The importance of maternal insulin resistance throughout pregnancy on neonatal adiposity.

BACKGROUND: Although previous studies evaluated the association of maternal health parameters with neonatal adiposity, little is known regarding the complexity of the relationships among different maternal health parameters throughout pregnancy and its impact on neonatal adiposity. OBJECTIVES: To evaluate the direct and indirect associations between maternal insulin resistance during pregnancy, in women with obesity, and neonatal adiposity. In addition, associations between maternal fasting glucose, triglycerides (TG), non-esterified fatty acids (NEFA), and neonatal adiposity were also assessed. METHODS: This is a longitudinal, secondary analysis of the DALI study, an international project conducted in nine European countries with pregnant women with obesity. Maternal insulin resistance (HOMA-IR), fasting glucose, TG, and NEFA were measured three times during pregnancy (<20, 24-28, and 35-37 weeks of gestation). Offspring neonatal adiposity was estimated by the sum of four skinfolds. Structural equation modelling was conducted to evaluate the direct and indirect relationships among the variables of interest. RESULTS: Data on 657 mother-infant pairs (50.7% boys) were analysed. Neonatal boys exhibited lower mean sum of skinfolds compared to girls (20.3 mm, 95% CI 19.7, 21.0 vs 21.5 mm, 95% CI 20.8, 22.2). In boys, maternal HOMA-IR at <20 weeks was directly associated with neonatal adiposity (ß = 0.35 mm, 95% CI 0.01, 0.70). In girls, maternal HOMA-IR at 24-28 weeks was only indirectly associated with neonatal adiposity, which implies that this association was mediated via maternal HOMA-IR, glucose, triglycerides, and NEFA during pregnancy (ß = 0.26 mm, 95% CI 0.08, 0.44). CONCLUSIONS: The timing of the role of maternal insulin resistance on neonatal adiposity depends on fetal sex. Although the association was time-dependent, maternal insulin resistance was associated with neonatal adiposity in both sexes.

The importance of body weight status on motor competence development: From preschool to middle childhood.

We evaluated the association between weight status and motor competence from preschool age (3-5 years of age) until middle childhood (7-9 years of age). Longitudinal study with three to five-year-old preschool children (n = 1155) enrolled in public and private preschools in Recife, Brazil. Children were followed twice (2010, 2012, and 2014) for four years. Köperkoordinationstest für kinder (KTK) assessed the children's motor competence (KTK Motor Quotient). Weight status (underweight, normal weight, overweight, and obesity) was classified according to the children's sex and age. Preschool children with normal weight exhibited higher motor competence at 5-7 years of age compared to preschool children with overweight (+3.73 MQ, P = .03) and obesity (+5.09 MQ, P < .01). Preschool children with normal weight presented higher motor competence at 7-9 years of age compared to their peers with overweight (+6.00 MQ, P = .03) and obesity (+5.88 MQ, P = .01). Children with normal weight at 5-7 years of age presented higher motor competence at 7-9 years of age compared to their peers with overweight (+3.33 MQ, P = .02) and obesity (+4.00 MQ, P = .02). Independent of the childhood phase and extension of the period evaluated (2- or 4-year period), children who had excessive weight (overweight or obesity) and changed their weight status to underweight or normal weight presented similar motor competence compared to children who continued underweight or normal weight. Weight status already at preschool age is an important predictor of the children's motor competence until middle childhood. Interventions improving the children's weight status, already at preschool age, might impact their motor competence development positively.

Exploring the importance of diversified physical activities in early childhood for later motor competence and physical activity level: a seven-year longitudinal study.

