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Bridger Staatz C, Kelly Y, Lacey RE, Blodgett JM, George A, Arnot M, Walker E, Hardy R. Socioeconomic position and body composition in childhood in high- and middle-income countries: a systematic review and narrative synthesis. Int J Obes (Lond) 2021; 45:2316-2334. [PMID: 34315999 PMCID: PMC8528703 DOI: 10.1038/s41366-021-00899-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 05/24/2021] [Accepted: 06/30/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The relation between socioeconomic position (SEP) and obesity measured by body mass index (BMI), a measure of weight for height, has been extensively reviewed in children, showing consistent associations between disadvantaged SEP and higher BMI in high-income countries (HICs) and lower BMI in middle-income countries (MICs). Fat mass (FM), a more accurate measure of adiposity, and fat-free mass (FFM) are not captured by BMI, but have been shown to track from childhood to adulthood, and be important for cardiovascular health and functional outcomes in later life. It is not clear whether body composition is associated with SEP. We systematically reviewed the association between SEP and body composition in childhood. METHODS A systematic review was carried out following PRISMA guidelines. The protocol was pre-registered with PROSPERO (CRD42019119937). Original studies in the English language, which examined the association between SEP and body composition in childhood, were included. An electronic search of three databases was conducted. Two independent reviewers carried out screening, data extraction and quality assessment. Due to heterogeneity in results, a narrative synthesis was conducted. Heterogeneity in findings according to SEP, sex, body composition measure and country income level was investigated. RESULTS 50 papers were included, the majority from HICs. No papers were from low-income countries. Disadvantage in childhood was associated with greater FM and lower FFM in HICs, but with lower FM and lower FFM in MICs. When measures of FFM indexed to height were used there was no evidence of associations with SEP. In HICs, more studies reported associations between disadvantaged SEP and higher FM among girls comparative to boys. CONCLUSIONS Inequalities in FM are evident in HICs and, in the opposite direction, in MICs and follow similar trends to inequalities for BMI. Inequalities in height are likely important in understanding inequalities in FFM.
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Affiliation(s)
- Charis Bridger Staatz
- Social Research Institute, Institute of Education, University College London, London, UK.
| | - Yvonne Kelly
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Rebecca E Lacey
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Joanna M Blodgett
- Institute of Sport Exercise and Health, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
| | - Anitha George
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Megan Arnot
- Department of Anthropology, University College London, London, UK
| | - Emma Walker
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Rebecca Hardy
- Social Research Institute, Institute of Education, University College London, London, UK
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Staatz CB, Kelly Y, Lacey RE, Hardy R. Area-level and family-level socioeconomic position and body composition trajectories: longitudinal analysis of the UK Millennium Cohort Study. Lancet Public Health 2021; 6:e598-e607. [PMID: 34332672 PMCID: PMC8342403 DOI: 10.1016/s2468-2667(21)00134-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/28/2021] [Accepted: 06/02/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Inequalities in the trajectories of body composition in childhood and adolescence have been infrequently studied. Despite the importance of environmental factors in obesity development, little research has looked at area-level socioeconomic position, independent of family socioeconomic position. We aimed to assess how inequalities in body composition develop with age. METHODS The Millennium Cohort Study is a longitudinal study of 19 243 families who had a child born between 2000 and 2002 in the UK. Multilevel growth curve models were applied to examine change in fat mass index (FMI), fat free mass index (FFMI; using the Benn index), and fat mass to fat free mass ratio (FM:FFM), measured using Bioelectrical Impedance Analysis, from ages 7 years to 17 years by the Index of Multiple Deprivation (IMD) and household income at baseline. FINDINGS Inequalities in FMI and FM:FFM ratio are evident at age 7 years and widen with age. At age 17 years, adolescents in the most disadvantaged IMD group had FMI 0·57 kg/mB (B=Benn parameter; 95% CI 0·43 to 0·70) higher and FM:FFM ratio 0·037 (95% CI 0·026 to 0·047) higher compared with the most advantaged group. Disadvantaged socioeconomic position is associated with higher FFMI but is reversed in adolescence after adjustment for FMI. Inequalities were greater in girls at age 7 years (mean FMI 0·22 kg/mB; 95% CI 0·13 to 0·32) compared with boys of the same age (0·05 kg/mB; -0·04 to 0·15, p=0·3), but widen fastest in boys, especially for FMI, in which there was over an 11 times increase in the inequality from age 7 years of 0·05kg/mB (95% CI -0·04 to 0·15) to 0·62 kg/mB at 17 years (0·42 to 0·82). Inequalities for the IMD were similar to income, and persisted at age 17 years independent of family socioeconomic position. INTERPRETATION Childhood and adolescence is an important period to address inequalities in body composition, as they emerge and widen. Policies should consider FFM as well as FM, and inequalities in the environment. FUNDING Medical Research Council, Economic and Social Research Council.
