone binding globulin (SHBG), ultra-sensitive C-reactive protein (usCRP), androgens, luteinizing hormone (LH), follicle-stimulating hormone (FSH), oestradiol, growth-and-differentiation factor 15 (GDF15), C-X-C motif chemokine ligand-14 (CXCL14), safety parameters, and quantification of hepato-visceral fat. DISCUSSION The present study, if successful, may provide a first proof of the concept that the rapid maturation of girls with an upward mismatch between pre- and post-natal weight gain can be slowed down with a fixed low-dose combination of old and safe generics jointly targeting a reduction of ectopic fat without necessarily lowering body weight. TRIAL REGISTRATION EudraCT 2021-006766-21. Registered on May 30, 2022.
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Affiliation(s)
- Judit Bassols
- Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Francis de Zegher
- Leuven Research & Development, University of Leuven, Leuven, Belgium
| | - Marta Diaz
- Endocrinology Department, Pediatric Research Institute Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | - Gemma Carreras-Badosa
- Pediatric Endocrinology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Cristina Garcia-Beltran
- Endocrinology Department, Pediatric Research Institute Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Cora Oliver-Vila
- Pediatric Endocrinology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Paula Casano
- Endocrinology Department, Pediatric Research Institute Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | - Céline Alicia Franco
- Endocrinology Department, Pediatric Research Institute Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Rita Malpique
- Endocrinology Department, Pediatric Research Institute Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | - Abel López-Bermejo
- Pediatric Endocrinology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain.
- Pediatrics, Dr. Josep Trueta Hospital, Girona, Spain.
- Department of Medical Sciences, University of Girona, Girona, Spain.
| | - Lourdes Ibáñez
- Endocrinology Department, Pediatric Research Institute Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain.
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de Oliveira IDR, Maciel NMS, da Costa BT, Soares ADN, Gomes JMG. Association between abdominal obesity, screen time and sleep in adolescents. J Pediatr (Rio J) 2023; 99:45-52. [PMID: 35697123 PMCID: PMC9875269 DOI: 10.1016/j.jped.2022.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To assess the association between abdominal obesity, food intake, sleep deprivation, and screen time in adolescents. METHODS This cross-sectional study was conducted with 432 adolescents aged 14-19 years, from public and private schools. Anthropometric and body composition measures included body weight, waist circumference, body mass index for age, waist-to-hip ratio, waist-to-height ratio, and body fat percentage. Abdominal obesity was defined by age and sex specific cut-off points for waist circumference. Food intake, screen time, sexual maturation, and sleep duration were evaluated by self-administered questionnaires. RESULTS The prevalence of excess body weight and abdominal obesity was 16.7% and 27.5%, respectively. Students in the adult phase (post-puberty), with inadequate waist-to-height ratio, high body fat percentage, and screen time ≥ 3 h/day were, respectively, 2.5 (95% CI 1.40-4.46), 7.44 (95% CI 1.08-51.46), 2.79 (95% CI 1.04-7.50), and 1.43 (95% CI 1.24-3.89) more likely to have abdominal obesity. Low intake of unprocessed or minimally processed foods was associated with inadequate sleep duration, while high intake of ultra-processed foods was associated with high screen time. CONCLUSIONS Abdominal obesity was associated with the adult phase, short sleep duration and high screen time. The degree of food processing was associated with screen time and sleep duration. Assessing the risk factors of abdominal obesity may be a useful strategy for preventing cardiovascular disease in adolescents.
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Affiliation(s)
| | | | - Bianca Tomaz da Costa
- Instituto Federal de Educação, Ciência e Tecnologia do Sudeste de Minas Gerais, Barbacena, MG, Brazil
| | | | - Júnia Maria Geraldo Gomes
- Instituto Federal de Educação, Ciência e Tecnologia do Sudeste de Minas Gerais, Barbacena, MG, Brazil.