BACKGROUND: Research indicates that childhood motor competence (MC) can predict physical activity (PA) levels later in life and it has been argued that frequently engaging in a wide diversity of physical activities will eventually improve children's MC. However, no longitudinal or experimental studies have confirmed this theoretical rationale. The aims of this study are to explore the longitudinal associations between diversified physical activities at age six and later MC and PA (time spent in moderate-to-vigorous PA) (age nine and 13). Furthermore, we explore to what extent the longitudinal association between diversified physical activity and PA is mediated by MC. METHODS: Longitudinal data from the Copenhagen School Intervention Study were used for this analysis, where 704 participated (69% response rate). Diversified physical activity (self-reported), MC (The Körperkoordinationstest für Kinder battery of postural stability and locomotor skills) and PA (accelerometer) were assessed in the children at age six, age nine and age 13. A total of 654 participated in at least two of the measures and, therefore, were included in the analysis. Two structural equation models were constructed, with diversified physical activity at age six and MC and PA at age nine as predictors of PA and MC at age 13. RESULTS: The data from both models demonstrated good model fit. Diversified physical activity at 6 years of age was significantly associated with physical activity and MC at age 13, when adjusting for sex, age, intervention, weight, height, and previous levels of PA and MC. Diversified physical activity at age six was also positively associated with PA and MC at age nine, which were, in turn, positively related to PA at age 13 but to a lesser degree than diversified PA at age six. The association between diversified physical activity at age six and PA at age 13 was not mediated by MC at age nine. CONCLUSIONS: The results of this study indicate that diversified physical activity at age six is important for the development of MC and PA in adolescence. Increasing the diversity of children's daily physical activities, not only the amount and intensity, seems important for future PA behavior and thereby health promotion in a life course perspective.

Metabolic risk associated with liver enzymes, uric acid, and hemoglobin in adolescents.

BACKGROUND: The associations of renal, hepatic, and hematologic markers with metabolic risk (MR) have already been shown in adolescents. However, it is still controversial which marker best predicts metabolic changes in youth. The aim of this study was to verify the association of MR with alanine aminotransferase (ALT), aspartate aminotransferase (AST), uric acid, and hemoglobin (Hb) in adolescents. METHODS: We evaluated 1713 Brazilian adolescents aged 10 to 17 years. MR was calculated using a continuous metabolic risk score, including the sum of Z-scores of waist circumference, systolic blood pressure, fasting glucose, high-density lipoproteins, triglycerides, and cardiorespiratory fitness. Cutoff points were set for MR prediction for five metabolic components (ALT, AST, AST/ALT ratio, uric acid, and Hb). RESULTS: MR was strongly associated with increased uric acid (odds ratio [OR]: 2.50; 95% confidence interval [CI]: 1.74-3.59), ALT (OR: 2.64; 95% CI: 1.63-4.27), and AST levels (OR: 2.53; 95% CI: 1.24-5.18). Uric acid was shown to be the best predictor for MR (sensitivity: 55.79%; specificity: 61.35%; area under the curve: 0.616). CONCLUSION: Elevated hepatic, renal, and hematological markers were associated with MR in adolescents, especially ALT, AST, and uric acid levels. IMPACT: Elevated hepatic, renal, and hematological markers were associated with metabolic risk in adolescents, especially ALT, AST, and uric acid levels. It is still controversial which marker best predicts metabolic changes in adolescents. In addition, association of Hb with metabolic risk is under-studied in this population. It is important to further investigate the relationship between elevated Hb and hepatic markers, since there are key aspects not addressed yet. Our results highlight the importance of creating public health policies aimed to child and adolescent population, to prevention of metabolic disorders from an early age.

Physical Activity Participation Decreases the Risk of Depression in Older Adults: The ATHLOS Population-Based Cohort Study.