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Affiliation(s)
- Charis Bridger Staatz
- Social Research Institute, Institute of Education, University College London, London, UK.
| | - Yvonne Kelly
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Rebecca E Lacey
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Rebecca Hardy
- Social Research Institute, Institute of Education, University College London, London, UK
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García-Hermoso A, Ezzatvar Y, Ramírez-Vélez R, Olloquequi J, Izquierdo M. Is device-measured vigorous physical activity associated with health-related outcomes in children and adolescents? A systematic review and meta-analysis. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:296-307. [PMID: 33285309 PMCID: PMC8167335 DOI: 10.1016/j.jshs.2020.12.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/21/2020] [Accepted: 10/15/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study sought to analyze the prospective association between vigorous-intensity physical activity (VPA) and health-related outcomes in children and adolescents. METHODS Studies reporting associations between device-measured VPA and health-related factors in children and adolescents aged 3-18 years were identified through database searches (MEDLINE, EMBASE, and SPORTDiscus). Correlation coefficients were pooled if outcomes were reported by at least 3 studies, using DerSimonian-Laird random effects models. RESULTS Data from 23 studies including 13,674 participants were pooled using random effects models. Significant associations were found between VPA at baseline and overall adiposity (r = -0.09, 95% confidence interval (95%CI): -0.15 to -0.03; p = 0.002; I2 = 89.8%), cardiometabolic risk score (r = -0.13, 95%CI: -0.24 to -0.02, p = 0.020; I2 = 69.6%), cardiorespiratory fitness (r = 0.25, 95%CI: 0.15-0.35; p < 0.001; I2 = 57.2%), and total body bone mineral density (r = 0.16, 95%CI: 0.06 to 0.25; p = 0.001; I2 = 0%). CONCLUSION VPA seems to be negatively related to adiposity and cardiometabolic risk score and positively related to cardiorespiratory fitness and total body bone mineral density among children and adolescents at follow-up. Therefore, our findings support the need to strengthen physical activity recommendations regarding VPA due to its health benefits in children and adolescents.
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Affiliation(s)
- Antonio García-Hermoso
- Navarrabiomed, Navarra Hospital Complex (CHN), Public University of Navarra (UPNA), IdiSNA, Pamplona 31008, Spain; University of Santiago of Chile (USACH), Sciences of Physical Activity, Sports and Health School, Santiago 71783-5, Chile.
| | - Yasmin Ezzatvar
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, Universitat de València, Valencia 46010, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Navarra Hospital Complex (CHN), Public University of Navarra (UPNA), IdiSNA, Pamplona 31008, Spain
| | - Jordi Olloquequi
- Institute of Biomedical Sciences, Faculthy of Health Sciences, Universidad Autónoma de Chile, Talca 3460000, Chile
| | - Mikel Izquierdo
- Navarrabiomed, Navarra Hospital Complex (CHN), Public University of Navarra (UPNA), IdiSNA, Pamplona 31008, Spain
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López-Bueno R, López-Sánchez GF, Casajús JA, Calatayud J, Tully MA, Smith L. Potential health-related behaviors for pre-school and school-aged children during COVID-19 lockdown: A narrative review. Prev Med 2021; 143:106349. [PMID: 33271236 PMCID: PMC7701882 DOI: 10.1016/j.ypmed.2020.106349] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/25/2020] [Accepted: 11/24/2020] [Indexed: 01/22/2023]
Abstract
As a consequence of the COVID-19 pandemic, different measures have been implemented by governments from each affected country. Such measures usually involve restrictions on the movement of citizens, and have had a profound effect on usual activities and timetables. As a result of school closures and strict restrictions regarding going outside home, children have been one of the most disadvantaged population groups during the lockdown period. We therefore aimed to investigate potential health risk behaviors amongst isolated pre-school and school-aged children. We retrieved relevant articles from MEDLINE, Web of Science, PsycInfo, and Scopus databases to describe identified health-related behaviors (i.e. screen exposure, environmental influence, physical activity and fitness, sedentariness, sleep patterns, eating habits, psychological response, body composition, and injuries) in relation to social isolation and social deprivation of children without previous illness or conditions. This review depicts the potential health-related behaviors according to related literature, and put the focus on future short and long-term sequels of social isolation. Socio-affective complications and insufficient physical activity are underscored as two of the main concerns, particularly among socio-economic deprived children. Both issues could be effectively addressed with either adequate parental or community guidance.