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McConnell-Nzunga J, Gabel L, Macdonald HM, Rhodes RE, Hofer SM, Naylor PJ, McKay HA. A 4-Yr Mixed Longitudinal Study of Health Behaviors and Fat Mass Accrual during Adolescence and Early Adulthood. Med Sci Sports Exerc 2022; 54:2178-2187. [PMID: 35868009 DOI: 10.1249/mss.0000000000003003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Physical activity (PA), sedentary time (SED), and energy intake (EI) are associated with fat mass accrual in children and youth. Previous studies relied primarily on cross-sectional designs and proxy measures of body composition such as body mass index. We aimed to prospectively investigate associations between PA, SED, EI, and total body fat mass accrual using dual-energy x-ray absorptiometry. METHODS This analysis of the mixed longitudinal Healthy Bones III Study included data from 312 participants (138 boys age 9 to 21 yr at baseline). For each participant, we acquired a maximum of four annual total body dual-energy x-ray absorptiometry scans from which we determined fat mass (in kilograms; n = 748 observations). We assessed total PA, moderate-to-vigorous PA (MVPA) and SED with accelerometers (ActiGraph GT1M) and measured EI via 24-h dietary recall. We fit sex-specific multilevel models adjusting for maturity (years from age at peak height velocity (APHV)), weight status, ethnicity, total PA, MVPA, SED, and EI. RESULTS Boys and girls demonstrated divergent trajectories of fat mass accrual; rate of fat mass accrual in girls was four times greater than boys at APHV and increased across adolescence, whereas boys' fat mass plateaued after APHV. In boys, within-person change in MVPA negatively predicted fat mass independent of SED; each annual increase in MVPA of 6 min·d -1 was associated with a 0.21-kg lower fat mass. In girls, between-person average MVPA negatively predicted fat mass accrual independent of SED; greater MVPA of 4 min·d -1 across adolescence was associated with a 0.31-kg lower fat mass. CONCLUSIONS MVPA demonstrates an independent and negative effect on fat mass in boys and girls. Given different trajectories of fat mass accrual and movement behaviors between boys and girls, PA interventions aimed at preventing obesity in youth may benefit from a sex and gendered approach.
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Affiliation(s)
- Jennifer McConnell-Nzunga
- Social Dimensions of Health, University of Victoria, Interdisciplinary Programs, Victoria, BC, CANADA
| | - Leigh Gabel
- Faculty of Kinesiology, University of Calgary, Calgary, AB, CANADA
| | | | - Ryan E Rhodes
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, CANADA
| | - Scott M Hofer
- Department of Psychology, University of Victoria, Victoria, BC, CANADA
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, CANADA
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11
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Huang L, Hou JW, Fan HY, Tsai MC, Yang C, Hsu JB, Chen YC. Critical body fat percentage required for puberty onset: the Taiwan Pubertal Longitudinal Study. J Endocrinol Invest 2022; 46:1177-1185. [PMID: 36436189 PMCID: PMC9702699 DOI: 10.1007/s40618-022-01970-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/17/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Prepubescent body fat percentage (BFP) is associated with puberty onset; however, the association between the timing of puberty onset and BFP remains unclear. This study aimed to determine whether and how the timing of puberty onset is associated with various anthropometric measures, and to investigate the critical time period of the BFP transition before and after puberty. METHODS The Taiwan Pubertal Longitudinal Study (TPLS) has a multicenter, population-based prospective cohort and was established in July 2018 at 4 pediatric departments. We included girls aged 6-14 years and boys aged 9-17 years evaluated as having puberty onset and excluded those with precocious puberty diagnosis. The anthropometric measures were collected every 3 months. The main outcome was age at puberty onset. Data were analyzed between July 2018 and September 2020. RESULTS For 153 girls and 83 boys, BFP was significantly related to puberty onset for girls. Longitudinal analysis revealed that BFP in the girls was reduced to less than 18% 6 months before puberty and rapidly increased by 2.85% over 3 months, then exceeding 20% before puberty onset. After puberty onset, BFP was no longer lower than 22%. CONCLUSIONS BFP is an essential predictor of age at puberty onset. BFP first decreases and then begins to increase 3-6 months before puberty in girls. Parents and schools could monitor the BFP of prepubescent girls every 6 months to predict puberty onset.
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Affiliation(s)
- L Huang
- Department of Family Medicine, Taipei Medical University Hospital, Taipei Medical University, No. 252, Wuxing St, Xinyi District, Taipei, 110, Taiwan
| | - J-W Hou
- Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan
- College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - H-Y Fan
- Department of Family Medicine, Taipei Medical University Hospital, Taipei Medical University, No. 252, Wuxing St, Xinyi District, Taipei, 110, Taiwan
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - M-C Tsai
- Department of Pediatrics, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - C Yang
- Department of Pediatrics, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - J B Hsu
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Y C Chen
- Department of Family Medicine, Taipei Medical University Hospital, Taipei Medical University, No. 252, Wuxing St, Xinyi District, Taipei, 110, Taiwan.
- Department of Family Medicine, School of medicine, College of medicine, Taipei Medical University, Taipei, Taiwan.
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan.
- Graduate Institute of Metabolism and Obesity Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan.
