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Agbaje AO. Accelerometer-based sedentary time and physical activity from childhood through young adulthood with progressive cardiac changes: a 13-year longitudinal study. Eur J Prev Cardiol 2024:zwae129. [PMID: 38711312 DOI: 10.1093/eurjpc/zwae129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 05/08/2024]
Abstract
AIMS Longitudinal evidence on the relationship of sedentary time (ST), light-intensity physical activity (LPA), and moderate-to-vigorous-intensity physical activity (MVPA) with changes in cardiac structure and function in the paediatric population is scarce. This evidence is clinically important due to the impact ST can have on the long-term prognosis of healthy young population in the lifetime continuum. This prospective observational study examined the relationships of cumulative ST, LPA, and MVPA from childhood with longitudinal changes in cardiac structure and function. METHODS AND RESULTS This is a secondary analysis from the Avon Longitudinal Study of Parents and Children, UK birth cohort of 1682 children aged 11 years. Participants who had at least one follow-up timepoints accelerometer-measured ST, LPA, and MVPA over a period of 13 years and repeated echocardiography-measured cardiac structure and function at ages 17- and 24-year clinic visit were included. Left ventricular mass indexed for height2.7 (LVMI2.7) and left ventricular (LV) diastolic function from mitral E/A ratio (LVDF) were computed. Among 1682 children (mean [SD] age, 11.75 [0.24] years; 1054 [62.7%] females), the cumulative one-min/day increase in ST from ages 11 to 24 years was associated with progressively increased LVMI2.7 {effect estimate 0.002 g/m2.7 [confidence interval (CI) 0.001-0.003], P < 0.001}, irrespective of sex, obesity, and hypertensive status. Cumulative one-min/day increase in LPA was associated with a decreased LVMI2.7 (-0.005 g/m2.7 [-0.006 to -0.003], P < 0.0001) but an increased LVDF. Cumulative one-minute/day increase in MVPA was associated with progressively increased LVMI2.7 (0.003 g/m2.7 [0.001-0.006], P = 0.015). CONCLUSION ST contributed +40% to the 7-year increase in cardiac mass, MVPA increased cardiac mass by +5%, but LPA reduced cardiac mass by -49%. Increased ST may have long-term pathologic effects on cardiac structure and function during growth from childhood through young adulthood; however, engaging in LPA may enhance cardiac health in the young population.
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Affiliation(s)
- Andrew O Agbaje
- Clinical Epidemiology and Child Health Unit, Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 8, P.O. Box 1627, 70211 Kuopio, Finland
- Children's Health and Exercise Research Centre, Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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Agbaje AO, Barker AR, Lewandowski AJ, Leeson P, Tuomainen TP. Accelerometer-based sedentary time, light physical activity, and moderate-to-vigorous physical activity from childhood with arterial stiffness and carotid IMT progression: A 13-year longitudinal study of 1339 children. Acta Physiol (Oxf) 2024; 240:e14132. [PMID: 38509836 DOI: 10.1111/apha.14132] [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: 11/25/2023] [Revised: 02/18/2024] [Accepted: 03/04/2024] [Indexed: 03/22/2024]
Abstract
AIMS We examined the longitudinal associations of sedentary time (ST), light physical activity (LPA), and moderate-to-vigorous PA (MVPA) from childhood with carotid-femoral pulse wave velocity (cfPWV), a measure of arterial stiffness and carotid intima-media thickness (cIMT). METHODS We studied 1339 children, aged 11 years from Avon Longitudinal Study of Parents and Children, UK, followed up for 13 years. Accelerometer-based ST, LPA, and MVPA were assessed at ages 11, 15, and 24 years clinic visits. cfPWV and cIMT were measured with Vicorder and ultrasound, respectively, at ages 17 and 24 years. RESULTS Among 1339 [56.4% female] participants, mean ST increased from ages 11 through 24 years, while mean LPA and MVPA decreased. Persistently high ST tertile from childhood was associated with increased cfPWV progression, effect estimate 0.047 m/s; [(95% CI 0.005 to 0.090); p = 0.030], but not cIMT progression. Persistently high LPA tertile category was associated with decreased cfPWV progression in males -0.022 m/s; [(-0.028 to -0.017); p < 0.001] and females -0.027 m/s; [(-0.044 to -0.010); p < 0.001]. Cumulative LPA exposure decreased the odds of progressively worsening cfPWV [Odds ratio 0.994 (0.994-0.995); p < 0.0001] and cIMT. Persistent exposure to ≥60 min/day of MVPA was paradoxically associated with increased cfPWV progression in males 0.053 m/s; [(0.030 to 0.077); p < 0.001] and females 0.012 m/s; [(0.002 to 0.022); p = 0.016]. Persistent exposure to ≥60 min/day of MVPA was inversely associated with cIMT progression in females -0.017 mm; [(-0.026 to -0.009); p < 0.001]. CONCLUSION LPA >3 h/day from childhood may attenuate progressively worsening vascular damage associated with increased ST in youth.
