Associations of diet quality and food consumption with serum biomarkers for lipid and amino acid metabolism in Finnish children: the PANIC study.

PURPOSE: To investigate the associations of overall diet quality and dietary factors with serum biomarkers for lipid and amino acid metabolism in a general population of children. METHODS: We studied 194 girls and 209 boys aged 6-8 years participating in the Physical Activity and Nutrition in Children study. Food consumption was assessed by 4-day food records and diet quality was quantified by the Finnish Children Healthy Eating Index (FCHEI). Fasting serum fatty acids, amino acids, apolipoproteins, as well as lipoprotein particle sizes were analyzed with high-throughput nuclear magnetic resonance spectroscopy. Data were analyzed using linear regression adjusted for age, sex, and body fat percentage. RESULTS: FCHEI was directly associated with the ratio of polyunsaturated (PUFA) to saturated fatty acids (SFA) (PUFA/SFA), the ratio of PUFA to monounsaturated fatty acids (MUFA) (PUFA/MUFA), the ratio of PUFA to total fatty acids (FA) (PUFA%), the ratio of omega-3-fatty acids to total FA (omega-3 FA%), and inversely associated with the ratio of MUFA to total FA (MUFA%), alanine, glycine, histidine and very-low density lipoprotein (VLDL) particle size. Consumption of vegetable oils and vegetable-oil-based margarine (≥ 60% fat) was directly associated with PUFA/SFA, PUFA/MUFA, PUFA%, the ratio of omega-6 FA to total FA (omega-6 FA%), and inversely associated with SFA, MUFA, SFA to total FA (SFA%), MUFA%, alanine and VLDL particle size. Consumption of high-fiber grain products directly associated with PUFA/SFA, PUFA/MUFA, omega-3 FA%, omega-6 FA%, PUFA% and inversely associated with SFA and SFA%. Fish consumption directly related to omega-3 FA and omega-3 FA%. Consumption of sugary products was directly associated with histidine and VLDL particle size. Vegetable, fruit, and berry consumption had direct associations with VLDL particle size and the ratio of apolipoprotein B to apolipoprotein A1. Consumption of low fat (< 1%) milk was directly associated with phenylalanine. A higher consumption of high-fat (≥ 1%) milk was associated with lower serum MUFA/SFA and higher SFA%. Sausage consumption was directly related to SFA% and histidine. Red meat consumption was inversely associated with glycine. CONCLUSIONS: Better diet quality, higher in intake of dietary sources of unsaturated fat and fiber, and lower in sugary product intake were associated with more favorable levels of serum biomarkers for lipid and amino acid metabolism independent of adiposity. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01803776, registered March 3, 2013.

Sources of vitamin D and determinants of serum 25-hydroxyvitamin D in Finnish adolescents.

PURPOSE: To study the intake and sources of vitamin D and determinants of serum 25-hydroxyvitamin D (S-25(OH)D) in Finnish adolescents. METHODS: We studied 265 adolescents (117 girls) aged 15-17 years attending 8-year examinations of the PANIC Study, assessed diet using food records and other lifestyle factors by questionnaires, and analyzed S-25(OH)D by chemiluminescence immunoassay and determinants of S-25(OH)D using multivariate linear regression. RESULTS: Mean (standard deviation) of total vitamin D intake from food and supplements was 19.2 (13.1) µg/d, and that of dietary vitamin D intake was 9.9 (5.4) µg/d. Milk fortified with vitamin D was the main dietary source of vitamin D, providing 45% of daily intake. Altogether, 29% of the adolescents used no vitamin D supplements and 25% did not meet the recommended total vitamin D intake of 10 µg/d. Mean (standard deviation) of S-25(OH)D was 62.0 (18.8) nmol/l, and S-25(OH)D was < 50 nmol/l in 29.5% of the adolescents. Vitamin D intake from supplements was the main determinant of S-25(OH)D (ß = 0.465, p < 0.001), followed by consumption of milk products (ß = 0.251, p < 0.001), consumption of meat products (ß = 0.179, p = 0.002), travels to sunny countries (ß = 0.178, p = 0.002), and average daylight time (ß = 0.162, p = 0.004). CONCLUSION: Most of the adolescents had vitamin D intake at the recommended level, although a fourth did not meet the recommended total vitamin D intake of 10 µg/d and almost a third had S-25(OH)D < 50 nmol/l. More attention should be paid to the sufficient intake of vitamin D in adolescents who do not use vitamin D supplements or fortified milk products. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01803776, registered March 3, 2013.