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Affiliation(s)
- Rubén López-Bueno
- Depatment of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain.
| | | | - José A Casajús
- Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Mark A Tully
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Belfast, United Kingdom
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Science, Anglia Ruskin University, Cambridge, United Kingdom
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Aars NA, Beldo S, Jacobsen BK, Horsch A, Morseth B, Emaus N, Furberg AS, Grimsgaard S. Association between objectively measured physical activity and longitudinal changes in body composition in adolescents: the Tromsø study fit futures cohort. BMJ Open 2020; 10:e036991. [PMID: 33033016 PMCID: PMC7542926 DOI: 10.1136/bmjopen-2020-036991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Physical activity may be important in deterring the obesity epidemic. This study aimed to determine whether objectively measured physical activity in first year of upper secondary high school predicted changes in body composition over 2 years of follow-up in a cohort of Norwegian adolescents (n=431). DESIGN A longitudinal study of adolescents (mean age of 16 (SD 0.4) at baseline, 60.3% girls) participating in the Fit Futures studies 1 (2010-2011) and 2 (2012-2013). SETTING All eight upper secondary high schools in two municipalities in Northern Norway. PARTICIPANTS Students participating in both studies and under the age of 18 at baseline and with valid measurement of physical activity at baseline and body composition in both surveys. PRIMARY AND SECONDARY OUTCOMES Change in objectively measured body mass index and waist circumference and change in dual-energy X-ray absorptiometry measured fat mass index, lean mass index (LMI) and appendicular LMI (aLMI) between baseline and follow-up. RESULTS At baseline, boys had significantly higher physical activity volume (p=0.01) and spent on average of 6.4 (95% CI 2.1 to 10.6) more minutes in moderate-to-vigorous physical activity (MVPA) than girls (p<0.01). In girls, multivariate regression analyses showed that more sedentary time was negatively associated with changes in LMI (p<0.01) and aLMI (p<0.05), whereas more light activity had opposite effects on these measures (p<0.01 and p<0.05, respectively). No significant associations between measures of baseline physical activity and changes in body composition parameters were observed in boys. CONCLUSIONS In this cohort of Norwegian adolescents, sedentary and light physical activity was associated with changes in LMI and aLMI in girls, but not boys. Minutes spent in MVPA in first year of upper secondary high school was not associated with changes in measures of body composition in neither sex after 2 years.
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Affiliation(s)
- Nils Abel Aars
- Department of Community Medicine, UiT The Arctic University of Norway, Tromso, Troms, Norway
- Nordlandssykehuset HF, Bodø, Norway
| | - Sigurd Beldo
- School of Sport Sciences, UiT Arctic University of Norway, Alta, Finnmark, Norway
| | - Bjarne Koster Jacobsen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromso, Troms, Norway
- Centre for Sami Health Research, UiT The Arctic University of Norway, Tromso, Troms, Norway
| | - Alexander Horsch
- Department of Computer Science, UiT The Arctic University of Norway, Tromso, Troms, Norway
| | - Bente Morseth
- Department of Community Medicine, UiT The Arctic University of Norway, Tromso, Troms, Norway
- School of Sport Sciences, UiT Arctic University of Norway, Alta, Finnmark, Norway
| | - Nina Emaus
- Department of Health and Care Siences, UiT The Arctic University of Norway, Tromso, Troms, Norway
| | - Anne-Sofie Furberg
- Department of Microbiology and Infection Control, Universitetssykehuset Nord-Norge, Tromsø, Norway
- Faculty of Health and Social Sciences, Molde University College, Molde, Norway
| | - Sameline Grimsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromso, Troms, Norway
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Physical Activity Levels for Girls and Young Adult Women versus Boys and Young Adult Men in Spain: A Gender Gap Analysis. SUSTAINABILITY 2020. [DOI: 10.3390/su12156265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Despite that the health benefits of physical activity (PA) are clear, during the last years, a noticeable plateau or slight increase in physical inactivity levels in Spanish adolescents and young adults has been reported. In addition, there seems to be a progressive reduction of the total PA performed with age in both adolescent and young women as well as adult men. We aimed to analyze these changes with age in moderate-to-vigorous physical activity (MVPA) in a sample of Spanish adolescents and young adults within the age range of 15–24 years old (n = 7827), considering the gender and using the short form of the International Physical Activity Questionnaire. For that, we implemented a two-way analysis of variance (ANOVA) considering both the gender and the age group surveyed. Generally, our findings showed a reduction in the daily MVPA performed from adolescence to young adulthood in Spaniards. Within these reductions, girls reduce their PA levels at a different age and pace in adolescence and young adulthood in comparison to boys. Though girls were less active than boys in the 15–18 year age range, these differences were no longer significant at older ages. Our results point out the necessity of implementing different policy approaches based on gender (i.e., for girls and young women), since reductions in the MVPA performed occur at particular ages and paces in comparison to boys and young men. This difference indicates that the traditional approach during adolescence and young adulthood is inadequate for tackling physical inactivity without considering the population’s gender.