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12
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Li Y, Ma T, Ma Y, Gao D, Chen L, Chen M, Liu J, Dong B, Dong Y, Ma J. Adiposity Status, Trajectories, and Earlier Puberty Onset: Results From a Longitudinal Cohort Study. J Clin Endocrinol Metab 2022; 107:2462-2472. [PMID: 35779008 DOI: 10.1210/clinem/dgac395] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Adiposity is associated with earlier puberty onset in girls, but such an association among boys is controversial. OBJECTIVE To estimate the association of prepubertal adiposity status, trajectories, and the earlier puberty onset based on a cohort study. METHODS A total of 1322 children were included in 2017 (mean age of 8.1 ± 0.6 years for girls and 9.1 ± 0.6 years for boys) and were followed every 6 months until October 2020. Anthropometric profiles, including BMI, WC, and body composition indicators, were used to determine adiposity status. Group-based trajectory modeling was used to identify trajectory groups of anthropometric profiles. Testicular volume for boys and breast stage for girls were clinically assessed. Pubertal development was assessed through clinical inspection and palpation by using The Tanner rating map and Prader orchidometer. Covariate information was obtained through questionnaires. RESULTS Childhood adiposity was associated with increased risk of earlier puberty onset. Body composition was more sensitive to earlier puberty onset than BMI and WC. Boys and girls with high-level body fat percentage had increased risk of earlier puberty onset compared with those with low-level body fat percentage. However, boys and girls with high-level FFM (fat-free mass)/FM (fat mass) had a decreased risk of earlier puberty onset compared with those with low-level FFM/FM. High-level trajectories of rapid increase in anthropometric profiles, in addition to FFM/FM, were also significantly associated with higher risk of earlier puberty onset. CONCLUSION Prepubertal adiposity and distinct trajectories were associated with earlier puberty onset. It is important to maintain healthy adiposity status to prevent earlier puberty onset in children.
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Affiliation(s)
- Yanhui Li
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Tao Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Ying Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Di Gao
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Li Chen
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Manman Chen
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Jieyu Liu
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Bin Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China
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13
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O'Neill KN, Bell JA, Davey Smith G, Tilling K, Kearney PM, O'Keeffe LM. Puberty Timing and Sex-Specific Trajectories of Systolic Blood Pressure: a Prospective Cohort Study. Hypertension 2022; 79:1755-1764. [PMID: 35587023 PMCID: PMC9278704 DOI: 10.1161/hypertensionaha.121.18531] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Sex differences in systolic blood pressure (SBP) emerge during adolescence but the role of puberty is not well understood. We examined sex-specific changes in SBP preceding and following puberty and examined the impact of puberty timing on SBP trajectories in females and males. METHODS Trajectories of SBP before and after puberty and by timing of puberty in females and males in a contemporary birth cohort study were analyzed. Repeated measures of height from age 5 to 20 years were used to identify puberty timing (age at peak height velocity). SBP was measured on ten occasions from 3 to 24 years (N participants, 4062; repeated SBP measures, 29 172). Analyses were performed using linear spline multilevel models based on time before and after puberty and were adjusted for parental factors and early childhood factors. RESULTS Mean age at peak height velocity was 11.7 years (SD, 0.8) for females and 13.6 years (SD, 0.9) for males. Males had faster rates of increase in SBP before puberty leading to 10.19 mm Hg (95% CI, 6.80-13.57) higher mean SBP at puberty which remained similar at 24 years (mean difference, 11.43 mm Hg [95% CI, 7.22-15.63]). Puberty timing was associated with small transient differences in SBP trajectories postpuberty in both sexes and small differences at 24 years in females only. CONCLUSIONS A large proportion of the higher SBP observed in males compared with females in early adulthood is accrued before puberty. Interventions targeting puberty timing are unlikely to influence SBP in early adulthood.
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Affiliation(s)
- Kate N O'Neill
- School of Public Health, University College Cork, Ireland (K.N.O.N., P.M.K., L.M.O.K.)
| | - Joshua A Bell
- MRC Integrative Epidemiology Unit at the University of Bristol, United Kingdom (J.A.B., G.D.S., K.T., L.M.O.K.).,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom (J.A.B., G.D.S., K.T., L.M.O.K.)
| | - George Davey Smith
- MRC Integrative Epidemiology Unit at the University of Bristol, United Kingdom (J.A.B., G.D.S., K.T., L.M.O.K.).,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom (J.A.B., G.D.S., K.T., L.M.O.K.)
| | - Kate Tilling
- MRC Integrative Epidemiology Unit at the University of Bristol, United Kingdom (J.A.B., G.D.S., K.T., L.M.O.K.).,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom (J.A.B., G.D.S., K.T., L.M.O.K.)
| | - Patricia M Kearney
- School of Public Health, University College Cork, Ireland (K.N.O.N., P.M.K., L.M.O.K.)
| | - Linda M O'Keeffe
- School of Public Health, University College Cork, Ireland (K.N.O.N., P.M.K., L.M.O.K.).,MRC Integrative Epidemiology Unit at the University of Bristol, United Kingdom (J.A.B., G.D.S., K.T., L.M.O.K.).,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom (J.A.B., G.D.S., K.T., L.M.O.K.)