Effects of 2-year dietary and physical activity intervention on cognition in children-a nonrandomized controlled trial.

BACKGROUND AND OBJECTIVE: We investigated the effects of a combined dietary and PA intervention on cognition in children and whether changes in diet quality, PA, sedentary behavior (SB), and sedentary time (ST) are associated with changes in cognition. METHODS: We conducted a 2-year nonrandomized controlled trial in 504 children aged 6-9 years at baseline. The children were allocated to a combined dietary and PA intervention group (n = 237) or a control group (n = 160) without blinding. INTERVENTIONS: The children and their parents allocated to the intervention group had six dietary counseling sessions of 30-45 min and six PA counseling sessions of 30-45 min during the 2-year intervention period. The children were also encouraged to participate in after-school exercise clubs. Cognition was assessed by the Raven's Colored Progressive Matrices. We assessed dietary factors by 4 days food records and computed the Baltic Sea Diet Score (BSDS) as a measure of diet quality. PA and ST were assessed by a combined heart rate and body movement monitor, types of PA and SB by a questionnaire. RESULTS: The intervention had no effect on cognition. Increased BSDS and consumption of low-fat milk and decreased consumption of red meat and sausages were associated with improved cognition over 2 years. Increased organized sports, ST, and reading were positively, while unsupervised PA, computer use, and writing were negatively associated with cognition. CONCLUSION: Combined dietary and PA intervention had no effect on cognition. Improved diet quality and increased organized sports and reading were associated with improved cognition.

Associations of diet quality, food consumption, eating frequency and eating behaviour with dental caries experience in Finnish children: a 2-year longitudinal study.

We examined cross-sectional and longitudinal associations of dietary factors with caries experience in a population sample of 487 children aged 6-9 years at baseline examinations of the Physical Activity and Nutrition in Children (PANIC) Study. Altogether, 406 of these children attended 2-year follow-up examinations. Food consumption and eating frequency were assessed using 4-day food records, diet quality using the Baltic Sea Diet Score (BSDS) and eating behaviour using the Children's Eating Behavior Questionnaire. Caries experience was examined clinically. The cross-sectional associations of dietary factors with caries experience at baseline were analysed using linear regression and the longitudinal associations of dietary factors with a change in caries experience over follow-up using generalised mixed-effects regression adjusted for other risk factors. A higher consumption of high-fibre grain products (standardised regression coefficient ß = -0·16, P = 0·003) and milk (ß = -0·11, P = 0·025) and higher BSDS (ß = -0·15, P = 0·007) were associated with lower caries experience, whereas a higher consumption of potatoes (ß = 0·11, P = 0·048) and emotional overeating (ß = 0·12, P = 0·025) were associated with higher caries experience. Higher snacking frequency (fixed coefficient ß = 0·07, P = 0·033), desire to drink (ß = 0·10, P = 0·046), slowness in eating (ß = 0·12, P = 0·027) and food fussiness (ß = 0·12, P = 0·018) were associated with higher caries experience, whereas enjoyment of food (ß = -0·12, P = 0·034) and higher BSDS (ß = -0·02, P = 0·051) were associated with lower caries experience.

Cost-effectiveness of physical activity intervention in children - results based on the Physical Activity and Nutrition in Children (PANIC) study.

BACKGROUND: We assessed the cost-effectiveness of a 2-year physical activity (PA) intervention combining family-based PA counselling and after-school exercise clubs in primary-school children compared to no intervention from an extended service payer's perspective. METHODS: The participants included 506 children (245 girls, 261 boys) allocated to an intervention group (306 children, 60 %) and a control group (200 children, 40 %). The children and their parents in the intervention group had six PA counselling visits, and the children also had the opportunity to participate in after-school exercise clubs. The control group received verbal and written advice on health-improving PA at baseline. A change in total PA over two years was used as the outcome measure. Intervention costs included those related to the family-based PA counselling, the after-school exercise clubs, and the parents' taking time off to travel to and participate in the counselling. The cost-effectiveness analyses were performed using the intention-to-treat principle. The costs per increased PA hour (incremental cost-effectiveness ratio, ICER) were based on net monetary benefit (NMB) regression adjusted for baseline PA and background variables. The results are presented with NMB and cost-effectiveness acceptability curves. RESULTS: Over two years, total PA increased on average by 108 h in the intervention group (95 % confidence interval [CI] from 95 to 121, p < 0.001) and decreased by 65.5 h (95 % CI from 81.7 to 48.3, p < 0.001) in the control group, the difference being 173.7 h. the incremental effectiveness was 87 (173/2) hours. For two years, the intervention costs were €619 without parents' time use costs and €860 with these costs. The costs per increased PA hour were €6.21 without and €8.62 with these costs. The willingness to pay required for 95 % probability of cost-effectiveness was €14 and €19 with these costs. The sensitivity analyses revealed that the ICER without assuming this linear change in PA were €3.10 and €4.31. CONCLUSIONS: The PA intervention would be cost-effective compared to no intervention among children if the service payer's willingness-to-pay for a 1-hour increase in PA is €8.62 with parents' time costs. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01803776. Registered 4 March 2013 - Retrospectively registered, https://clinicaltrials.gov/ct2/results?cond=&term=01803776&cntry=&state=&city=&dist= .