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Affiliation(s)
- Andrew O Agbaje
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Children's Health and Exercise Research Centre, Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Alan R Barker
- Children's Health and Exercise Research Centre, Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Adam J Lewandowski
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Paul Leeson
- Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Agbaje AO. Mediating effect of fat mass, lean mass, blood pressure and insulin resistance on the associations of accelerometer-based sedentary time and physical activity with arterial stiffness, carotid IMT and carotid elasticity in 1574 adolescents. J Hum Hypertens 2024; 38:393-403. [PMID: 38409590 PMCID: PMC11076203 DOI: 10.1038/s41371-024-00905-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 02/28/2024]
Abstract
This study examined the mediating effect of total body fat mass, lean mass, blood pressure (BP) and insulin resistance on the associations of sedentary time (ST), light physical activity (LPA) and moderate-to-vigorous PA (MVPA) with carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (cIMT) and carotid elasticity in 1574 adolescents from the Avon Longitudinal Study of Parents and Children birth cohort, UK. ST, LPA and MVPA were assessed with ActiGraph accelerometer. ST and LPA were sex-categorised in tertiles as low (reference), moderate and high, while MVPA was categorised as <40 min/day (reference), 40-<60 min/day and ≥60 min/day. cfPWV, cIMT and carotid elasticity were measured with Vicorder and ultrasound. Fat mass and lean mass were assessed with dual-energy X-ray absorptiometry and homeostatic model assessment of insulin resistance (HOMA-IR) was computed. Mediation analyses structural equation models and linear mixed-effect models adjusted for cardiometabolic and lifestyle factors were conducted. Among 1574 adolescents [56.2% female; mean (SD) age 15.4 (0.24) years], 41% males and 17% females accumulated ≥60 min/day of MVPA. Higher ST was associated with lower cIMT partly mediated by lean mass. Higher LPA (standardized β = -0.057; [95% CI -0.101 to -0.013; p = 0.014]) and the highest LPA tertile were associated with lower cfPWV. BP had no significant mediating effect movement behaviour relations with vascular indices. Lean mass partially mediated associations of higher MVPA with higher cIMT (0.012; [0.007-0.002; p = 0.001], 25.5% mediation) and higher carotid elasticity (0.025; [0.014-0.039; p = 0.001], 28.1% mediation). HOMA-IR mediated the associations of higher MVPA with higher carotid elasticity (7.7% mediation). Engaging in ≥60 min/day of MVPA was associated with higher carotid elasticity. In conclusion, higher LPA was associated with lower arterial stiffness, but higher MVPA was associated with thicker carotid wall explained by higher lean mass.
