The Fueling Learning Through Exercise Study Cluster RCT: Impact on Children's Moderate-to-Vigorous Physical Activity

INTRODUCTION

Most children do not meet the recommendations for school-time and daily moderate-to-vigorous physical activity, with significant demographic disparities and declines over the elementary school years. Investigators examined the impact of Fueling Learning through Exercise study school-based physical activity programs on school-time and total daily moderate-to-vigorous physical activity among lower-income school children.

DESIGN, PARTICIPANTS, AND INTERVENTION

Urban elementary schools (N=18) were cluster randomized to 100 Mile Club, Just Move, or control. Data collection and analyses occurred from 2015 to 2019 among third- and fourth-grade school children (N=1,008) across 2 academic years.

MAIN OUTCOME MEASURES

Student's moderate-to-vigorous physical activity was measured by 7-day accelerometry (Actigraph GT3X+) at baseline (before intervention), midpoint (6 months), and endpoint (18 months). Mixed-effects linear regression models examined program impact on school-time and daily moderate-to-vigorous physical activity, adjusting for clustering, demographics, weight status, free/reduced-price lunch eligibility, school physical activity environment, wear time, and weather. Program reach by sex, weight status, race/ethnicity, and baseline activity levels was explored.

RESULTS

Of the 979 participants analyzed (aged 8.7 [SD=0.7] years, 44% male, 60% non-White, 40% overweight/obese, 55% eligible for free/reduced-price lunch), 8.4% (18.2 [SD=7.9] minutes per day) and 19.8% (45.6 [SD=19.4] minutes per day) fulfilled the 30-minute school-time and 60-minute daily moderate-to-vigorous physical activity recommendations at baseline, respectively. Overall, daily moderate-to-vigorous physical activity decreased from baseline to 18 months (p<0.001, -5.3 minutes, 95% CI= -8.2, -2.4) with no effect of programming. However, for school-time moderate-to-vigorous physical activity, intervention schools maintained school-time moderate-to-vigorous physical activity across the 2 academic years, whereas school-time moderate-to-vigorous physical activity decreased in control schools (p=0.004, -2.3 minutes, 95% CI= -4.3, -0.4). Program reach on school-time moderate-to-vigorous physical activity appeared equitable by sex and weight status but was different by race/ethnicity (p<0.001).

CONCLUSIONS

Two different school-based physical activity programs were effective in preventing the decline in school-time moderate-to-vigorous physical activity that is typical across the elementary years, with similar reach by sex and weight status. Multiple opportunities for physical activity during school are needed to promote meeting school-time moderate-to-vigorous physical activity recommendations among diverse children.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT02810834.

Abstract 410: High Sensitive C-Reactive Protein Independently Predicts Insulin Resistance in Women in a South Asian Population, With a Stronger Association in Urban Areas

Objectives: Insulin resistance (IR), which plays a fundamental role in the pathogenesis of metabolic syndrome and type 2 diabetes mellitus, is associated with serum levels of inflammatory markers and abdominal obesity. Whether the association of inflammation with IR is independent of obesity remains unresolved; moreover, whether this association varies with gender and urban living is not known. We therefore conducted a cross-sectional study to investigate the gender specific association between IR and high sensitive C-reactive protein (HsCRP), independent of abdominal obesity, in urban and rural communities in a South Asian population.

Methods: We conducted a population-based cross-sectional survey in 8,080 South Indians above the age of 20 years in both urban and rural environments. The study assessed of waist circumference (WC), blood pressure (BP), socioeconomic status, family history, anxiety and stress levels, and fasting blood for plasma glucose, insulin, total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL) and HsCRP. IR was calculated using the homeostasis model assessment (HOMA-IR). After the exclusion of individuals with diabetics, 6,309 subjects (mean age 42 years; 58% women) were eligible and constituted the study sample.