The effects of a 2-year physical activity and dietary intervention on plasma lipid concentrations in children: the PANIC Study.

PURPOSE: We studied the effects of a physical activity and dietary intervention on plasma lipids in a general population of children. We also investigated how lifestyle changes contributed to the intervention effects. METHODS: We carried out a 2-year controlled, non-randomized lifestyle intervention study among 504 mainly prepubertal children aged 6-9 years at baseline. We assigned 306 children to the intervention group and 198 children to the control group. We assessed plasma concentrations of total, LDL, HDL, and VLDL cholesterol, triglycerides, HDL triglycerides, and VLDL triglycerides. We evaluated the consumption of foods using 4-day food records and physical activity using a movement and heart rate sensor. We analyzed data using linear mixed-effect models adjusted for age at baseline, sex, and pubertal stage at both time points. Furthermore, specific lifestyle variables were entered in these models. RESULTS: Plasma LDL cholesterol decreased in the intervention group but did not change in the control group ( - 0.05 vs. 0.00 mmol/L, regression coefficient (ß) = - 0.0385, p = 0.040 for group*time interaction). This effect was mainly explained by the changes in the consumption of high-fat vegetable oil-based spreads (ß = - 0.0203, + 47% change in ß) and butter-based spreads (ß = - 0.0294, + 30% change in ß), moderate-to-vigorous physical activity (ß = - 0.0268, + 30% change in ß), light physical activity (ß = - 0.0274, + 29% change in ß) and sedentary time (ß = - 0.0270, + 30% change in ß). The intervention had no effect on other plasma lipids. CONCLUSION: Lifestyle intervention resulted a small decrease in plasma LDL cholesterol concentration in children. The effect was explained by changes in quality and quantity of dietary fat and physical activity. CLINICAL TRIAL REGISTRY NUMBER: NCT01803776, ClinicalTrials.gov.

Dental caries among Finnish teenagers participating in physical activity and diet intervention: association with anthropometrics and behavioural factors.

BACKGROUND: An association between childhood anthropometric measurements and dental caries is conflicting. The prevalence and severity of dental caries and its association with anthropometric and behavioural factors, were investigated among Finnish teenagers. METHODS: The study sample comprised 202 15-17-year-old participants in the Physical Activity and Nutrition in Children (PANIC) Study. Dental caries findings were recorded using International Caries Detection and Assessment System (ICDAS) criteria, including activity estimation; numbers of decayed teeth (DT) and decayed, missing and filled teeth (DMFT) were recorded. Body weight, height and waist circumference were measured and respective body mass index (BMI) was calculated. Body fat percentage was assessed by dual-energy X-ray absorptiometry. Health-related behaviours and consumption of food and drinks were assessed using questionnaires, and intake of nutrients using a 4-day food record. RESULTS: Mean DMFT for all the participants was 2.4 (SD = 2.9), DT 0.6 (SD = 1.3), and 36% had DMFT = 0. No difference between genders was observed. In bivariate analyses, use of sugar-sweetened beverages (SSB) three times or less per week and not having used snuff associated significantly, whereas higher carbohydrate intake (E%), toothbrushing less often than twice a day and higher caries experience at baseline almost significantly with DT > 0. In adjusted regression analyses, frequent use of SSB and higher carbohydrate intake increased the odds for DT > 0. Additionally, higher carbohydrate intake (E%) and infrequent tooth brushing significantly associated with a higher number of DT. CONCLUSION: Caries prevalence is still low and similar in Finnish teenage girls and boys. Behavioural factors are, but anthropometric factors are not associated with dental caries.