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López-Bueno R, López-Sánchez GF, Casajús JA, Calatayud J, Gil-Salmerón A, Grabovac I, Tully MA, Smith L. Health-Related Behaviors Among School-Aged Children and Adolescents During the Spanish Covid-19 Confinement. Front Pediatr 2020; 8:573. [PMID: 33042917 PMCID: PMC7516648 DOI: 10.3389/fped.2020.00573] [Citation(s) in RCA: 162] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/06/2020] [Indexed: 11/13/2022] Open
Abstract
In response to the coronavirus disease 2019 (Covid-19) world pandemic, affected countries such as Spain enacted measures comprising compulsory confinement as well as restrictions regarding free movement. Such measures likely influence children's and adolescents' lifestyles. Our study aimed to investigate the impact that the Covid-19 confinement has on health-related behaviors (HRBs) among Spanish children and adolescents. An online survey was administered to 516 parents to collect data about 860 children and adolescents (49.2% girls) aged between 3 and 16 years in relation to physical activity, screen exposure, sleep time, and fruit and vegetable consumption during the Covid-19 confinement. Respectively, t-paired test and t-test between groups served to check differences between HRBs levels before and during the confinement as well as between strict and relaxed confinement. Significant differences were found for a reduction of weekly minutes of physical activity during the confinement (-102.5, SD 159.6) (p < 0.001), an increase of daily hours of screen exposure (2.9, SD 2.1) (p < 0.001), and a reduction of daily fruit and vegetable consumption (-0.2, SD 1.6) (p < 0.001). Sleep time showed a significant difference between strict and relaxed confinement (-0.3, SD 0.1) (p < 0.05), whereas binomial logistic regression adjusted for covariates (age, sex, education of the parents, siblings, current condition, exposure to Covid-19, and previous health risk behavior) showed significantly lower odds for screen exposure risk behavior with relaxed confinement (OR 0.60, 95%CI 0.40-0.91). The present study suggests that Covid-19 confinement reduced physical activity levels, increased both screen exposure and sleep time, and reduced fruit and vegetable consumption. Therefore, most HRBs worsened among this sample of Spanish children and adolescents. Closure of schools, online education, and the lack of policies addressing the conciliation between labor and family life could have played an important role in HRBs worsening among pupils, which might be mitigated with adequate conciliation policies, parental guidance, and community support.
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Affiliation(s)
- Rubén López-Bueno
- Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain
| | | | - José A Casajús
- Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | | | - Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Mark A Tully
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey, United Kingdom
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Science, Anglia Ruskin University, Cambridge, United Kingdom
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Aars NA, Jacobsen BK, Morseth B, Emaus N, Grimsgaard S. Longitudinal changes in body composition and waist circumference by self-reported levels of physical activity in leisure among adolescents: the Tromsø study, Fit Futures. BMC Sports Sci Med Rehabil 2019; 11:37. [PMID: 31867112 PMCID: PMC6918575 DOI: 10.1186/s13102-019-0150-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 11/14/2019] [Indexed: 01/06/2023]
Abstract
Background It is not clear how physical activity affects body composition in adolescents. Physical activity levels are often reduced during this period, and the relative proportion of body fat mass and lean mass undergo natural changes in growing adolescents. We aimed to examine whether self-reported physical activity in leisure time at baseline or change in activity during follow-up affect changes in four measures of body composition; body mass index (kg/m2), waist circumference, fat mass index (fat mass in kg/m2) and lean mass index (lean mass in kg/m2). Methods We used data from the Tromsø Study Fit Futures, which invited all first year students in upper secondary high school in two municipalities in northern Norway in 2010–2011. They were reexamined in 2012–2013. Longitudinal data was available for 292 boys and 354 girls. We used multiple linear regression analyses to assess whether self-reported level of physical activity in leisure time at baseline predicted changes in body composition, and analysis of covariance to assess the effects of change in level of activity during follow-up on change in body composition. All analyses were performed sex-specific, and a p-value of < 0.05 was considered statistically significant. Results There were no associations between self-reported leisure time physical activity in the first year of upper secondary high school and changes in any of the considered measure of body composition after 2 years of follow up, with the exception of waist circumference in boys (p = 0.05). In boys, change in fat mass index differed significantly between groups of activity change (p < 0.01), with boys adopting activity or remaining physically active having less increase in fat mass index than the consistently inactive. In girls, change in lean mass index differed significantly between groups of activity change (p = 0.04), with girls adopting physical activity having the highest increase. Conclusions Self-reported leisure time physical activity does not predict changes in body composition in adolescents after 2 years of follow up. Change in the level of physical activity is associated with change in fat mass index in boys and lean mass index in girls.
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Affiliation(s)
- Nils Abel Aars
- 1Department of Community Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway.,2Nordland Hospital, Bodø, Norway
| | - Bjarne K Jacobsen
- 1Department of Community Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway.,3Centre for Sami Health Research, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bente Morseth
- 1Department of Community Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway.,4School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Nina Emaus
- 5Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Sameline Grimsgaard
- 1Department of Community Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway
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Quadri M, Ariza AJ, Selvaraj K, Schaller K, Binns HJ. Percent Body Fat Measurement in the Medical Management of Children with Obesity. Pediatr Ann 2018; 47:e487-e493. [PMID: 30543377 DOI: 10.3928/19382359-20181116-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sustaining weight loss can be challenging, as physiological responses to weight loss, including metabolic and hormonal adaptations and decreased energy expenditure, promote weight regain. Paired with sustained dietary changes, physical activity can promote weight maintenance after successful weight loss, as physical activity can help maintain fat-free mass. We present several illustrative cases to highlight the potential use of body composition measurement using a bioelectrical impedance analysis (BIA) scale to augment obesity management counseling in a tertiary care pediatric weight-management clinic. BIA does require some interpretation, as it can be affected by hydration status and time of day, as well as patient age, sex, and body mass index. Nonetheless, BIA can be a helpful aid to obesity counseling. More research is needed to better understand how to use change in percent body fat over time as a motivational tool for management of children with obesity. [Pediatr Ann. 2018;47(12):e487-e493.].