Results: The HOMA-IR level (mean ± SD) was higher in women (1.98 ± 1.62), when compared to men (1.71 ± 1.38), and HsCRP levels were 4.00 ± 5.14 and 3.42 ± 7.22 mg/dl in women and men, respectively. There was stronger correlation of HsCRP with HOMA-IR in women (r= 0.371) when compared to men (r= 0.203). In a multiple regression analysis, after adjusting for WC and other co-variants such as, BP, TC, LDL, TG, socioeconomic status, physical activity and family history of diabetes, HsCRP continued to be a significant predictor only in women (p<0.001). In women with elevated HsCRP levels (≥ 3 mg/dl), after multivariate adjustments, the odds ratio of elevated HOMA-IR (≥ 2.86) was 2.13 [CI: 1.66, 2.74; p <0.001] in urban women, when compared to odds ratio of 1.41 [CI: 1.02, 1.96; p=0.037] in rural women.

Conclusion: HsCRP is associated with IR independent of abdominal obesity in non-diabetic South Asian women, and at elevated HsCRP levels the association is stronger in urban women.

Rapid donor liver procurement with only aortic perfusion

ATM: To describe a rapid technique for procurement of donor liver with aortic perfusion only (APO).

METHODS: Only the aorta is cannulated and perfused with chilled preservation solution.

RESULTS: The quality of donor liver can ensure the grafted liver functions.

CONCLUSION: The method of APO can simplify the operative procedure, compared with the dual cannulation. It also can minimize the danger of injuring vascular structures and involve less dissection.

Manganese intake and cholestatic jaundice in neonates receiving parenteral nutrition: a randomized controlled study

Infants requiring parenteral nutrition (n = 244) were randomized to receive either 1 (group 1, n = 121) or 0.0182 micromol/kg/d (group 2, n = 123) of manganese supplementation. The whole-blood manganese and serum direct bilirubin concentrations of the infants were monitored, as was the development of cholestasis (peak serum direct bilirubin concentration >50 micromol/L). Subgroup analysis was carried out on the data of 78 infants in group 1 and 82 in group 2 who had received manganese supplementation and more than three-quarters of their total daily fluid as parenteral nutrition for >14 d. Of all the infants randomized, the high manganese group (group 1) showed a trend towards developing higher peak whole-blood manganese concentration [group 1 versus group 2: median (interquartile range): 606.0 (421.0; 1005.0) vs 566.0 (336.0: 858.0); p=0.061] and higher peak serum direct bilirubin concentration [37.0 (10.5; 122.5) vs 19.0 (8.0; 112.5); p=0.153], but the differences between the 2 groups did not reach statistical significance. The 2 groups did not differ in terms of the occurrence of cholestasis during parenteral nutrition (63/121 vs 57/123; p=0.444). Subgroup analysis of infants who had received more than three-quarters of their total daily fluid as parenteral nutrition showed, however, that the high manganese group developed significantly higher whole-blood manganese concentration [743.5 (498.0; 1211.0) vs 587.0 (438.0; 982.0); p=0.037] and serum direct bilirubin concentration [84.0 (28.0; 170.0) vs 25.5 (9.0; 117.0): p < 0.001]. Although there was no significant difference in the occurrence of cholestasis (58/78 vs 49/82; p = 0.073), more infants in the high manganese group developed a more severe degree of direct hyperbilirubinaemia, with peak serum direct bilirubin >100 micromol/L (32/78 vs 20/82; p = 0.038).

CONCLUSION

We conclude that the pathogenesis of parenteral nutrition-related cholestasis is probably multifactorial, and that high manganese intake is a significant contributory factor.

Roles of two homotetrameric kinesins in sea urchin embryonic cell division

To improve our understanding of the roles of microtubule cross-linking motors in mitosis, we analyzed two sea urchin embryonic kinesin-related proteins. It is striking to note that both of these proteins behave as homotetramers, but one behaves as a more compact molecule than the other. These observations suggest that these two presumptive motors could cross-link microtubules into bundles with different spacing. Both motors localize to mitotic spindles, and antibody microinjection experiments suggest that they have mitotic functions. Thus, one of these kinesin-related proteins may cross-link spindle microtubules into loose bundles that are "tightened" by the other.