A 2 year physical activity and dietary intervention attenuates the increase in insulin resistance in a general population of children: the PANIC study.

AIMS/HYPOTHESIS: We studied for the first time the long-term effects of a combined physical activity and dietary intervention on insulin resistance and fasting plasma glucose in a general population of predominantly normal-weight children. METHODS: We carried out a 2 year non-randomised controlled trial in a population sample of 504 children aged 6-9 years at baseline. The children were allocated to a combined physical activity and dietary intervention group (306 children at baseline, 261 children at 2-year follow-up) or a control group (198 children, 177 children) without blinding. We measured fasting insulin and fasting glucose, calculated HOMA-IR, assessed physical activity and sedentary time by combined heart rate and body movement monitoring, assessed dietary factors by a 4 day food record, used the Finnish Children Healthy Eating Index (FCHEI) as a measure of overall diet quality, and measured body fat percentage (BF%) and lean body mass by dual-energy x-ray absorptiometry. The intervention effects on insulin, glucose and HOMA-IR were analysed using the intention-to-treat principle and linear mixed-effects models after adjustment for sex, age at baseline, and pubertal status at baseline and 2 year follow-up. The measures of physical activity, sedentary time, diet and body composition at baseline and 2 year follow-up were entered one-by-one as covariates into the models to study whether changes in these variables might partly explain the observed intervention effects. RESULTS: Compared with the control group, fasting insulin increased 4.65 pmol/l less (absolute change +8.96 vs +13.61 pmol/l) and HOMA-IR increased 0.18 units less (+0.31 vs +0.49 units) over 2 years in the combined physical activity and dietary intervention group. The intervention effects on fasting insulin (regression coefficient ß for intervention effect -0.33 [95% CI -0.62, -0.04], p = 0.026) and HOMA-IR (ß for intervention effect -0.084 [95% CI -0.156, -0.012], p = 0.023) were statistically significant after adjustment for sex, age at baseline, and pubertal status at baseline and 2 year follow-up. The intervention had no effect on fasting glucose, BF% or lean body mass. Changes in total physical activity energy expenditure, light physical activity, moderate-to-vigorous physical activity, total sedentary time, the reported consumption of high-fat (≥60%) vegetable oil-based spreads, and FCHEI, but not a change in BF% or lean body mass, partly explained the intervention effects on fasting insulin and HOMA-IR. CONCLUSIONS/INTERPRETATION: The combined physical activity and dietary intervention attenuated the increase in insulin resistance over 2 years in a general population of predominantly normal-weight children. This beneficial effect was partly mediated by changes in physical activity, sedentary time and diet but not changes in body composition. TRIAL REGISTRATION: ClinicalTrials.gov NCT01803776 Graphical abstract.

Consortium-based genome-wide meta-analysis for childhood dental caries traits.

Prior studies suggest dental caries traits in children and adolescents are partially heritable, but there has been no large-scale consortium genome-wide association study (GWAS) to date. We therefore performed GWAS for caries in participants aged 2.5-18.0 years from nine contributing centres. Phenotype definitions were created for the presence or absence of treated or untreated caries, stratified by primary and permanent dentition. All studies tested for association between caries and genotype dosage and the results were combined using fixed-effects meta-analysis. Analysis included up to 19 003 individuals (7530 affected) for primary teeth and 13 353 individuals (5875 affected) for permanent teeth. Evidence for association with caries status was observed at rs1594318-C for primary teeth [intronic within ALLC, odds ratio (OR) 0.85, effect allele frequency (EAF) 0.60, P 4.13e-8] and rs7738851-A (intronic within NEDD9, OR 1.28, EAF 0.85, P 1.63e-8) for permanent teeth. Consortium-wide estimated heritability of caries was low [h2 of 1% (95% CI: 0%: 7%) and 6% (95% CI 0%: 13%) for primary and permanent dentitions, respectively] compared with corresponding within-study estimates [h2 of 28% (95% CI: 9%: 48%) and 17% (95% CI: 2%: 31%)] or previously published estimates. This study was designed to identify common genetic variants with modest effects which are consistent across different populations. We found few single variants associated with caries status under these assumptions. Phenotypic heterogeneity between cohorts and limited statistical power will have contributed; these findings could also reflect complexity not captured by our study design, such as genetic effects which are conditional on environmental exposure.