BACKGROUND: To which extent physical activity is associated with depression independent of older adults' physical and cognitive functioning is largely unknown. This cohort study using harmonised data by the EU Ageing Trajectories of Health: Longitudinal Opportunities and Synergies consortium, including over 20 countries, to evaluate the longitudinal association of physical activity (light-to-moderate or vigorous intensity) with depression in older adults (aged ≥ 50 years). RESULTS: We evaluated 56,818 participants (light-to-moderate models; 52.7% females, age 50-102 years) and 62,656 participants (vigorous models; 52.7% females, age 50-105 years). Compared to never, light-to-moderate or vigorous physical activity was associated with a lower incidence rate ratio (IRR) of depression (light-to-moderate model: once/week: 0.632, 95% CI 0.602-0.663; twice or more/week: 0.488, 95% CI 0.468-0.510; vigorous model: once/week: 0.652, 95% CI 0.623-0.683; twice or more/week: 0.591, 95% CI 0.566-0.616). Physical activity remained associated with depression after adjustment for the healthy ageing scale, which is a scale that incorporated 41 items of physical and cognitive functioning (light-to-moderate model: once/week: 0.787, 95% CI 0.752-0.824; twice or more/week: 0.711, 95% CI 0.682-0.742; vigorous model: once/week: 0.828, 95% CI 0.792-0.866; twice or more/week: 0.820, 95% CI 0.786-0.856). CONCLUSIONS: Physical activity, of any intensity and weekly frequency, was a strong protective factor against depression, independent of physical and mental functioning. Health policies could stimulate the incorporation of lower physical activity intensity to protect against depression, which might be more feasible at the population level.

Investigation of the retinal biocompatibility of acid violet for chromovitrectomy.

PURPOSE: The primary objective was to investigate the retinal biocompatibility of acid violet (AV) as a vital dye for chromovitrectomy. The secondary objective was to evaluate the capacity of AV to stain the anterior capsule of the lens. METHODS: An amount of 0.05 ml of 0.25 g/l and 0.5 g/l AV was injected intravitreally in the OD, while balanced salt solution (BSS) was applied in the OS for control. Clinical examination and histology with light microscopy (LM) were performed after 7 days. Retinal cell layers were evaluated for morphologic alterations and number of cells. The electroretinographic (ERG) changes were assessed at baseline and 7 days. In another part of the study, 0.1 ml of 0.25 g/l AV was injected into the anterior chamber of ex-vivo porcine eyes, and its capacity to stain the anterior capsule was determined. Cadaveric eyes were used to test the capacity of AV to stain the internal limitant membrane (ILM) during vitrectomy. RESULTS: The gross histopathologic appearance of the retina, choroids, sclera, and optic nerve was within normal limits, without any signs of severe retinal necrosis or cystic degeneration. AV caused no substantial retinal alterations in retinal layers by LM at either the lower or higher dose when compared with the control eye. The injection of AV did not induce considerable ERG alterations. The violet dye stained the anterior capsule after anterior chamber injection and the ILM, allowing a safer capsulorrhexis and vitrectomy. CONCLUSION: Acid violet may be safe for the retina at concentrations of 0.25 and 0.50 g/l after intravitreous injection, and may be used as a vital dye for staining the anterior capsule and the ILM.

Tracking of cardiometabolic risk in a Brazilian schoolchildren cohort: a 3-year longitudinal study.

BACKGROUND: Clustering of cardiometabolic risk factors is a sign of detrimental health. Tracking is a term used to describe a variable longitudinal stability across time. High tracking provides the chance to determine which cardiometabolic risk factors should be the target of early treatment and prevention efforts. The present study aims to analyze the tracking of cardiometabolic risk factors and clustered cardiometabolic risk score in children across a 3-year time span, and to verify the odds of staying at risk (measured by the clustered score) from baseline to follow-up. METHODS: Longitudinal study that included 354 (155 boys) children, aged 7-12 years at baseline. A clustered score was calculated by summing the systolic blood pressure, waist circumference, triglycerides, glucose, and the TC/HDL-C ratio Z-scores divided by five. A second clustered score was calculated including cardiorespiratory fitness (CRF). RESULTS: CRF and anthropometric parameters presented high tracking (r≥0.662), whereas the cardiometabolic parameters exhibited low-to-moderate tracking (0.100≤r≤0.571). The clustered scores' tracking was moderate (r≥0.508; r≥0.588 [CRF]). Participants in the higher risk groups at baseline presented 3.81 (95% CI: 2.40; 6.05) and 4.64 (95% CI: 2.85; 7.56), including CRF, times higher chance of remaining at risk three years later. Moreover, participants in the worst profile regarding CRF or anthropometrics at baseline presented at least 4.00 times higher chance of being at risk three years later. CONCLUSIONS: Participants with worst CRF and adiposity had an increased risk of presenting higher clustered risk after three years.