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Longitudinal changes in vigorous intensity physical activity from childhood to adolescence: Gateshead Millennium Study. J Sci Med Sport 2018; 22:450-455. [PMID: 30448321 DOI: 10.1016/j.jsams.2018.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/10/2018] [Accepted: 10/18/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aims of our study were to quantify levels and investigate sex-specific changes and trajectories in VPA longitudinally from age 7 to 15 years. DESIGN Longitudinal observational study. METHODS Participants were part of the Gateshead Millennium Study. Measures were taken at age 7 (n=507), 9 (n=510), 12 (n=425) and 15 years (n=310). Vigorous physical activity was quantified objectively using ActiGraph GT1M accelerometers over 5-7days at the four time-points. Multilevel linear spline random-effects model and trajectory analysis to identify sub-groups were performed. RESULTS In boys, average VPA declined across childhood followed by an increase at adolescence, while in girls, average VPA declined across the 8-year study period. In boys, daily VPA decreased from 9-12 years (1.70minutes/year) and increased from 12-15 years (1.99minutes/year) (all p <0.05). In girls daily VPA decreased from 7-9 years (1.70minutes/year) (p <0.05). Three VPA trajectories were identified which differed between the sexes. In boys, one group decreased from an initial relatively high level, one group, initially relatively low, increased, whereas the third one was stable over the 8-year period. In girls, all three groups declined from baseline. CONCLUSIONS Marked sex and age-specific trajectories in VPA change were observed. These novel findings should help sports and exercise medicine specialists, as well as policy makers, in their effort to maintain or increase VPA in childhood and adolescence.
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Tarp J, Bugge A, Andersen LB, Sardinha LB, Ekelund U, Brage S, Møller NC. Does adiposity mediate the relationship between physical activity and biological risk factors in youth?: a cross-sectional study from the International Children's Accelerometry Database (ICAD). Int J Obes (Lond) 2017; 42:ijo2017241. [PMID: 29087387 PMCID: PMC6952275 DOI: 10.1038/ijo.2017.241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/14/2017] [Accepted: 09/05/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES To model the association between accumulating 60 daily minutes of moderate-to-vigorous physical activity and a composite score of biological risk factors into a direct and an indirect effect, using abdominal obesity as the mediator. SUBJECTS/METHODS Cross-sectional data from the International Children's Accelerometry Database (ICAD) including 6-18-year-old children and adolescents (N=3412) from 4 countries providing at least 3 days of accelerometry-assessed physical activity. A standardized composite risk score was calculated from systolic blood pressure and fasting blood samples of insulin, glucose, triacylglycerol and inverse HDL-cholesterol. Abdominal obesity was assessed by the waist-circumference:height ratio. Two-stage regression analysis, allowing for exposure-mediator interaction, was used for the effect decomposition. RESULTS Participants achieving 60 daily minutes of moderate-to-vigorous physical activity had a 0.31 (95% CI: -0.39, -0.23) standard deviations lower composite risk score than those achieving less than 60 min. Modelling the associations suggested that 0.24 standard deviations (95% CI: -0.32, -0.16) was attributed to the direct effect and -0.07 (95% CI: -0.11, -0.02) to the indirect effect indicating that 22% of the total effect was mediated by central adiposity. Modelling 30 and 90 min of moderate-to-vigorous physical activity per day resulted in changes in the direct but not the indirect effect. CONCLUSIONS One hour of daily moderate-to-vigorous physical activity was associated with clinically relevant differences in metabolic control compared to engagement in less than this minimally recommended amount. The majority of the difference was explained by the direct effect of physical activity.International Journal of Obesity advance online publication, 31 October 2017; doi:10.1038/ijo.2017.241.