Associations of dietary carbohydrate and fatty acid intakes with cognition among children.

OBJECTIVE: To investigate the cross-sectional associations of dietary carbohydrate and fatty acid intakes with cognition in mid-childhood. DESIGN: Dietary carbohydrate and fatty acid intakes were assessed using 4-d food records, and cognition was evaluated using the Raven's Coloured Progressive Matrices (RCPM) score. The cross-sectional associations of dietary carbohydrate and fatty acid intakes with cognition were investigated using linear regression analyses adjusted for age, sex, body fat percentage, household income, parental education and daily energy intake. SETTING: The baseline examinations of the Physical Activity and Nutrition in Children study. PARTICIPANTS: A population-based sample of 487 children (250 boys, 237 girls) aged 6-8 years living in the city of Kuopio, Finland. RESULTS: A higher dietary intake of fructose (standardised regression coefficient, ß = 0·24, P < 0·001), total fibre (ß = 0·16, P = 0·02) and soluble fibre (ß = 0·15, P = 0·02) was associated with a higher RCPM score in boys. Other dietary carbohydrates and fatty acids, including total carbohydrates, glucose, sucrose, starch, insoluble fibre, total fat, SFAs, MUFAs, PUFAs, palmitic acid (C16), stearic acid (C18), linoleic acid (C18:2), α-linoleic acid (C18:3), arachidonic acid (C20:4), EPA (C20:5n-3) and DHA (C22:6n-6), were not associated with the RCPM score in boys. Dietary carbohydrates or fatty acids were not associated with the RCPM score in girls. CONCLUSIONS: Higher dietary fructose and fibre intakes were associated with better cognition in boys, but not in girls. Dietary fatty acids were not related to cognition in boys or in girls.

Functional and structural asymmetry in primary motor cortex in Asperger syndrome: a navigated TMS and imaging study.

Motor functions are frequently impaired in Asperger syndrome (AS). In this study, we examined the motor cortex structure and function using navigated transcranial magnetic stimulation (nTMS) and voxel-based morphometry (VBM) and correlated the results with the box and block test (BBT) of manual dexterity and physical activity in eight boys with AS, aged 8-11 years, and their matched controls. With nTMS, we found less focused cortical representation areas of distinct hand muscles in AS. There was hemispheric asymmetry in the motor maps, silent period duration and active MEP latency in the AS group, but not in controls. Exploratory VBM analysis revealed less gray matter in the left postcentral gyrus, especially in the face area, and less white matter in the precentral area in AS as compared to controls. On the contrary, in the right leg area, subjects with AS displayed an increased density of gray matter. The structural findings of the left hemisphere correlated negatively with BBT score in controls, whereas the structure of the right hemisphere in the AS group correlated positively with motor function as assessed by BBT. These preliminary functional (neurophysiological and behavioral) findings are indicative of asymmetry, and co-existing structural alterations may reflect the motor impairments causing the deteriorations in manual dexterity and other motor functions commonly encountered in children with AS.

Associations of lifestyle factors with serum dehydroepiandrosterone sulphate and insulin-like growth factor-1 concentration in prepubertal children.

OBJECTIVE: Little is known about the relationships of dietary factors, physical activity and sedentary behaviour to dehydroepiandrosterone sulphate (DHEAS) and insulin-like growth factor-1 (IGF-1) concentrations among prepubertal children. Therefore, we studied the associations of these lifestyle factors with serum DHEAS and IGF-1 in children. DESIGN AND SUBJECTS: Cross-sectional analysis of a population sample of 431 prepubertal children aged 6-9 years. MEASUREMENTS: Assessment of dietary factors by food records and physical activity and sedentary behaviour by a combined heart rate and movement monitor and a questionnaire. Measurement of serum DHEAS and IGF-1. RESULTS: Consumption of low-fibre grain products (standardized regression coefficient ß = .118, P = .017) and intake of vegetable protein (ß = .100, P = .045) was positively and consumption of sugar-sweetened beverages (ß = -.117, P = .018) was inversely associated with DHEAS after adjustment for sex, age and body fat percentage. Energy intake (ß = .160, P = .001) was positively associated with IGF-1 adjusting for sex, age and body fat percentage. Vigorous physical activity was inversely associated with DHEAS after adjustment for sex and age (ß = -.120, P = .027), and total (ß = -.137, P = .007), moderate (ß = -.130, P = .012), vigorous (ß = -.136, P = .011) and moderate to vigorous physical activity (ß = -.160, P = .003) were inversely and total sedentary behaviour (ß = .151, P = .003) was positively associated with IGF-1 adjusting for sex and age. None of physical activity measures was associated with DHEAS or IGF-1 after additional adjustment for body fat percentage. CONCLUSIONS: Lifestyle factors have weak and moderate associations with biochemical markers of adrenarche in prepubertal children. These associations indicate body fat independent and dependent influences of diet and physical activity, respectively.

