Low cardiorespiratory fitness is a strong predictor for clustering of cardiovascular disease risk factors in children independent of country, age and sex.

BACKGROUND AND DESIGN: Few studies have investigated the association between maximal cardiorespiratory capacity (fitness) and the clustered cardiovascular disease (CVD) risk in children and youth from culturally diverse countries. This cross-sectional study examined the association between fitness and clustered CVD risk in children and adolescents from three European countries. METHODS: Participants were 2845 randomly selected school children aged 9 or 15 years from Portugal (n=944), Denmark (n=849) and Estonia (n=1052). Cardiorespiratory fitness was determined during a maximal test on a cycle ergometer. CVD risk factors selected to assess the degree of clustering were the total cholesterol/high-density lipoprotein cholesterol ratio, plasma triglycerides, insulin resistance (homeostasis model assessment), sum of four skinfolds, and systolic blood pressure. RESULTS: There was a strong association between cardiorespiratory fitness and the clustering of CVD risk factors. The odds ratios for clustering in each quartile of fitness, using the quartile with the highest fitness as reference, were 13.0 [95% confidence interval (CI) 8.8-19.1]; 4.8 (95% CI 3.2-7.1) and 2.5 (95% CI 1.6-3.8), respectively, after adjusting for country, age, sex, socio-economic status, pubertal stage, family history of CVD and diabetes. In stratified analyses by age group, sex and country, similar strong patterns were observed. CONCLUSION: Low cardiorespiratory fitness is strongly associated with the clustering of CVD risk factors in children independent of country, age and sex.

Cardiorespiratory fitness relates more strongly than physical activity to cardiovascular disease risk factors in healthy children and adolescents: the European Youth Heart Study.

BACKGROUND: Physical activity and cardiorespiratory fitness are closely related to health variables in adults, especially those considered to be among risk factors for cardiovascular diseases. The possible tracking of cardiovascular disease risk factors from childhood to adulthood makes it important to increase our understanding of the complex relationships between physical activity, cardiorespiratory fitness and cardiovascular risk factors early in life. DESIGN: A cross-sectional, school-based study on healthy children and adolescents, aged 9-10 years (295 girls, 295 boys) and 15-16 years (302 girls, 233 boys) was performed during a school year in Sweden and Estonia, as part of the European Youth Heart Study. METHODS: Total physical activity, and minutes spent in inactivity and activity of moderate or higher intensity were measured by accelerometry. A maximal ergometer bike test was used for estimation of cardiorespiratory fitness. The risk factors included blood pressure and fasting blood levels of insulin, glucose, triglycerides, total cholesterol and high-density lipoprotein cholesterol. RESULTS: Canonical correlations between physical activity and cardiorespiratory fitness versus cardiovascular disease risk factors showed significant associations in both age and sex groups (rc=0.46-0.61, P<0.0001). The cardiorespiratory fitness was found to be the strongest contributor to these relationships. In girls high values of the physical activity variables were also associated with a favourable cardiovascular profile. CONCLUSIONS: Cardiorespiratory fitness relates more strongly to cardiovascular risk factors than components of objectively measured physical activity in children and adolescents. Physical activity becomes more important in the 15-year-old adolescents, indicating that these modifiable lifestyle factors increase in importance with age.

Platelet MAO activity and the 5-HTT gene promoter polymorphism are associated with impulsivity and cognitive style in visual information processing.

RATIONALE: Low capacity of the central serotonergic system has been associated with impulsive behaviour. Both low platelet monoamine oxidase (MAO) activity and the short (S) allele of the serotonin transporter gene promoter region polymorphism (5-HTTLPR) are proposed to be markers of less efficient serotonergic functioning. OBJECTIVES: The effect of the two markers for serotonin system efficiency on performance in a visual comparison task (VCT) and self-reported impulsiveness (Barratt Impulsiveness Scale, BIS-11) were investigated in healthy adolescents participating in the Estonian Children Personality Behaviour and Health Study. Possible confounding effect of general cognitive abilities on the performance in VCT was controlled for. RESULTS: Low platelet MAO activity and carrying of the S allele of 5-HTTLPR were both associated with higher error-rate and more impulsive performance in VCT. Platelet MAO activity and 5-HTTLPR S allele had a significant interactive effect on self-reported impulsivity (BIS-11). The effect of platelet MAO activity on both self-reported and performance impulsivity was significant only in the S allele carriers. The effect of 5-HTTLPR S allele on impulsive performance remained significant after controlling for general cognitive abilities. CONCLUSIONS: The two markers of lower serotonergic capacity, 5-HTTLPR S allele and low platelet MAO activity, have a similar and partly synergistic influence on self-reported as well as performance measures of impulsivity.