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Affiliation(s)
- Jakob Tarp
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anna Bugge
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lars Bo Andersen
- Department of Teacher Education and Sport, Western Norway University of Applied Sciences, Sogndal, Norway
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Luis B. Sardinha
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada, Portugal
| | - Ulf Ekelund
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Soren Brage
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Niels Christian Møller
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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12
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Jago R, Solomon-Moore E, Macdonald-Wallis C, Sebire SJ, Thompson JL, Lawlor DA. Change in children's physical activity and sedentary time between Year 1 and Year 4 of primary school in the B-PROACT1V cohort. Int J Behav Nutr Phys Act 2017; 14:33. [PMID: 28449679 PMCID: PMC5408437 DOI: 10.1186/s12966-017-0492-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 03/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to examine how children's and parents' physical activity changes from Year 1 (5-6) to Year 4 (8-9 years of age). METHODS Data are from the Bristol (UK) B-PROACT1V cohort. Fifty-seven primary schools were recruited when the children were in Year 1, with 1299 children and their parents providing data. Forty-seven schools were re-recruited in Year 4, with 1223 children and parents providing data (685 of whom participated in Year 1). Children and at least one parent wore an accelerometer for 5 days including a weekend and mean minutes of sedentary time, moderate-to-vigorous intensity physical activity (MVPA) and accelerometer counts per minute (CPM) were derived. Multiple imputation was used to impute missing data for all 1837 families who took part, including those who participated at just one time. Paired t-tests examined if there was statistical evidence of change in accelerometer measures. RESULTS Multiple imputation and observed data were comparable and results using complete observed data were mostly the same as those using imputed data. Imputed data showed that mean boys' CPM decreased from 747 to 673 (difference in mean 74 [95% CI 45 to 103]) and girls' from 686 to 587 (99 [79 to 119]). Boys' time spent in MVPA reduced from 72 to 69 (3 [0 to 6]) and girls' from 62 to 56 (7 [4 to 9]) minutes per day. There were increases in sedentary time for both boys (354 to 428 min, 74 [61 to 88]) and girls (365 to 448, 83 [71 to 96]). There was no evidence of change in parent CPM or MVPA. Mothers' sedentary time increased by 26 min per day [16 to 35]. CONCLUSIONS There were similar increases in sedentary time in girls and boys between age 5-6 and 8-9, and decreases in MVPA that were more marked in girls. The similarity of multiple-imputed and complete observed data suggest that these findings may not be markedly affected by selection bias. Result support early interventions to prevent the age-related decline in children's physical activity.
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Affiliation(s)
- Russell Jago
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
| | - Emma Solomon-Moore
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
| | - Corrie Macdonald-Wallis
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
| | - Simon J. Sebire
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
| | - Janice L. Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Deborah A. Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
- School of Social and Community Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, BS8 2PS UK
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13
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Haapala EA, Väistö J, Lintu N, Westgate K, Ekelund U, Poikkeus AM, Brage S, Lakka TA. Physical activity and sedentary time in relation to academic achievement in children. J Sci Med Sport 2016; 20:583-589. [PMID: 27908560 PMCID: PMC5429389 DOI: 10.1016/j.jsams.2016.11.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 10/21/2016] [Accepted: 11/15/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the independent and combined associations of objectively measured moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) with reading and arithmetic skills. DESIGN Cross-sectional/prospective. METHODS Participants were 89 boys and 69 girls aged 6-8 years. MVPA and ST were measured using a combined heart rate and movement sensor and body fat percentage by dual-energy X-ray absorptiometry in Grade 1. Reading fluency, reading comprehension, and arithmetic skills were assessed using standardized tests in Grades 1-3. The data were analyzed using linear regression analyses and analyses of covariance with repeated measures. RESULTS In boys, MVPA was directly and ST inversely associated with reading fluency in Grades 1-3 and arithmetic skills in Grade 1 (P<0.05). Higher levels of MVPA were also related to better reading comprehension in Grade 1 (P<0.05). Most of the associations of MVPA and ST with reading and arithmetic skills attenuated after mutual adjustment for MVPA or ST. Furthermore, boys with a combination of lower levels of MVPA and higher levels of ST had consistently poorer reading fluency (P=0.002) and reading comprehension (P=0.027) across Grades 1-3 than other boys. In girls, ST was directly associated with arithmetic skills in Grade 2 (P<0.05). However, this relationship of ST with arithmetic skills was no longer significant after adjustment for body fat percentage. CONCLUSIONS Lower levels of MVPA and higher levels of ST and particularly their combination were related to poorer reading skills in boys. In girls, higher levels of ST were related to better arithmetic skills.
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Affiliation(s)
- Eero A Haapala
- Institute of Biomedicine/Physiology, University of Eastern Finland, Kuopio Campus, Finland; Childhood Health and Active Living Research Group, Department of Biology of Physical Activity, University of Jyväskylä, Finland.