Birth weight is associated with dietary factors at the age of 6-8 years: the Physical Activity and Nutrition in Children (PANIC) study.

OBJECTIVE: Low and high birth weight have been associated with increased risk of type 2 diabetes and CVD. Diet could partly mediate this association, e.g. by intra-uterine programming of unhealthy food preferences. We examined the association of birth weight with diet in Finnish children. DESIGN: Birth weight standard deviation score (SDS) was calculated using national birth register data and Finnish references. Dietary factors were assessed using 4 d food records. Diet quality was defined by the Finnish Children Healthy Eating Index (FCHEI). SETTING: The Physical Activity and Nutrition in Children (PANIC) study. SUBJECTS: Singleton, full-term children (179 girls, 188 boys) aged 6-8 years. RESULTS: Birth weight was inversely associated (standardized regression coefficient ß; 95 % CI) with FCHEI (-0·15; -0·28, -0·03) in all children and in boys (-0·27; -0·45, -0·09) but not in girls (-0·01; -0·21, 0·18) after adjusting for potential confounders (P=0·044 for interaction). Moreover, higher birth weight was associated with lower fruit and berries consumption (-0·13; -0·25, 0·00), higher energy intake (0·17; 0·05, 0·29), higher sucrose intake (0·19; 0·06, 0·32) and lower fibre intake (-0·14; -0·26, -0·01). These associations were statistically non-significant after correction for multiple testing. Children with birth weight >1 SDS had higher sucrose intake (mean; 95 % CI) as a percentage of energy intake (14·3 E%; 12·6, 16·0 E%) than children with birth weight of -1 to 1 SDS (12·8 E%; 11·6, 14·0 E%) or <-1 SDS (12·4 E%; 10·8, 13·9 E%; P=0·036). CONCLUSIONS: Higher birth weight may be associated with unhealthy diet in childhood.

Health-related correlates of psychological well-being among girls and boys 6-8 years of age: The Physical Activity and Nutrition in Children study.

AIM: Due to limited knowledge on the differences in the correlates of psychological well-being (PSWB) between girls and boys, we compared the correlates of PSWB between primary school girls and boys. METHODS: A population sample of 412 children participated in the Physical Activity and Nutrition in Children study. Parents completed a questionnaire that included 19 questions on the components of PSWB, and a PSWB score was computed. We assessed correlates of PSWB, including physical activity, sedentary behaviour, cardiorespiratory fitness, diet quality, body fat content, sleep duration, sleep disordered breathing, prevalent diseases and parental characteristics. We used logistic regression to analyse the risk of being in the lowest third of the PSWB scores. RESULTS: Low parental education was associated with increased risk (odds ratio (OR) 2.34, P = 0.039) and high cardiorespiratory fitness with decreased risk (OR 0.26, P = 0.006) of poor PSWB in girls. At least 2 h of screen-based sedentary behaviour per day (OR 1.93, P = 0.037), daily parental smoking (OR 2.10, P = 0.034) and sleep disordered breathing (OR 4.24, P = 0.003) were related to increased risk of poor PSWB in boys. CONCLUSIONS: There are large differences in the correlates of PSWB between girls and boys. Most of these correlates are modifiable and related to the health behaviour of children and their parents.

Mediating effects of motor performance, cardiorespiratory fitness, physical activity, and sedentary behaviour on the associations of adiposity and other cardiometabolic risk factors with academic achievement in children.