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Grants
- 65191835, 00200150, and 00230190 Suomen Kulttuurirahasto (Finnish Cultural Foundation)
- 230082 Alfred Kordelinin Säätiö (Alfred Kordelin Foundation)
- 20217390 Yrjö Jahnssonin Säätiö (Yrjö Jahnsson Foundation)
- 220021 and 230012 Sydäntutkimussäätiö (Finnish Foundation for Cardiovascular Research)
- 00180006 Jenny ja Antti Wihurin Rahasto (Jenny and Antti Wihuri Foundation)
- Orion Research Foundation sr, Aarne Koskelo Foundation, Antti and Tyyne Soininen Foundation, Paulo Foundation, Paavo Nurmi Foundation, Ida Montin Foundation, Kuopio University Foundation, Eino Räsänen Fund, Matti and Vappu Maukonen Fund,
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Affiliation(s)
- Andrew O Agbaje
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
- Children's Health and Exercise Research Centre, Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
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Agbaje AO. Waist-circumference-to-height-ratio had better longitudinal agreement with DEXA-measured fat mass than BMI in 7237 children. Pediatr Res 2024:10.1038/s41390-024-03112-8. [PMID: 38443520 DOI: 10.1038/s41390-024-03112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/25/2024] [Accepted: 02/15/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND The absolute agreement of surrogate measures of adiposity with dual-energy X-ray absorptiometry (DEXA)-measured body composition was examined. METHODS Over a 15-year follow-up, 7237 (3667 females) nine-year-old children from the Avon Longitudinal Study of Parents and Children (ALSPAC) UK birth cohort were included. Total fat mass (FM) and trunk FM were serially measured with DEXA at ages 9, 11, 15, 17, and 24 years. BMI and waist circumference-to-height ratio (WHtR) were computed. Pearson's correlations, intraclass correlations (ICC), and area under curve (AUC) analyses were conducted. RESULTS Over 15 years, BMI, total FM, and trunk FM, increased but WHtR was relatively stable. WHtR provided a better longitudinal absolute agreement [males ICC 0.84 (95% CI 0.84-0.85); females 0.81 (0.80-0.82)] than BMI [(males (0.65 (0.64-0.66); females 0.72 (0.71-0.73)] with total FM as well as trunk FM from ages 9-24 years. WHtR cut-point for predicting excess total FM (75th-95th percentile) was 0.50-0.53 in males [AUC 0.86-0.94, sensitivity 0.51-0.79 and specificity 0.93-0.95]. WHtR cut-point for predicting excess total FM (75th-95th percentile) was 0.52-0.54 in females [AUC 0.83-0.95, sensitivity 0.38-0.68 and specificity 0.92-0.95]. Results were similar with trunk FM. CONCLUSION WHtR is an inexpensive alternative to BMI for predicting FM in pediatrics. IMPACT Waist circumference-to-height ratio (WHtR) is a better adiposity surrogate measure than body mass index (BMI) in predicting fat mass and discriminating lean mass from childhood through young adulthood. BMI has been used as an inexpensive surrogate measure of adiposity in children for several decades. However, emerging findings suggest that BMI fails to discriminate between fat mass adiposity and lean mass. This is the first-ever longitudinal study in over 7000 children followed up for 15 years that identified WHtR as an inexpensive accurate measure that discriminates fat mass from lean mass that could replace BMI measure of obesity in pediatrics.