Dynamic Balance, but Not Precision Throw, Is Positively Associated with Academic Performance in Children.

We analyzed the longitudinal association between dynamic balance and throwing skill with academic performance and whether waist circumference mediated these relationships. The current one-year longitudinal study followed 1020 first (mean age 7.87 ± 0.34 years) through fifth grade (mean age 11.87 ± 0.37 years) children, measured twice in 2010 and 2011. Dynamic balance and precision throw were measures of motor competence. Waist circumference was measured with a measuring tape at the umbilicus level. Academic performance was assessed by a combined score of standardized Danish language and math tests. Structural equation modeling was used for analysis. All coefficients are standardized. Balance was associated with academic performance when both sexes were combined (ß = 0.126, 95% CI: 0.074 to 0.179), and waist circumference partially mediated the relationship (ß = 0.021, 95% CI: 0.008 to 0.034). For boys, balance was associated with academic performance, but waist circumference did not mediate the association. For girls, balance presented direct, mediated (via waist circumference), and total associations with academic performance. Dynamic balance is an important gross motor function that was longitudinally related to academic performance, and waist circumference partially mediated the relationship. Precision throw was not found to be associated with academic performance in both sexes combined or when analyzed separately.

Secular trends in suicidal ideation and associated factors among adolescents.

OBJECTIVES: Suicide is one of the leading causes of death in adolescence, and the second most common cause of death among young people. The objective of this study was to identify trends in suicidal ideation by sex and ascertain factors associated with this outcome. METHODS: Secular trend study with statewide coverage conducted at 5-year intervals, with 4,207 adolescents (2006), 6,264 adolescents (2011) and 6,026 adolescents (2016). Logistic regression was used to evaluate the secular trend of suicidal ideation. Multilevel logistic regressions evaluated the factors associated with suicidal ideation in the survey conducted in 2016. RESULTS: There was a positive trend in suicidal ideation prevalence in 2016 compared to the prevalence in 2006 and 2011, in both boys and girls. Low social support, poor sleep quality, and low parental supervision were associated with suicidal ideation in boys and girls. Exposure to violence and bullying was associated with suicidal ideation only in girls. TV time and computer and videogame time were not associated with suicidal ideation in boys or girls. CONCLUSION: There is an alarming trend of increased suicidal ideation in adolescents. Several dimensions were associated with suicidal ideation in adolescents, especially social support, sleep quality, and parental supervision.

Temporal relationships between maternal metabolic parameters with neonatal adiposity in women with obesity differ by neonatal sex: Secondary analysis of the DALI study.

OBJECTIVES: To investigate the importance of time in pregnancy and neonatal sex on the association between maternal metabolic parameters and neonatal sum of skinfolds. METHODS: This was a longitudinal, secondary analysis of the vitamin D and lifestyle intervention for gestational diabetes mellitus study, conducted in nine European countries during 2012 to 2015. Pregnant women with a pre-pregnancy body mass index (BMI) of ≥29 kg/m2 were invited to participate. We measured 14 maternal metabolic parameters at three times during pregnancy: <20 weeks, 24 to 28 weeks, and 35 to 37 weeks of gestation. The sum of four skinfolds assessed within 2 days after birth was the measure of neonatal adiposity. RESULTS: In total, 458 mother-infant pairs (50.2% female infants) were included. Insulin resistance (fasting insulin and HOMA-index of insulin resistance) in early pregnancy was an important predictor for boys' sum of skinfolds, in addition to fasting glucose and maternal adiposity (leptin, BMI and neck circumference) throughout pregnancy. In girls, maternal lipids (triglycerides and fatty acids) in the first half of pregnancy were important predictors of sum of skinfolds, as well as fasting glucose in the second half of pregnancy. CONCLUSIONS: Associations between maternal metabolic parameters and neonatal adiposity vary between different periods during pregnancy. This time-dependency is different between sexes, suggesting different growth strategies.