| | - Juuso Väistö
- Institute of Biomedicine/Physiology, University of Eastern Finland, Kuopio Campus, Finland; Institute of Dentistry, University of Eastern Finland, Kuopio Campus, Finland
| | - Niina Lintu
- Institute of Biomedicine/Physiology, University of Eastern Finland, Kuopio Campus, Finland
| | - Kate Westgate
- MRC Epidemiology Unit, University of Cambridge, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, United Kingdom
| | - Ulf Ekelund
- MRC Epidemiology Unit, University of Cambridge, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, United Kingdom; Department of Sport Medicine, Norwegian School of Sports Science, Norway
| | | | - Soren Brage
- MRC Epidemiology Unit, University of Cambridge, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, United Kingdom
| | - Timo A Lakka
- Institute of Biomedicine/Physiology, University of Eastern Finland, Kuopio Campus, Finland; Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland, Kuopio Campus, Finland; Kuopio Research Institute of Exercise Medicine, Finland
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14
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BMI-specific associations between health-related behaviours and overweight - a longitudinal study among Norwegian adolescents. Public Health Nutr 2016; 20:481-491. [PMID: 27652897 PMCID: PMC5426315 DOI: 10.1017/s1368980016002536] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective To investigate BMI-specific associations between health-related behaviours in early adolescence and the likelihood of overweight in mid-adolescence in a sample of Norwegian adolescents. Design Longitudinal study of 393 adolescents recruited from schools in Telemark County, Norway. Parents reported baseline data on children’s behavioural variables and background data (at age 12–13 years). Dietary data were reported by means of a retrospective FFQ. Eating patterns were identified using principal component analysis. Height and weight were measured at baseline and 3-year follow-up. BMI-specific differences in health-related behaviours (eating patterns, physical activity and screen time) at baseline were analysed using cross-tabulation and Pearson’s χ2 test (Fisher’s test). Associations between early health-related behaviours and the likelihood of later overweight were examined using multiple logistic regression. Setting Primary and secondary schools, Telemark, Norway. Subjects Children (n 393) in 7th grade (mean age 12·7 (sd 0·3) years), followed up in 10th grade, and parents. Results A moderate to high intake of a varied Norwegian eating pattern combined with moderate-to-vigorous physical activity ≥1 h/d in the 7th grade were associated with a reduced likelihood of being overweight in the 10th grade, but only among already overweight adolescents (adjusted OR=0·2; 95 % CI 0·1, 1·0). Screen time of >3 h/d in the 7th grade was associated with an increased likelihood of subsequent overweight only among adolescents with an initial normal weight (adjusted OR=2·8; 95 % CI 1·1, 7·3). Conclusions BMI-specific associations were observed between health-related behaviours in early adolescence and the likelihood of being overweight in mid-adolescence.
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15
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Butte NF, Puyau MR, Wilson TA, Liu Y, Wong WW, Adolph AL, Zakeri IF. Role of physical activity and sleep duration in growth and body composition of preschool-aged children. Obesity (Silver Spring) 2016; 24:1328-35. [PMID: 27087679 PMCID: PMC4882246 DOI: 10.1002/oby.21489] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/11/2016] [Accepted: 01/26/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The impact of physical activity patterns and sleep duration on growth and body composition of preschool-aged children remains unresolved. Aims were (1) to delineate cross-sectional associations among physical activity components, sleep, total energy expenditure (TEE), and body size and composition; and (2) to determine whether physical activity components, sleep, and TEE predict 1-year changes in body size and composition in healthy preschool-aged children. METHODS Anthropometry, body composition, accelerometry, and TEE by doubly labeled water were measured at baseline; anthropometry and body composition were repeated 1 year later (n = 111). RESULTS Cross-sectionally, positive associations between sedentary activity and weight and fat-free mass (FFM) (P = 0.009-0.047), and a negative association between moderate-vigorous physical activity (MVPA) and percent fat mass (FM) (P = 0.015) were observed. TEE and activity energy expenditure (AEE) were positively associated with weight, body mass index (BMI), FFM, and FM (P = 0.0001-0.046). Prospectively, TEE, AEE, physical activity level, and MVPA, but not sedentary activity, were positively associated with changes in BMI (P = 0.0001-0.051) and FFM (P = 0.0001-0.037), but not percent FM. Sleep duration inversely predicted changes in FM (P = 0.005) and percent FM (P = 0.006). CONCLUSIONS Prospectively, MVPA, TEE, AEE, and physical activity level promote normal growth and accretion of FFM, whereas sleep duration inversely predicts changes in adiposity in preschool-aged children.
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Affiliation(s)
- Nancy F. Butte
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030
| | - Maurice R. Puyau
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030
| | - Theresa A. Wilson
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030
| | - Yan Liu
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030
| | - William W. Wong
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030
| | - Anne L. Adolph
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030
| | - Issa F. Zakeri
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA 19120
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16
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Tarp J, Brønd JC, Andersen LB, Møller NC, Froberg K, Grøntved A. Physical activity, sedentary behavior, and long-term cardiovascular risk in young people: A review and discussion of methodology in prospective studies. JOURNAL OF SPORT AND HEALTH SCIENCE 2016; 5:145-150. [PMID: 30356550 PMCID: PMC6188740 DOI: 10.1016/j.jshs.2016.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 05/11/2023]
Abstract
The long-term effects of physical activity (PA) or sedentary behavior on cardiovascular health in young people are not well understood. In this study, we use a narrative format to review the evidence for a prospective association with adiposity and other well-established biological cardiovascular risk factors in healthy young people, considering only studies with at least 2 years of follow-up. PA appears to elicit a long-term beneficial effect on adiposity and particularly markers of cardiovascular health. With adiposity, however, a few studies also reported that higher levels of PA were associated with higher levels of adiposity. Time spent sedentary does not appear to be related to adiposity or markers of cardiovascular health independent of PA. We then discuss the uncertainties in the underlying causal chain and consider a number of alternative modeling strategies, which could improve our understanding of the relationship in future studies. Finally, we consider the current methodology for assessing PA and sedentary time.