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Affiliation(s)
- Andrew O Agbaje
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
- Children's Health and Exercise Research Centre, Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
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Padmapriya N, Fogel A, Tan SYX, Goh CMJL, Tan SL, Chia A, Chu AHY, Chong YS, Tan KH, Chan SY, Yap F, Godfrey KM, Lee YS, Eriksson JG, Tan CS, Bernard JY, Müller-Riemenschneider F. The cross-sectional and prospective associations of parental practices and environmental factors with 24-hour movement behaviours among school-aged Asian children. Int J Behav Nutr Phys Act 2024; 21:27. [PMID: 38438945 PMCID: PMC10913559 DOI: 10.1186/s12966-024-01574-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/12/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Parental practices and neighbourhood environmental factors may influence children's movement behaviours. We aimed to investigate the cross-sectional and prospective associations of parental practices and neighbourhood environmental factors with accelerometer-measured 24-hour movement behaviours (24 h-MBs) among school-aged children in Singapore. METHODS The Growing Up in Singapore Towards healthy Outcomes (GUSTO) study collected information on dimensions of parental practices and neighbourhood environment at age 5.5 years. Confirmatory factor analyses were performed to generate latent variables and used to compute overall parental practices [involvement in PA + support for PA + control of screen viewing context] and environmental scores [facilities for active play + active mobility facilitators + barriers*-1]. Children wore an accelerometer on their non-dominant wrist for seven consecutive days at ages 5.5 and 8 years. The R-package GGIR 2.6 was used to derive moderate-to-vigorous-intensity physical activity (MVPA), light-intensity physical activity (LPA), inactivity, and total-sleep (napping+night sleep) minutes per day. Associations were determined using compositional data analysis with multivariate linear regression models, taking into account potential confounders. RESULTS Among 425 children (48% girls, 59% Chinese), higher parental involvement in PA, parental support for PA and overall parental practices were associated with 24 h-MBs at ages 5.5 and 8 years, specifically with greater time spent in MVPA and less time being inactive relative to the remaining movement behaviours. The corresponding mean changes in the overall 24 h-MB for increasing parental practices from lowest to highest scores (- 2 to + 2 z-scores) indicated potential increases of up to 15-minutes in MVPA, 20-minutes in LPA, 5-minutes in sleep duration, and a reduction of 40-minutes in inactivity at age 5.5 years. At age 8 years, this could translate to approximately 15-minutes more of MVPA, 20-minutes more of LPA, a 20-minute reduction in sleep duration, and a 20-minute reduction in inactivity. Parental control of screen viewing contexts and neighbourhood environmental factors were not associated with 24 h-MBs. CONCLUSIONS Parental practices but not environmental factors were associated with higher MVPA and lower inactivity among Singaporean children, even at a later age. Further research may provide insights that support development of targeted public health strategies to promote healthier movement behaviours among children. STUDY REGISTRATION This study was registered on 4th August 2010 and is available online at ClinicalTrials.gov: NCT01174875.
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Affiliation(s)
- Natarajan Padmapriya
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
- Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Anna Fogel
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Sarah Yi Xuan Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Shuen Lin Tan
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Airu Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Anne Hin Yee Chu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Yap Seng Chong
- Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Kok Hian Tan
- KK Women's and Children's Hospital, Singapore, Singapore
- Duke-National University of Singapore, Singapore, Singapore
| | - Shiao-Yng Chan
- Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Fabian Yap
- KK Women's and Children's Hospital, Singapore, Singapore
- Duke-National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Johan G Eriksson
- Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of General Practice and Primary Health Care, University of Helsinki and Folkhälsan Research Center, Helsinki, Finland
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jonathan Y Bernard
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, F-75004, France
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Digital Health Center, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Agbaje AO. Increasing lipids with risk of worsening cardiac damage in 1595 adolescents: A 7-year longitudinal and mediation study. Atherosclerosis 2024; 389:117440. [PMID: 38246095 DOI: 10.1016/j.atherosclerosis.2023.117440] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/30/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND AND AIMS Longitudinal evidence on the associations of changes in lipids level with changes in cardiac structure and function in youth is limited due to few repeated echocardiography measures. This study examined whether changes in lipid levels from adolescence through young adulthood associate with the risk of cardiac damage progression and potential mechanistic pathways. METHODS From the Avon Longitudinal Study of Parents and Children (ALSPAC), UK birth cohort, 1595 adolescents aged 17 years who had fasting plasma total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), and non-HDL-c measured at 17- and 24-year clinic visit were included. Echocardiography measured left ventricular mass indexed for height2.7 (LVMI2.7), and LV diastolic function from mitral E/A ratio (LVDF). LVMI2.7 ≥51 g/m2.7 and LVDF<1.5 were categorized as LV hypertrophy and LVD dysfunction, respectively. Multivariable adjusted associations were examined using generalized logit mixed-effect models and structural equation models for mediation analyses. RESULTS The prevalence of LV hypertrophy increased from 3.6% at baseline to 11.6% at follow-up in males and increased from 1.6% to 4.0% in females. The prevalence of LVD dysfunction increased from 7.8% at baseline to 16.6% at follow-up in males and increased from 10.3% to 15.4% in females. Each 1 mmol increase in total cholesterol (OR, 1.18; [95% CI, 1.09-1.27]), triglyceride (2.89; [1.54-5.43]), LDL-c (1.19; [1.08-1.32]), and non-HDL-c (1.21; [1.11-1.33]) was associated with higher odds of worsening LV hypertrophy progression over 7 years. Increased triglyceride was associated with the odds of progressively worsening LVD dysfunction (1.98; [1.06-3.71]). Increased HDL-c was not associated with the odds of cardiac structural and functional damage. Systolic blood pressure (12% mediation) and fat mass (25% mediation) partly mediated the associations of LDL-c with increased LVMI2.7. CONCLUSIONS Increased lipids may independently associate with the risk of progressively worsening structural and functional cardiac damage in youth but increased systolic blood pressure and fat mass explained circa forty percent of the relationship.