Development of dental anxiety in schoolchildren: A 2-year prospective study.

AIM: To assess the development of high dental anxiety and the factors that are associated with it over a 2-year period. DESIGN: This longitudinal study focused on 416 Brazilian children aged 5-7 years over 2 years. Interviews were conducted with the children's parents to investigate the children's health-related behaviours. Additionally, the children's dental caries experience was clinically evaluated to obtain information about DMFT/dmft (decayed, filled and missing teeth) indices. Using the Dental Anxiety Question, children whose parents responded "yes" to the prompt "Is he/she very afraid of going to the dentist?" were classified as having high dental anxiety. Multilevel mixed-effects logistic regression was used to analyse factors to determine the extent to which they were associated with high dental anxiety longitudinally. RESULTS: The prevalence of high dental anxiety in children at baseline was 16.2%, whereas it was 19.8% at follow-up. Additionally, 38% of the children with high dental anxiety at baseline still had the condition after two years, although 62% of them no longer had high dental anxiety. The incidence of high dental anxiety at 2-year follow-up was 15.0%. Children who used medication chronically had a 2.1 times greater likelihood of having high dental anxiety. Furthermore, children whose parents reported high dental anxiety had a 2.6 times greater likelihood of having high dental anxiety themselves. A one-unit increase in a child's dmft score increased the risk of high dental anxiety by 1.1 times at follow-up. CONCLUSION: After two years, the incidence of high dental anxiety was 15.0%. Poor oral health, unstable general health and parents with high dental anxiety were factors that were associated with this type of anxiety in schoolchildren. It is important that dentists are aware of children's high dental anxiety and the associated factors so that they can appropriately intervene. Dentists fulfil an important role and should stimulate and promote good general hygiene habits that may prevent future problems.

Physical Activity and Motor Competence Present a Positive Reciprocal Longitudinal Relationship Across Childhood and Early Adolescence.

BACKGROUND: The current study evaluated the reciprocal longitudinal relationship between physical activity (PA) and motor competence (MC) and the potential mediation of cardiorespiratory endurance across 7 years. METHODS: This was a 7-year longitudinal study, the Copenhagen School Child Intervention Study (CoSCIS), with 3 measuring points [mean ages (in years) and respective sample size: 6.75 ± 0.37, n = 696; 9.59 ± 1.07, n = 617; 13.35 ± 0.34, n = 513]. PA was assessed using accelerometers. MC was evaluated by the Körperkoordinationstest für Kinder (KTK) test battery. Cardiorespiratory fitness (VO2peak) was evaluated using a continuous running protocol until exhaustion. Structural equation modeling was performed to evaluate the longitudinal associations. RESULTS: Vigorous PA (VPA) and MC presented reciprocal longitudinal association during the 7-year follow-up (VPA → MC; ß = 0.18; 95% CI: 0.10, 0.26; MC → VPA; ß = 0.14; 95% CI: 0.08, 0.21). In addition, VO2peak mediated the relationship in both directions (VPA → MC; ß = 0.09; 95% CI: 0.06, 0.12; MC → VPA; ß = 0.06; 95% CI: 0.03, 0.09). CONCLUSIONS: PA and MC presented a positive reciprocal relationship across childhood through early adolescence and VO2peak mediated the association in both directions. Interventions targeting to increase PA in children and adolescents should also address the development of MC skills because of the clear positive feedback loop between PA and MC.