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14
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Lunddorf LLH, Ernst A, Brix N, Arendt LH, Andersen SL, Olsen J, Ramlau-Hansen CH. Maternal thyroid disease in pregnancy and timing of pubertal development in sons and daughters. Fertil Steril 2022; 118:136-146. [PMID: 35568525 DOI: 10.1016/j.fertnstert.2022.03.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To study whether maternal thyroid disease in pregnancy is associated with pubertal timing in sons and daughters. DESIGN Cohort study. SETTING National birth cohort and health registers. PATIENT(S) A total of 15,763 mothers and children from the Danish National Birth Cohort and its Puberty Cohort. INTERVENTION(S) Register-based and self-reported information on maternal thyroid diseases during pregnancy (hyperthyroidism, hypothyroidism, benign goiter, or no thyroid disease [reference group]). MAIN OUTCOME MEASURE(S) The adjusted mean age difference (months) at attaining several self-reported pubertal milestones collected every 6 months using an interval-censored regression and the average difference in age at attaining all pubertal milestones using the Huber-White robust variance estimation (primary outcome). RESULT(S) Sons of mothers with hyperthyroidism had earlier pubertal development (average difference, -2.9 [95% confidence interval (CI), -5.0 to -0.7] months) than unexposed sons. Maternal hypothyroidism was not associated with pubertal development in sons (average difference, -1.2 [95% CI, -5.1 to 2.7] months). We observed nonstatistically significant indications of earlier pubertal development in sons of mothers with benign goiter (average difference, -1.9 [95% CI, -4.6 to 0.9] months). Maternal thyroid disease was not associated with pubertal development in daughters (average difference (months), hyperthyroidism, -0.8 [95% CI, -2.8 to 1.2]; hypothyroidism, 0.3 [95% CI, -3.1 to 3.8]; and benign goiter, 0.7 [95% CI, -2.0 to 3.4]). CONCLUSION(S) We found indications of earlier pubertal development in sons of mothers with hyperthyroidism. More research is needed to further investigate the observed sex-specific association.
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Affiliation(s)
- Lea L H Lunddorf
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark.
| | - Andreas Ernst
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark; Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Nis Brix
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark; Department of Clinical Genetics, and Aarhus University Hospital, Aarhus, Denmark
| | - Linn H Arendt
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark; Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Stine L Andersen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Jørn Olsen
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Cecilia H Ramlau-Hansen
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark
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15
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Silventoinen K, Jelenkovic A, Palviainen T, Dunkel L, Kaprio J. The Association Between Puberty Timing and Body Mass Index in a Longitudinal Setting: The Contribution of Genetic Factors. Behav Genet 2022; 52:186-194. [PMID: 35381915 PMCID: PMC9135891 DOI: 10.1007/s10519-022-10100-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/17/2022] [Indexed: 12/11/2022]
Abstract
We analyzed the contribution of genetic factors on the association between puberty timing and body mass index (BMI) using longitudinal data and two approaches: (i) genetic twin design and (ii) polygenic scores (PGS) of obesity indices. Our data were derived from Finnish cohorts: 9080 twins had information on puberty timing and BMI and 2468 twins also had genetic data. Early puberty timing was moderately associated with higher BMI in childhood in both boys and girls; in adulthood these correlations were weaker and largely disappeared after adjusting for childhood BMI. The largest proportion of these correlations was attributable to genetic factors. The higher PGSs of BMI and waist circumference were associated with earlier timing of puberty in girls, whereas weaker associations were found in boys. Early puberty is not an independent risk factor for adult obesity but rather reflects the association between puberty timing and childhood BMI contributed by genetic predisposition.
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Affiliation(s)
- Karri Silventoinen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, 00014, Helsinki, Finland.
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Aline Jelenkovic
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Teemu Palviainen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Leo Dunkel
- Barts & the London Medical School, William Harvey Research Institute, London, UK
| | - Jaakko Kaprio
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
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16
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Xiong J, Xu Y, Liu X, Wang X, Shan S, Crabbe MJC, Zhao L, Fang H, Cheng G. Prospective association of dietary soy and fibre intake with puberty timing: a cohort study among Chinese children. BMC Med 2022; 20:145. [PMID: 35369873 PMCID: PMC8978387 DOI: 10.1186/s12916-022-02320-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/02/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Dietary phytoestrogens have been suggested to influence puberty timing, a critical stage for well-being in adulthood. We hypothesized that childhood soy intake might prospectively influence puberty timing and that dietary fibre and the key isoflavone metabolite equol might play roles. METHODS Cox proportional hazard regression models were performed in 4781 children (2152 girls and 2629 boys) aged 6-8 years old from the Chinese Adolescent Cohort Study for whom a food frequency questionnaire at baseline and information about potential confounders were available. Anthropometry and pubertal status including age at Tanner stage 2 for breast development (B2) or age at the initiation of gonadal growth (G2), and age at menarche (M) or voice break (VB) were assessed annually. Equol excretion was determined by urine samples from 1311 participants. RESULTS Among girls and boys, higher soy intake was associated with later puberty timing (hazard ratio (HR)-B2: 0.88 (95% CI, 0.80-0.96), p=0.02; HR-M, 0.87 (0.77-0.94), p=0.01; HR-G2, 0.91 (0.82-0.98), p=0.013; HR-VB, 0.90 (0.82-0.9), p=0.02), independent of prepubertal body fatness and fibre intake. These associations were more pronounced among children with a high urinary equol level (pfor-interaction ≤ 0.04) or with a high cereal fibre intake (pfor-interaction ≤ 0.06). Intake of dietary fibre or its subtype was not prospectively associated with puberty onset after adjusting for dietary soy intake (p≥0.06). CONCLUSION Higher childhood soy intake is prospectively associated with later puberty timing in both Chinese girls and boys, independent of prepubertal body fatness, and the association is particularly pronounced among individuals with a higher urinary equol level.
