Associations Between Meeting the 24-Hour Movement Guidelines and Cardiometabolic Risk in Young Children.

INTRODUCTION: The authors aimed to examine the association between meeting the integrative movement behavior guidelines (physical activity, screen viewing, and sleep) and cardiometabolic risk (CMR) factors in young children. METHODS: In this cross-sectional study, physical activity, screen viewing, and sleep were assessed using parent-reported data. The 24-Hour Movement Guidelines for the Early Years (0-4 y) were defined as 180 minutes of physical activity/day (of which ≥60 min should be moderate-to-vigorous intensity), ≤1 hour of screen viewing/day, and 10 to 13 hours of sleep/night. Waist circumference, glucose, high-density lipoprotein cholesterol, triglycerides, and systolic blood pressure were measured in a clinical setting by trained staff. A total CMR score and individual CMR factors served as primary and secondary outcomes, respectively. RESULTS: Of the 767 participants (3-4 y), 26.4% met none of the guideline's recommendations, whereas 41.3%, 33.1%, and 10.6% of the sample met 1, 2, or all 3 recommendations, respectively. The number of recommendations met was not associated with the total CMR score or individual CMR factors (P > .05), with the exceptions of high-density lipoprotein (odds ratio = 1.61; 95% confidence interval, 1.11 to 2.33; P = .01). CONCLUSION: Meeting the 24-Hour Movement Guidelines in early childhood was not associated with overall CMR, but was associated with favorable cholesterol outcomes.

The Association of Breastfeeding Duration and Early Childhood Cardiometabolic Risk.

OBJECTIVE: To evaluate the association between breastfeeding duration and early childhood cardiometabolic risk. STUDY DESIGN: A cross-sectional study of 1539 healthy children, 3-6 years of age, recruited through The Applied Research Group for Kids! practice-based research network between October 2009 and August 2015. Adjusted multivariable linear regression was used to examine the association between breastfeeding duration and cardiometabolic risk z score and individual cardiometabolic risk factors of waist circumference, systolic blood pressure, glucose, high-density lipoprotein cholesterol, and triglycerides. RESULTS: The mean breastfeeding duration was 12.5 months (SD = 8.4). Breastfeeding duration was associated with lower cardiometabolic risk z score (beta = -0.03; 95% CI -0.05, -0.01). In analysis of cardiometabolic risk factors, each additional 3 months of breastfeeding was associated with a 0.13 cm (95% CI -0.20, -0.05) lower waist circumference and 0.16 mm Hg (95% CI -0.30, -0.02) lower systolic blood pressure. Compared with children who breastfed for 6-12 months, those who breastfed for 12-24 months had a lower systolic blood pressure of 1.07 mm Hg (95% CI -2.04, -0.10). There was no association between breastfeeding duration and cardiometabolic risk for those who breastfed beyond 24 months. CONCLUSIONS: Breastfeeding duration is associated with lower cardiometabolic risk, although the magnitude of association is small. Causation cannot be inferred. Breastfeeding beyond 24 months may not have an added benefit for cardiometabolic health.

The Digital Media Environment and Cardiovascular Risk in Children.

Children today are exposed to multiple forms of digital media including traditional (eg, televisions, computers) and newer mobile devices (eg, smartphones, tablets, etc). As the digital media environment evolves, it is important that health care providers and policymakers adapt to develop, implement, and evaluate strategies to ameliorate its effects on health. In this article we provide an overview of the literature on the relationship between the digital media environment and cardiovascular risk factors in childhood. Existing evidence on the relationship between digital media environment and cardiovascular risk in infants, children, and youth are reported. Potential mechanisms underpinning the relationship between the digital media environment and cardiovascular disease risk in children such as the displacement of movement behaviours, food and beverage marketing to children, and eating while viewing were explored. National and international guidelines aimed at addressing the digital media environment are highlighted, and suggestions for future research and guideline development are provided. Action-oriented professional recommendations for health care providers, families, and children are urgently needed. As the prevalence of screen use in childhood continues to exceed those of past generations, concern about the effects and strategies to reduce harm including cardiovascular outcomes must remain a top public health priority.

Association of Physical Activity and Cardiometabolic Risk in Children 3-12 Years.

BACKGROUND: This study aimed to examine the association between physical activity (PA) and a total cardio metabolic risk (CMR) score in children aged 3-12 years. Secondary objectives were to examine the association between PA and individual CMR factors. METHODS: A longitudinal study with repeated measures was conducted with participants from a large primary care practice-based research network in Toronto, Canada. Mixed effects models were used to examine the relationship between parent-reported physical activity and outcome variables (total CMR score, triglycerides, glucose, high-density lipoprotein cholesterol, systolic blood pressure, waist circumference, weight-to-height ratio, and non-high-density lipoprotein cholesterol). RESULTS: Data from 1885 children (6.06 y, 54.4% male) with multiple visits (n = 2670) were included in the analyses. For every unit increase of 60 minutes of PA, there was no evidence of an association with total CMR score (adjusted: -0.02 [-0.014 to 0.004], P = .11]. For the individual CMR components, there was evidence of a weak association between PA and systolic blood pressure (-0.01 [-0.03 to -0.01], P < .001) and waist-to-height ratio (-0.81 [-1.62 to -0.003], P < .001). CONCLUSION: Parent-reported PA among children aged 3-12 years was not statistically associated with total CMR, but was weakly associated with systolic blood pressure and waist-to-height ratio.

Xylitol for the prevention of acute otitis media episodes in children aged 2-4 years: protocol for a pragmatic randomised controlled trial.

INTRODUCTION: Xylitol (or 'birch sugar') is a naturally occurring sugar with antibacterial properties that has been used as a natural non-sugar sweetener in chewing gums, confectionery, toothpaste and medicines. In this preventative randomised trial, xylitol will be tested for the prevention of acute otitis media (AOM), a common and costly condition in young children. The primary outcome will be the incidence of AOM. Secondary outcomes will include upper respiratory tract infections (URTIs) and dental caries. METHODS AND ANALYSIS: This study will be a pragmatic, blinded (participant and parents, practitioners and analyst), two-armed superiority, placebo-controlled randomised trial with 1:1 allocation, stratified by clinical site. The trial will be conducted in the 11 primary care group practices participating in the TARGet Kids! research network in Canada. Eligible participants between the ages of 2-4 years will be randomly assigned to the intervention arm of regular xylitol syrup use or the control arm of regular sorbitol use for 6 months. We expect to recruit 236 participants, per treatment arm, to detect a 20% relative risk reduction in AOM episodes. AOM will be identified through chart review. The secondary outcomes of URTIs and dental caries will be identified through monthly phone calls with specified questions. ETHICS AND DISSEMINATION: Ethics approval from the Research Ethics Boards at the Hospital for Sick Children and St. Michael's Hospital has been obtained for this study and also for the TARGet Kids! research network. Results will be submitted for publication to a peer-reviewed journal and will be discussed with decision makers. TRIAL REGISTRATION NUMBER: NCT03055091; Pre-results.