Association of traffic behavior with personality and platelet monoamine oxidase activity in schoolchildren.

PURPOSE: Estimations, attitudes and behavioral decisions in everyday life, including traffic-related situations, are influenced by personality traits. It is known that that there is a strong link between certain personality traits, particularly impulsivity, and central serotonergic functioning. This study examined associations between traffic behavior, personality and platelet monoamine oxidase activity, a marker of central nervous system serotonergic neurotransmission, in schoolchildren. METHODS: Participants were 483 schoolchildren (aged 15.3 +/- .5 years) who filled in questionnaires on traffic behavior and personality. Platelet monoamine oxidase activity was measured radioenzymatically. RESULTS: Simple logistic regression analysis revealed that subjects with riskier traffic behavior had higher impulsivity (both adaptive as maladaptive facets) as well as lower Openness, Agreeableness, and Conscientiousness. In multiple logistic regression analysis, many of these associations became nonsignificant, but the high traffic risk group was more likely to have lower Agreeableness and lower platelet MAO activity. Low platelet MAO activity was a significant predictor of risky traffic behavior only in girls who were also influenced by higher Excitement Seeking. Smoking was an independent predictor of all groups with high traffic risks. CONCLUSION: Risky traffic behavior in schoolchildren is associated with basic personality dimensions, most consistently with Agreeableness, and with different aspects of impulsivity. Some of these traits, particularly in girls, may be related to central serotonergic neuronal activity.

Dietary intake among under-, normal- and overweight 9- and 15-year-old Estonian and Swedish schoolchildren.

OBJECTIVES: To determine the differences in macronutrient and food group contribution to total food and energy intakes between Estonian and Swedish under-, normal- and overweight schoolchildren, and to estimate the association between diet and body mass index (BMI). DESIGN: Cross-sectional comparison between Estonian and Swedish children and adolescents of different BMI groups. SETTING: Twenty-five schools from one region in Estonia and 42 in two regions of central Sweden. SUBJECTS: In total 2308 participants (1176 from Estonia and 1132 from Sweden), including 1141 children with a mean age of 9.6 +/- 0.5 years and 1167 adolescents with a mean age of 15.5 +/- 0.6 years. RESULTS: Overweight was more prevalent among younger girls in Sweden (17.0 vs. 8.9%) and underweight among girls of both age groups in Estonia (7.9 vs. 3.5% in younger and 10.5 vs. 5.1% in older age group of girls). Compared with that of normal- and underweight peers, the diet of overweight Estonian children contained more energy as fat (36.8 vs. 31.7%) but less as carbohydrates, and they consumed more milk and meat products. Absolute BMI of Estonian participants was associated positively with energy consumption from eggs and negatively with energy consumption from sweets and sugar. Swedish overweight adolescents tended to consume more energy from protein and milk products. Risk of being overweight was positively associated with total energy intake and energy from fish or meat products. In both countries the association of overweight and biological factors (pubertal maturation, parental BMI) was stronger than with diet. CONCLUSION: The finding that differences in dietary intake between under-, normal- and overweight schoolchildren are country-specific suggests that local dietary habits should be considered in intervention projects addressing overweight.

TV viewing and physical activity are independently associated with metabolic risk in children: the European Youth Heart Study.

BACKGROUND: TV viewing has been linked to metabolic-risk factors in youth. However, it is unclear whether this association is independent of physical activity (PA) and obesity. METHODS AND FINDINGS: We did a population-based, cross-sectional study in 9- to 10-y-old and 15- to 16-y-old boys and girls from three regions in Europe (n = 1,921). We examined the independent associations between TV viewing, PA measured by accelerometry, and metabolic-risk factors (body fatness, blood pressure, fasting triglycerides, inverted high-density lipoprotein (HDL) cholesterol, glucose, and insulin levels). Clustered metabolic risk was expressed as a continuously distributed score calculated as the average of the standardized values of the six subcomponents. There was a positive association between TV viewing and adiposity (p = 0.021). However, after adjustment for PA, gender, age group, study location, sexual maturity, smoking status, birth weight, and parental socio-economic status, the association of TV viewing with clustered metabolic risk was no longer significant (p = 0.053). PA was independently and inversely associated with systolic and diastolic blood pressure, fasting glucose, insulin (all p < 0.01), and triglycerides (p = 0.02). PA was also significantly and inversely associated with the clustered risk score (p < 0.0001), independently of obesity and other confounding factors. CONCLUSIONS: TV viewing and PA may be separate entities and differently associated with adiposity and metabolic risk. The association between TV viewing and clustered metabolic risk is mediated by adiposity, whereas PA is associated with individual and clustered metabolic-risk indicators independently of obesity. Thus, preventive action against metabolic risk in children may need to target TV viewing and PA separately.