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Affiliation(s)
- Jingyuan Xiong
- West China School of Public Health and West China Fourth Hospital and Healthy Food Evaluation Research Center, Sichuan University, Chengdu, People's Republic of China
| | - Yujie Xu
- West China School of Public Health and West China Fourth Hospital and Healthy Food Evaluation Research Center, Sichuan University, Chengdu, People's Republic of China
| | - Xueting Liu
- West China School of Public Health and West China Fourth Hospital and Healthy Food Evaluation Research Center, Sichuan University, Chengdu, People's Republic of China
| | - Xiaoyu Wang
- Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Shufang Shan
- Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - M James C Crabbe
- Wolfson College, Oxford University, Oxford, OX2 6UD, UK.,Institute of Biomedical and Environmental Science & Technology, University of Bedfordshire, Luton, LU1 3JU, UK
| | - Li Zhao
- West China School of Public Health and West China Fourth Hospital and Healthy Food Evaluation Research Center, Sichuan University, Chengdu, People's Republic of China
| | - He Fang
- West China School of Public Health and West China Fourth Hospital and Healthy Food Evaluation Research Center, Sichuan University, Chengdu, People's Republic of China
| | - Guo Cheng
- Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
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17
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Fortin-Guichard D, Huberts I, Sanders J, van Elk R, Mann DL, Savelsbergh GJP. Predictors of selection into an elite level youth football academy: A longitudinal study. J Sports Sci 2022; 40:984-999. [PMID: 35212615 DOI: 10.1080/02640414.2022.2044128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Talent identification in football is complex. Research regarding talent indicators that predict selection into professional academies is increasingly multi-disciplinary, though is typically cross-sectional, failing to consider whether the rate of change of those indicators influences selection. The aim of this study was to determine if longitudinal changes in talent indicators are associated with selection into a professional football academy. A total of 110 Dutch male football players (aged 8-12) playing in a youth development programme of a professional club were included in the study. Players were assessed regularly on their anthropometry, physical fitness, gross motor coordination, technical ability, and psychosocial capacities over four years. A subset of players was then selected into the academy. Cross-sectional and longitudinal analyses revealed the indicators that best predicted selection. The best indicator was the 30 m sprint speed, with prediction not improving when including other predictors or their rate of change. The individuals that the club ultimately selected at age 12 could have been predicted well above chance levels using the sprint speeds at age nine or ten. The relative consistency of the rate of improvement in indicators across participants meant that the rate at which they developed played little role in selections.