We investigated the associations of cardiometabolic risk factors with academic achievement and whether motor performance, cardiorespiratory fitness, physical activity, or sedentary behaviour mediated these associations. Altogether 175 children 6-8 years-of-age participated in the study. We assessed body fat percentage (BF%), waist circumference, insulin, glucose, triglycerides, HDL cholesterol, and systolic and diastolic blood pressure, leptin, alanine aminotransferase, and gamma-glutamyltransferase (GGT). Reading fluency, reading comprehension, and arithmetic skills were assessed using standardized tests. Speed/agility, balance, and manual dexterity test results were used to calculate motor performance score and physical activity was assessed by combined heart rate and movement sensor and cardiorespiratory fitness by maximal cycle ergometer test. In boys, BF% was inversely associated with reading fluency (ß = -0.262, P = 0.007) and reading comprehension (ß = -0.216, P = 0.025). Motor performance mediated these associations. Leptin was inversely related to reading fluency (ß = -0.272, P = 0.006) and reading comprehension (ß = -0.287, P = 0.003). The inverse association of leptin with reading fluency was mediated by motor performance. In girls, GGT was inversely associated with reading fluency independent of confounders (ß = -0.325, P = 0.007). The inverse association of BF% with academic achievement among boys was largely explained by motor performance. Leptin in boys and GGT in girls were inversely associated with academic achievement independent of confounding factors.

Predictors of sleep disordered breathing in children: the PANIC study.

Objective: We studied longitudinally the associations of craniofacial morphology, mouth breathing, orthodontic treatment, and body fat content with the risk of having and developing sleep disordered breathing (SDB) in childhood. We hypothesized that deviant craniofacial morphology, mouth breathing, and adiposity predict SDB among children. Materials and methods: The participants were 412 children 6-8 years of age examined at baseline and 329 children aged 9-11 years re-examined at an average 2.2-year follow-up. An experienced orthodontist evaluated facial proportions, dental occlusion, soft tissue structures, and mode of breathing and registered malocclusions in orthodontic treatment. Body fat percentage was assessed by dual-energy X-ray absorptiometry and SDB symptoms by a questionnaire. Results: Children with SDB more likely had convex facial profile, increased lower facial height, mandibular retrusion, tonsillar hypertrophy, and mouth breathing at baseline and convex facial profile, mandibular retrusion, and mouth breathing at follow-up than children without SDB at these examinations. Male gender and body adiposity, mouth breathing, and distal molar occlusion at baseline were associated with SDB later in childhood. Adipose tissue under the chin, mandibular retrusion, vertically large or normal throat and malocclusion in orthodontic treatment at baseline predicted developing SDB during follow-up of among children without SDB at baseline. Limitations: We could not conduct polysomnographic examinations to define sleep disturbances. Instead, we used a questionnaire filled out by the parents to assess symptoms of SDB. Conclusions: The results indicate that among children, deviant craniofacial morphology, mouth breathing, body adiposity, and male gender seem to have implications in the pathophysiology of SDB.

Diet quality and academic achievement: a prospective study among primary school children.

PURPOSE: Poor diet quality may impair academic achievement in children, but such evidence is limited. Therefore, we investigated the associations of healthy diet in Grade 1 assessed by Mediterranean Diet Score (MDS), Baltic Sea Diet Score (BSDS), and Finnish Children Healthy Eating Index (FCHEI) with academic achievement in Grades 1-3 in children. METHODS: The participants were 161 Finnish children who were 6-8 years old in Grade 1 and attended in a large ongoing physical activity and dietary intervention study. Dietary factors were assessed using 4-day food records, and MDS, BSDS, and FCHEI were calculated. Academic achievement was assessed by reading fluency, reading comprehension, and arithmetic skill tests. The data were analyzed using linear regression analysis and analysis of covariance adjusted for age, sex, parental education, household income, body fat percentage, physical activity, the PANIC Study group, and total energy intake. RESULTS: MDS was positively associated with reading comprehension in Grade 3 (standardized regression coefficient ß = 0.167, P = 0.032). BSDS was positively associated with reading fluency in Grades 2-3 and reading comprehension in Grades 1-3 (ß = 0.161-0.274, P < 0.05). FCHEI was positively related to reading fluency in Grades 1-2 and reading comprehension in Grades 1-3 (ß = 0.190-0.344, P < 0.05). Children in the highest third of BSDS and FCHEI had better reading fluency and reading comprehension in Grades 1-3 than children in the lowest third (P < 0.05). None of the diet scores was associated with arithmetic skills. CONCLUSIONS: Healthier diet assessed by BSDS or FCHEI in Grade 1 was associated with better reading skills, but not with arithmetic skills, among children in Grades 1-3. Long-term intervention studies are needed to investigate the effects of improvements in diet quality on academic achievement among children. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01803776.

Determinants for craniofacial pains in children 6-8 years of age: the PANIC study.