Physical activity and clustered cardiovascular risk in children: a cross-sectional study (The European Youth Heart Study).

BACKGROUND: Atherosclerosis develops from early childhood; physical activity could positively affect this process. This study's aim was to assess the associations of objectively measured physical activity with clustering of cardiovascular disease risk factors in children and derive guidelines on the basis of this analysis. METHODS: We did a cross-sectional study of 1732 randomly selected 9-year-old and 15-year-old school children from Denmark, Estonia, and Portugal. Risk factors included in the composite risk factor score (mean of Z scores) were systolic blood pressure, triglyceride, total cholesterol/HDL ratio, insulin resistance, sum of four skinfolds, and aerobic fitness. Individuals with a risk score above 1 SD of the composite variable were defined as being at risk. Physical activity was assessed by accelerometry. FINDINGS: Odds ratios for having clustered risk for ascending quintiles of physical activity (counts per min; cpm) were 3.29 (95% CI 1.96-5.52), 3.13 (1.87-5.25), 2.51 (1.47-4.26), and 2.03 (1.18-3.50), respectively, compared with the most active quintile. The first to the third quintile of physical activity had a raised risk in all analyses. The mean time spent above 2000 cpm in the fourth quintile was 116 min per day in 9-year-old and 88 min per day in 15-year-old children. INTERPRETATION: Physical activity levels should be higher than the current international guidelines of at least 1 h per day of physical activity of at least moderate intensity to prevent clustering of cardiovascular disease risk factors.

Agreement among adolescents, parents, and teachers on adolescent personality.

Agreement between adolescents, mothers, fathers, and teachers on adolescents' personality traits was investigated in a longitudinal study. The targets for personality ratings were the adolescents who participated in the European Youth Heart Study in Estonia. There were 593 participants in the first wave and 480 participants in the follow-up study 3 years later. Adolescents' self-reports as well as father, mother, and teacher ratings were collected using questionnaires to measure the five-factor model of personality. In both waves, inter-rater agreement was highest between mothers and fathers, was low to moderate for parent-self ratings, and was lowest for ratings between self and teacher, mother and teacher, and father and teacher. Test-retest correlations were moderate for parent and self-ratings but failed to reach statistical significance for three of the five teacher-rated traits, suggesting lower reliability of teacher ratings. Possible explanations for the low agreement between teachers and other judges are discussed.

Association of socioeconomic position with insulin resistance among children from Denmark, Estonia, and Portugal: cross sectional study.

OBJECTIVES: To examine the association between socioeconomic position and insulin resistance in children from three countries in northern Europe (Denmark), eastern Europe (Estonia), and southern Europe (Portugal) that have different physical, economic, and cultural environments. DESIGN: Cross sectional study. PARTICIPANTS: 3189 randomly selected schoolchildren aged 9 and 15 years from Denmark (n = 933), Estonia (n = 1103), and Portugal (n = 1153). MAIN OUTCOME MEASURE: Insulin resistance (homoeostasis model assessment). RESULTS: Family income and parental education were inversely associated with insulin resistance in Danish children but were positively associated with insulin resistance in Estonian and Portuguese children. Among Danish children, insulin resistance was 24% lower (95% confidence interval -38% to -10%) in those whose fathers had the most education compared with those with the least education. The equivalent results were 15% (2% to 28%) higher for Estonia and 19% (2% to 36%) higher for Portugal. These associations remained after adjustment for a range of covariates: -20% (-36% to -5%) for Denmark, 10% (-4% to 24%) for Estonia, and 18% (-1% to 31%) for Portugal. Strong statistical evidence supported differences between the associations in Denmark and those in the other two countries in both unadjusted and adjusted models (all P < 0.03). CONCLUSIONS: Among Danish children, those with the most educated and highest earning parents had least insulin resistance, whereas the opposite was true for children from Estonia and Portugal.

Changes in platelet monoamine oxidase activity, cholesterol levels and hyperactive behaviour in adolescents over a period of three years.