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Affiliation(s)
- Daniel Fortin-Guichard
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Inge Huberts
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jurrit Sanders
- Sport science & Analytics, PSV Eindhoven, Eindhoven, Netherlands
| | - Ruud van Elk
- Sport science & Analytics, PSV Eindhoven, Eindhoven, Netherlands
| | - David L Mann
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Geert J P Savelsbergh
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Faculty of Sports, Movement and Nutrition, University of Applied Sciences Amsterdam, Amsterdam, Netherlands
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18
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Chang YL, Kuan TH, Chen CH, Tsai YJ, Chen GB, Lin KL, Tuan SH. Differences in Cardiopulmonary Fitness Between Boy and Girls With Repaired Tetralogy of Fallot. Front Pediatr 2022; 10:911825. [PMID: 35874578 PMCID: PMC9298839 DOI: 10.3389/fped.2022.911825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Many studies have demonstrated that patients with repaired tetralogy of Fallot (rTOF) have generally poorer cardiopulmonary fitness (CPF). However, little is known about how the disease results in different CPF in each sex. Therefore, this study aimed to investigate whether sex (and gender) differences affect CPF in children and adolescents with rTOF. METHODS This retrospective study recruited adolescents and children (aged 10-18) with rTOF following an acute stage of tetralogy of Fallot (TOF) who received cardiopulmonary exercise testing (CPET) in the past 10 years. CPF was determined by symptom-limited CPET with a treadmill under ramped Bruce protocol. Boys and girls were categorized into groups based on body mass index (BMI) and fat mass index (FMI). The BMI was grouped by Taiwanese obesity cutoff points. The FMI was categorized by the body fat percentage. Excess adiposity was defined as (1) "overweight" and "obese" by BMI and (2) greater than the sex- and age-specific 75th percentile of whole subjects by FMI. RESULTS A total of 185 participants (104 boys and 81 girls) with rTOF were recruited for the final analysis. Within the BMI category, 76 boys and 63 girls were in the normal group, whereas 28 boys and 18 girls were in the excessive adiposity group. Within the FMI category, 77 boys and 60 girls were in the normal group, whereas 27 boys and 21 girls were in the excessive adiposity group. The analysis of the body composition of rTOF subjects showed that there was no statistically significant difference between the subgroups of the two sexes, but both showed a smaller body size than normal Taiwanese children. When comparing the CPF within different BMI and FMI groups, the children in the excessive adiposity group had significantly lower values in metabolic equivalents (MET) at anaerobic threshold, peak MET, and measured peak oxygen consumption (VO2) to predicted peak VO2, regardless of sex. Moreover, boys (60.90%) presented poorer CPF than girls (74.22%, p < 0.001). CONCLUSION In Taiwan, patients with rTOF had poorer CPF than healthy peers. This study found that girls with rTOF had better CPF than boys with rTOF. The effect of gender stereotypes on sports participation and self-efficacy might be one of the contributing factors; however, further investigations are warranted to determine the causal effect.
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Affiliation(s)
- Yung-Liang Chang
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Tzu-Hsuan Kuan
- Department of General Medicine, E-DA Hospital, Kaohsiung, Taiwan
| | - Chia-Hsin Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ju Tsai
- Institute of Allied Health Sciences, National Cheng Kung University, Tainan City, Taiwan.,Department of Physical Therapy, National Cheng Kung University, Tainan City, Taiwan
| | - Guan-Bo Chen
- Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Ko-Long Lin
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Physical Medicine and Rehabilitation, Kaohsiung Veteran General Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Sheng-Hui Tuan
- Institute of Allied Health Sciences, National Cheng Kung University, Tainan City, Taiwan.,Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan
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Zhou X, Hu Y, Yang Z, Gong Z, Zhang S, Liu X, Chen Y, Ye C, Chen L, Wang T. Overweight/Obesity in Childhood and the Risk of Early Puberty: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:795596. [PMID: 35722495 PMCID: PMC9203728 DOI: 10.3389/fped.2022.795596] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 05/06/2022] [Indexed: 12/02/2022] Open
Abstract
PURPOSE To determine the relationship between childhood overweight/obesity and early puberty in both boys and girls. Specifically, this is the first time to conduct a meta-analysis of the relationship between childhood overweight/obesity and early puberty in boys. METHODS Relevant studies were identified from PubMed, Web of Science, and EMBASE searches. The exposure of interest was overweight/obesity in childhood. Childhood was defined internationally as the age range of 0-18 years. The overall risk estimates were pooled using random effects models. Subgroup and sensitivity analyses were performed to explore possible sources of heterogeneity and to assess the robustness of the results. RESULTS A total of 10 studies involving 13,338 girls and 12,796 boys were included. Results showed that childhood overweight/obesity were associated with a significantly higher risk of early puberty in girls [odds ratio (OR): 2.22, 95% CI: 1.65-2.99]. Although without statistical significance, a higher risk of early puberty was also found in boys who were overweight/obese in childhood (OR: 1.29, 95% CI: 0.98-1.70). Heterogeneity in the risk estimates of early puberty was partially explained by study design, sample size, follow-up duration, definitions of early puberty and confounders controlled. Sensitivity analyses validated the robustness of the findings. CONCLUSIONS Our findings showed that for girls the associate between overweight/obesity and early puberty is definite or strong whereas for males, such an association is possible, prompting that future studies need to further explore the possible relationship between overweight/obesity and early puberty in boys. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021264649, PROSPERO CRD42021264649.