OBJECTIVE: Determinants for orofacial pain, headache, morning headache and painful signs of temporomandibular disorders (TMD) were investigated in prepubertal children. MATERIAL AND METHODS: The participants were a population sample of 439 children aged 6-8 years. Craniofacial pains, eating meals and snacks, sleep bruxism, sleep quality, sleep-disordered breathing (SDB), psychological well-being, parental education and household income were assessed by questionnaires filled out by the parents. Sleep duration was assessed using a combined heart rate and movement sensor and clinical signs of TMD and dental occlusion by a dentist. The determinants of pain conditions were analyzed using logistic regression. RESULTS: Of all 439 children, 26% had experienced orofacial pain and 31% headache during the past 3 months, 17% had suffered morning headache weekly and 13% had painful signs of TMD in a clinical examination. Restless sleep was associated with increased risk of orofacial pain, the painful signs of TMD and restless sleep with increased risk of headache and restless sleep, sleep bruxism and skipping meals with increased risk of morning headache after adjustment for other independent determinants of these pain conditions. Headache was associated with increased risk for painful signs of TMD. CONCLUSIONS: Craniofacial pains are common among prepubertal children. Prepubertal children with sleep bruxism, restless sleep and skipping meals have increased likelihood of craniofacial pains.

Association of MBOAT7 gene variant with plasma ALT levels in children: the PANIC study.

BACKGROUND: We studied for the first time among children differences in plasma alanine aminotransferase (ALT) among genotypes of the rs641738 polymorphism in the MBOAT7 gene that has been associated with increased risk of nonalcoholic fatty liver disease among adults. We also investigated the associations of a genetic risk score combining information from the MBOAT7, PNPLA3, and TM6SF2 polymorphisms with plasma ALT. METHODS: We performed a 2-y follow-up study in 467 Caucasian children aged 6-9 y, genotyped the MBOAT7, PNPLA3, and TM6SF2 polymorphisms, calculated a genetic risk score from these polymorphisms (scored 0-3) and assessed plasma ALT. RESULTS: Children carrying the T allele of the MBOAT7 polymorphism had 7% higher plasma ALT at baseline (17.8 vs. 19.1 U/l, P = 0.022) and 10% higher plasma ALT at 2-y follow-up (18.0 vs. 19.7 U/l, P = 0.022) than the noncarriers. A higher genetic risk score was associated with higher plasma ALT at baseline (17.5, 18.5, 19.2, and 22.8 U/l, P = 0.008 for linear trend) and 2-y follow-up (18.2, 18.9, 18.9, and 32.8 U/l, P = 0.017 for linear trend). CONCLUSION: Children carrying the T allele of the MBOAT7 polymorphism had higher plasma ALT than the noncarriers. Children with the MBOAT7, PNPLA3, and TM6SF2 variants had the highest plasma ALT.

The effects of a 2-year individualized and family-based lifestyle intervention on physical activity, sedentary behavior and diet in children.

OBJECTIVE: To investigate the effects of a long-term, individualized and family-based lifestyle intervention on physical activity, sedentary behavior and diet quality in children. METHODS: We carried out a 2-year intervention study in a population sample of 506 children aged 6-8years in Finland in 2007-2012. We allocated the participants at baseline in the intervention and control group. We assessed physical activity and sedentary behavior by questionnaires and diet by food records. RESULTS: Total physical activity (+9min/d in intervention group vs. -5min/d in control group, p=0.001 for time*group interaction), unsupervised physical activity (+7min/d vs. -9min/d, p<0.001) and organized sports (+8min/d vs. +3min/d, p=0.001) increased in the intervention group but not in the control group. Using computer and playing video games increased less in the intervention group than in the control group (+9min/d vs. +19min/d, p=0.003). Consumption of vegetables (+12g/d vs. -12g/d, p=0.001), high-fat vegetable-oil based margarine (+10g/d vs. +3g/d, p<0.001) and low-fat milk (+69g/d vs. +11g/d, p=0.042) and intake of dietary fiber (+1.3g/d vs. +0.2g/d, p=0.023), vitamin C (+4.5mg/d vs. -7.2mg/d, p=0.042) and vitamin E (+1.4mg/d vs. +0.5mg/d, p=0.002) increased in the intervention group but not in the control group. Consumption of butter-based spreads increased in the control group but not in the intervention group (+2g/d vs. -1g/d, p=0.002). CONCLUSIONS: Individualized and family-based lifestyle intervention increased physical activity, attenuated increase in sedentary behavior and enhanced diet quality in children. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01803776.