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Affiliation(s)
- Andrew O Agbaje
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Children's Health and Exercise Research Centre, Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
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Agbaje AO, Saner C, Zhang J, Henderson M, Tuomainen TP. DEXA-based Fat Mass with the Risk of Worsening Insulin Resistance in Adolescents: A 9-Year Temporal and Mediation Study. J Clin Endocrinol Metab 2024:dgae004. [PMID: 38173399 DOI: 10.1210/clinem/dgae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/05/2024]
Abstract
CONTEXT Surrogate measures of childhood and adolescent obesity have impaired the understanding of body composition's relationship with insulin resistance in the young population. OBJECTIVES We aim to examine the longitudinal associations of directly measured total fat mass, trunk fat mass, and lean mass with the risk of hyperglycaemia, hyperinsulinemia, and insulin resistance from ages 15-24 years, the mediation path through which lipids and inflammation influence insulin resistance and whether increased fat mass temporally precede insulin resistance. METHODS We studied 3160 adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC), UK birth cohort, who had complete dual-energy Xray absorptiometry measure and fasting blood samples at age 15 years and repeated measures at ages 17- and 24-years clinic visit. Fasting glucose >6.1 mmol/L, insulin >11.78 mU/L, and homeostatic model assessment for insulin resistance (HOMA-IR) ≥75th percentile were categorized as hyperglycaemia, hyperinsulinemia, and high insulin resistance, respectively. Longitudinal associations were examined with generalized logit-mixed effect models, whilst mediation and temporal path analyses were examined using structural equation models, adjusting for cardiometabolic and other lifestyle factors. RESULTS Among 3160 participants (51% female), fat mass and lean mass increased linearly in both males and females while glucose, insulin, and HOMA-IR had a U-shaped course from age 15 through 24 years. After full adjustment, each 1 kg cumulative increase in total fat mass [odds ratio 1.12 (95% confidence interval 1.11-1.13)] and trunk fat mass [1.21 (1.19-1.23)] from ages 15 through 24 years were associated with a progressively worsening risk of high insulin resistance as well as hyperglycaemia and hyperinsulinemia. The association of increased total fat mass with increased insulin resistance was partly mediated by triglycerides (9% mediation). In the temporal path analysis, higher total fat mass at age 15 years was associated with higher insulin resistance at 17 years, but not vice versa. Higher total fat mass at 17 years was bi-directionally associated with higher insulin resistance at 24 years. CONCLUSION Mid-adolescence may be an optimal time for interrupting the worsening fat mass-insulin resistance pathologic cycle and attenuating the risk of progressively worsening metabolic dysfunction before young adulthood.
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Affiliation(s)
- Andrew O Agbaje
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Children's Health and Exercise Research Centre, Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Christoph Saner
- Division of Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Jie Zhang
- Department of Public Health, Aarhus University, DK-8000 Aarhus, Denmark
| | - Mélanie Henderson
- School of Public Health, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Research Center of Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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