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Affiliation(s)
- Xuan Zhou
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yang Hu
- Department of Plastic Surgery of Third Xiangya Hospital, Central South University, Changsha, China
| | - Ziqi Yang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Ziqiang Gong
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Senmao Zhang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xiaoling Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yan Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Changxiang Ye
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Lizhang Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
| | - Tingting Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,NHC Key Laboratory for Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital Hunan, Changsha, China
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20
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Sex differences in white adipose tissue expansion: emerging molecular mechanisms. Clin Sci (Lond) 2021; 135:2691-2708. [PMID: 34908104 DOI: 10.1042/cs20210086] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/15/2021] [Accepted: 11/29/2021] [Indexed: 12/15/2022]
Abstract
The escalating prevalence of individuals becoming overweight and obese is a rapidly rising global health problem, placing an enormous burden on health and economic systems worldwide. Whilst obesity has well described lifestyle drivers, there is also a significant and poorly understood component that is regulated by genetics. Furthermore, there is clear evidence for sexual dimorphism in obesity, where overall risk, degree, subtype and potential complications arising from obesity all differ between males and females. The molecular mechanisms that dictate these sex differences remain mostly uncharacterised. Many studies have demonstrated that this dimorphism is unable to be solely explained by changes in hormones and their nuclear receptors alone, and instead manifests from coordinated and highly regulated gene networks, both during development and throughout life. As we acquire more knowledge in this area from approaches such as large-scale genomic association studies, the more we appreciate the true complexity and heterogeneity of obesity. Nevertheless, over the past two decades, researchers have made enormous progress in this field, and some consistent and robust mechanisms continue to be established. In this review, we will discuss some of the proposed mechanisms underlying sexual dimorphism in obesity, and discuss some of the key regulators that influence this phenomenon.
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21
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Sylvestre M, Ahun MN, O'Loughlin J. Revisiting trajectories of BMI in youth: An in-depth analysis of differences between BMI and other adiposity measures. Obes Sci Pract 2021; 7:711-718. [PMID: 34877010 PMCID: PMC8633937 DOI: 10.1002/osp4.538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/01/2021] [Accepted: 06/05/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Body mass index (BMI) is used to identify trajectories of adiposity in youth, but it does not distinguish fat- from fat-free-mass. There are other inexpensive measures of adiposity which might better capture fat-mass in youth The objective of this study is to examine differences between sex-specific trajectories of BMI and other adiposity indicators (subscapular and triceps skinfold thickness, waist circumference, waist-to-height ratio) which may better capture fat-mass in youth. METHODS Data come from four cycles of a longitudinal cohort of 1293 students in Montréal, Canada at ages 12, 15, 17 and 24. Group-based trajectory models identified sex-specific adiposity trajectories among participants with data in ≥3 cycles (n = 417 males; n = 445 females). RESULTS There were six trajectory groups in males and females for all five indicators, except for waist circumference (seven) in both sexes and triceps skinfold thickness (four) and waist-to-height ratio (five) in females. Most trajectories indicated linear increases; only the skinfold thickness indicators identified a decreasing trajectory. While all indicators identified a trajectory with high levels of adiposity, they differed in the number and relative size of trajectories pertaining to individuals in lower half of the adiposity distribution. CONCLUSION BMI is a satisfactory indicator of adiposity in youth if the aim of the trajectory analysis is to identify youth with excess adiposity, a known risk factor for cardiometabolic outcomes in adulthood.
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Affiliation(s)
- Marie‐Pierre Sylvestre
- Centre de recherche du centre hospitalier de l`Université de Montréal (CRCHUM)MontréalQuebecCanada
- Department of Social and Preventive MedicineUniversité de MontréalMontréalQuebecCanada
| | - Marilyn N. Ahun
- Centre de recherche du centre hospitalier de l`Université de Montréal (CRCHUM)MontréalQuebecCanada
- Department of Social and Preventive MedicineUniversité de MontréalMontréalQuebecCanada
| | - Jennifer O'Loughlin
- Centre de recherche du centre hospitalier de l`Université de Montréal (CRCHUM)MontréalQuebecCanada
- Department of Social and Preventive MedicineUniversité de MontréalMontréalQuebecCanada
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22
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Abstract
PURPOSE OF REVIEW The objective of this review is to assess the most recent literature on pubertal trends in boys and girls as well as evaluate genetic, epigenetic, and environmental factors implicated in the timing of pubertal progression. RECENT FINDINGS Recent studies confirm the previously described link between increased adiposity and earlier onset of puberty in girls, and more recent studies shed light onto the previously unclear situation in boys as a preponderance of recent longitudinal studies suggests that increased adiposity is linked with earlier pubertal timing also in boys. Discoveries of novel pathways highlights the complexity of pubertal development and suggest mechanistic links between nutrition, obesity, leptin, insulin resistance, and puberty. Furthermore, genetic and epigenetic variants can be linked to early puberty. Other factors, such as prenatal and postnatal environment, gut microbiota, and endocrine-disrupting chemicals have also been linked to both obesity and earlier puberty. SUMMARY Understanding how the interactions of these factors contribute the relationship between obesity and early pubertal onset is crucial as early puberty has been linked with long-term consequences, such as short stature, earlier type 2 diabetes, cardiovascular disease, and poor psychological and behavioral outcomes.