Secular trends in suicidal ideation and associated factors among adolescents

Objectives: Suicide is one of the leading causes of death in adolescence, and the second most common cause of death among young people. The objective of this study was to identify trends in suicidal ideation by sex and ascertain factors associated with this outcome. Methods: Secular trend study with statewide coverage conducted at 5-year intervals, with 4,207 adolescents (2006), 6,264 adolescents (2011) and 6,026 adolescents (2016). Logistic regression was used to evaluate the secular trend of suicidal ideation. Multilevel logistic regressions evaluated the factors associated with suicidal ideation in the survey conducted in 2016. Results: There was a positive trend in suicidal ideation prevalence in 2016 compared to the prevalence in 2006 and 2011, in both boys and girls. Low social support, poor sleep quality, and low parental supervision were associated with suicidal ideation in boys and girls. Exposure to violence and bullying was associated with suicidal ideation only in girls. TV time and computer and videogame time were not associated with suicidal ideation in boys or girls. Conclusion: There is an alarming trend of increased suicidal ideation in adolescents. Several dimensions were associated with suicidal ideation in adolescents, especially social support, sleep quality, and parental supervision.

Investigation of new dyes for chromovitrectomy: preclinical biocompatibility of trisodium, orangell and methyl violet.

PURPOSE: To investigate the retinal toxicity by electroretinography (ERG), clinical examination and histology after intravitreal injection of biological stains in two concentrations: Trisodium (0.50 g/L and 1.00 g/L), Orangell (0.25 g/L and 1.00 g/L) and Methyl Violet (0.50 g/L and 1.00 g/L). METHODS: Eighteen New-Zealand albinos rabbits were assigned in six groups (n = 3 in each group). The animals in group 1 received Trisodium in the dose of 0.50 g/L and group 2 received 1.00 g/L; Group 3 received Orangell in the dose of 0.25 g/L and group 4 received 1.00 g/L; Group 5 received Methyl Violet in the dose of 1.00 g/L and group 6 received 0.50 g/L. A volume of 0.05 mL of dye was injected in the right eyes, whereas the left eyes received the same volume of balanced salt solution (BSS) as control. ERG recordings and clinical examination were performed at baseline and seven days after intravitreal injection. The ERG responses at one week after injection were compared with baseline levels. A decrease in the post-injection amplitude of more than 50% was considered remarkable. After the 7-day follow-up, rabbits were euthanized and eye enucleated for light microscopy (LM) histological evaluation. RESULTS: At clinical examination by indirect ophthalmoscopy seven days after dye injection, all eyes were negative for cataract, hemorrhage, retinal detachment, and intraocular opacities. Amplitude analysis of maximum scotopic b-wave showed no significant reduction in either dye injected or control eyes. Neither dye nor BSS caused significant retinal alteration on LM at doses tested. CONCLUSIONS: Trisodium, Orangell and Methyl Violet can be applied in future studies in order to prove the capacity to stain preretinal tissues and vitreous without toxicity. The three dyes did not induce significant ERG amplitude reduction or LM alterations in this preliminary experimental research. Trisodium, Orangell and Methyl Violet may be potentially useful vital dyes for ocular surgery, and deserve further investigation.

Retinal biocompatibility of brilliant blue g with deuterated water for chromovitrectomy.

PURPOSE: To investigate the retinal biocompatibility of Brilliant Blue G with deuterated water (BBG-D2O) as a vital dye for chromovitrectomy. METHODS: In this animal study, 0.05 mL of 0.25 g/L Brilliant Blue G (BBG) associated with 0.13 mL/mL of deuterium oxide (D2O) was injected intravitreally in the right eye and the same amount of balanced salt solution (BSS) was injected similarly in the left eye of rabbits. Clinical examination and histology with light microscopy were performed after seven days. Retinal cell layers were evaluated for morphologic alterations. Electroretinographic (ERG) changes were also assessed at baseline and 7 days after the injections. RESULTS: A total of 6 rabbits were included in the study. The gross histopathologic appearance of the retina, choroid, sclera and optic nerve was within normal limits without any sign of severe retinal necrosis or cystic degeneration. Light microscopy showed that BBG-D2O caused no substantial alterations in retinal layers as compared to control eyes. The injection of BBG-D2O did not induce considerable functional ERG alterations. CONCLUSION: Intravitreal injection of BBG-D2O 0.25 g/L seems to induce no retinal toxicity as documented by lack of functional and histological changes.