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Affiliation(s)
- Jakob Tarp
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense 5230, Denmark
- Corresponding author.
| | - Jan Christian Brønd
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense 5230, Denmark
| | - Lars Bo Andersen
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense 5230, Denmark
- Department of Sports Medicine, Norwegian School of Sport Sciences, Sognsveien 220, Oslo 0806, Norway
| | - Niels Christian Møller
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense 5230, Denmark
| | - Karsten Froberg
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense 5230, Denmark
| | - Anders Grøntved
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense 5230, Denmark
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17
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Collings PJ, Wijndaele K, Corder K, Westgate K, Ridgway CL, Sharp SJ, Atkin AJ, Stephen AM, Bamber D, Goodyer I, Brage S, Ekelund U. Objectively measured physical activity and longitudinal changes in adolescent body fatness: an observational cohort study. Pediatr Obes 2016; 11:107-14. [PMID: 25919340 PMCID: PMC4780592 DOI: 10.1111/ijpo.12031] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 02/17/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The data regarding prospective associations between physical activity (PA) and adiposity in youth are inconsistent. OBJECTIVE The objective of this study was to investigate associations between baseline levels of objectively measured PA and changes in adiposity over 2.5 years from mid-to-late adolescence. METHODS This was an observational cohort study in 728 school students (43% boys) from Cambridgeshire, United Kingdom. Fat mass index (FMI, kg m(-2) ) was estimated at baseline (mean ± standard deviation age: 15 ± 0.3 years) and follow-up (17.5 ± 0.3 years) by anthropometry and bioelectrical impedance. Habitual PA was assessed at baseline by ≥3 d combined heart rate and movement sensing. Average daily PA energy expenditure (PAEE) and the time (min d(-1) ) spent in light, moderate and vigorous intensity PA (LPA, MPA and VPA, respectively) was estimated. Multilevel models were used to investigate associations between baseline PA and change in FMI (ΔFMI). Adjustment for baseline age, sex, follow-up duration, area-level socioeconomic status, season of PA assessment, sedentary time, energy intake and sleep duration was made; baseline FMI was also added in a second model. RESULTS FMI increased significantly over follow-up (0.6 ± 1.2 kg m(-2) , P < 0.001). Baseline PAEE and LPA positively predicted ΔFMI in overfat participants (P ≤ 0.030), as did VPA in initially normal fat participants (P ≤ 0.044). There were further positive associations between PAEE and ΔFMI in normal fat participants, and between MPA and ΔFMI in both fat groups, when adjusted for baseline FMI (P ≤ 0.024). CONCLUSIONS Baseline PAEE and its subcomponents were positively associated with small and unlikely clinically relevant increases in ΔFMI. These counter-intuitive findings may be explained by behavioural changes during the course of study follow-up.
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Affiliation(s)
- P. J. Collings
- MRC Epidemiology UnitUniversity of Cambridge School of Clinical MedicineCambridgeUK
| | - K. Wijndaele
- MRC Epidemiology UnitUniversity of Cambridge School of Clinical MedicineCambridgeUK
| | - K. Corder
- MRC Epidemiology UnitUniversity of Cambridge School of Clinical MedicineCambridgeUK
| | - K. Westgate
- MRC Epidemiology UnitUniversity of Cambridge School of Clinical MedicineCambridgeUK
| | - C. L. Ridgway
- MRC Epidemiology UnitUniversity of Cambridge School of Clinical MedicineCambridgeUK
| | - S. J. Sharp
- MRC Epidemiology UnitUniversity of Cambridge School of Clinical MedicineCambridgeUK
| | - A. J. Atkin
- UKCRC Centre for Diet and Activity Research (CEDAR)MRC Epidemiology UnitUniversity of Cambridge School of Clinical MedicineCambridgeUK
| | - A. M. Stephen
- MRC Human Nutrition ResearchUniversity of CambridgeCambridgeUK
| | - D. Bamber
- Developmental Lifecourse Research GroupDepartment of PsychiatryUniversity of CambridgeCambridgeUK
| | - I. Goodyer
- Developmental Lifecourse Research GroupDepartment of PsychiatryUniversity of CambridgeCambridgeUK
| | - S. Brage
- MRC Epidemiology UnitUniversity of Cambridge School of Clinical MedicineCambridgeUK
| | - U. Ekelund
- MRC Epidemiology UnitUniversity of Cambridge School of Clinical MedicineCambridgeUK,Department of Sport MedicineNorwegian School of Sports ScienceOsloNorway
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