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Affiliation(s)
- Alyssa Huang
- Department of Pediatrics, University of Washington
| | - Christian L Roth
- Department of Pediatrics, University of Washington
- Seattle Children's Research Institute, Seattle, Washington, USA
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23
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Maher GM, Ryan L, McCarthy FP, Hughes A, Park C, Fraser A, Howe LD, Kearney PM, O'Keeffe LM. Puberty timing and markers of cardiovascular structure and function at 25 years: a prospective cohort study. BMC Med 2021; 19:78. [PMID: 33761960 PMCID: PMC7992788 DOI: 10.1186/s12916-021-01949-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/23/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Whether earlier onset of puberty is associated with higher cardiovascular risk in early adulthood is not well understood. Our objective was to examine the association between puberty timing and markers of cardiovascular structure and function at age 25 years. METHODS We conducted a prospective birth cohort study using data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Participants were born between April 1, 1991, and December 31, 1992. Exposure of interest was age at peak height velocity (aPHV), an objective and validated growth-based measure of puberty onset. Outcome measures included cardiovascular structure and function at age 25 years: carotid intima-media thickness (CIMT), left ventricular mass index (LVMI) and relative wall thickness (RWT), pulse wave velocity (PWV) and systolic blood pressure (SBP). Multiple imputation was used to impute missing data on covariates and outcomes. Linear regression was used to examine the association between aPHV and each measure of cardiac structure and function, adjusting for maternal age, gestational age, household social class, maternal education, mother's partner's education, breastfeeding, parity, birthweight, maternal body mass index, maternal marital status, maternal prenatal smoking status and height and fat mass at age 9. All analyses were stratified by sex. RESULTS A total of 2752-4571 participants were included in the imputed analyses. A 1-year older aPHV was not strongly associated with markers of cardiac structure and function in males and females at 25 years and most results spanned the null value. In adjusted analyses, a 1-year older aPHV was associated with 0.003 mm (95% confidence interval (CI) 0.00001, 0.006) and 0.0008 mm (95% CI - 0.002, 0.003) higher CIMT; 0.02 m/s (95% CI - 0.05, 0.09) and 0.02 m/s (95% CI - 0.04, 0.09) higher PWV; and 0.003 mmHg (95% CI - 0.60, 0.60) and 0.13 mmHg (95% CI - 0.44, 0.70) higher SBP, among males and females, respectively. A 1-year older aPHV was associated with - 0.55 g/m2.7 (95% CI - 0.03, - 1.08) and - 0.89 g/m2.7 (95% CI - 0.45, - 1.34) lower LVMI and - 0.001 (95% CI - 0.006, 0.002) and - 0.002 (95% CI - 0.006, 0.002) lower RWT among males and females. CONCLUSIONS Earlier puberty is unlikely to have a major impact on pre-clinical cardiovascular risk in early adulthood.
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Affiliation(s)
- Gillian M Maher
- INFANT Research Centre, University College Cork, Cork, Ireland.
- School of Public Health, University College Cork, Cork, Ireland.
| | - Lisa Ryan
- School of Public Health, University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Alun Hughes
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK
- MRC Unit for Lifelong Health and Ageing at University College London, London, UK
| | - Chloe Park
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK
| | - Abigail Fraser
- Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | - Laura D Howe
- Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | | | - Linda M O'Keeffe
- School of Public Health, University College Cork, Cork, Ireland
- Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
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"Selected Papers from the 2nd Ellisras Longitudinal Study and Other Non-Communicable Diseases Studies International Conference" Special Issue Editorial. CHILDREN-BASEL 2021; 8:children8020146. [PMID: 33669203 PMCID: PMC7919821 DOI: 10.3390/children8020146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 11/25/2022]
Abstract
Epidemics of non-communicable diseases (NCDs) are presently emerging and on the increase in South Africa. It is increasingly recognized that the occurrence of adult chronic disease are influenced by factors operating from childhood, which are sustained throughout the individual’s life course. Increased risk may start in infancy or even before birth and will continue to be influenced by health related behavior during adulthood. The academic level of people in the community influence the level of their health status. Commitment to the promotion of health through prevention, education, and suitable management is the building block for creating a healthy society. The community must make strides to shift from traditional knowledge and medication, and seek new innovative ways of addressing issues facing the population with regard to obesity, overweight, hypertension health, smoking cessation, alcohol abuse, and low physical activity in line with a healthy living lifestyle. The NCDs pose health problems in South Africa and deserve more attention. Poor control of obesity, hypertension, and diabetes, to name just a few, only adds to the current problems. The South African government and the business sector of South Africa should provide safe walking/riding trails in the cities and in rural area to combat emerging NCDs that are killing our community members indiscriminately without considering race, gender, age, and place of residence. Compulsory introduction of physical education lessons to all public schools cannot be over emphasized in the current escalating NCD situation in South Africa.
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