Platelet monoamine oxidase (MAO) activity is a peripheral marker of central serotonergic activity, and has been associated with aggressive, impulsive and hyperactive behaviour, alcohol and drug abuse. Central serotonergic activity has also been associated with plasma cholesterol levels. In the present longitudinal investigation in adolescents (n = 320) changes in platelet MAO activity and in plasma cholesterol levels over three years were measured, and their possible association with changes in aggressive and hyperactive behaviour, smoking, alcohol and drug use was studied. The measures were taken at age 15 and 18 years. Psychological data were obtained from teachers by using the Hyperactivity Scale [B. af Klinteberg, Studies on Sex-related Psychological and Biological Indicators of Psychosocial Vulnerability: A Developmental Perspective, University of Stockholm, Department of Psychology, 1988]. The results of the study show that in most of the tested individuals, platelet MAO activity is a relatively stable measure, however, there was a significant number of subjects with a noticeable change in MAO activity. In subjects with decreased platelet MAO activity, total and HDL cholesterol levels were significantly increased. Also, changes in HDL cholesterol and in platelet MAO activity were inversely associated with changes in the score of Concentration Difficulties. The changes in platelet MAO activity and cholesterol level were not associated with alcohol and drug use among the subjects. This longitudinal analysis provides preliminary evidence that changes in platelet MAO activity and cholesterol, which may reflect changes in central serotonergic activity are associated with attention deficit in adolescents.

Predicting drunk driving: contribution of alcohol use and related problems, traffic behaviour, personality and platelet monoamine oxidase (MAO) activity.

AIMS: The aim of the study was to characterize the predictive value of socio-economic data, alcohol consumption measures, smoking, platelet monoamine oxidase (MAO) activity, traffic behaviour habits and impulsivity measures for actual drunk driving. METHODS: Data were collected from 203 male drunk driving offenders and 211 control subjects using self-reported questionnaires, and blood samples were obtained from the two groups. RESULTS: We identified the combination of variables, which predicted correctly, approximately 80% of the subjects' belonging to the drunk driving and control groups. Significant independent discriminators in the final model were, among the health-behaviour measures, alcohol-related problems, frequency of using alcohol, the amount of alcohol consumed and smoking. Predictive traffic behaviour measures were seat belt use and paying for parking. Among the impulsivity measures, dysfunctional impulsivity was the best predictor; platelet MAO activity and age also had an independent predictive value. CONCLUSIONS: Our results support the notion that drunk driving is the result of a combination of various behavioural, biological and personality-related risk factors.

Increased behavioural activity of rats in forced swimming test after partial denervation of serotonergic system by parachloroamphetamine treatment.

The present study aimed at characterizing the effect of partial 5-HT denervation by parachloroamphetamine (PCA), a 5-HT selective neurotoxin, on forced swimming behaviour and monoamine levels in several rat brain regions. PCA was administered intraperitoneally in two independent experiments in doses of 2, 4 and 6 mg/kg and in doses 1, 2, 4 mg/kg, respectively. PCA (2 mg/kg) reduced immobility in the forced swimming test in the Experiment 1 and according to Experiment 2 this is explained by increased swimming time. Dose-dependent reductions in 5-HT and 5-HIAA levels were found in all brain regions studied, and the maximal effects were of a similar magnitude. In septum, the effect of PCA took more time to develop. The effects of the lowest dose of PCA suggest that the neurotoxin affects not only the dorsal raphe projection areas but also the fine axons which arise from the median raphe. alpha2-Adrenoceptors and beta-adrenoceptors in cerebral cortex were not affected by the PCA treatment. Binding affinity of the 5-HT(1A) receptors was higher after all doses of PCA. On the second exposure to the forced swimming the time spent in swimming was found to be negatively and the time spent in immobile posture positively correlated with serotonin turnover in frontal cortex. The time spent in struggling on the second exposure to test was found to be negatively correlated with KD of beta-adrenoceptor binding in cerebral cortex. These data suggest that partial 5-HT denervation with low doses of PCA, which elicits a specific pattern of neurodegeneration, results in an increased behavioural activity, and that the traditional interpretation of the measures in forced swimming test, despite of the test's predictive power in revealing antidepressants acting on monoaminergic systems, is not adequate for studies on the neurochemical basis of depression.

Physical activity levels and patterns of 9- and 15-yr-old European children.

PURPOSE: The purpose of this study was to assess physical activity levels and patterns from children participating in the European Youth Heart Study (EYHS). Very limited physical activity data exist that have been collected from representative samples of children and even fewer data collected where physical activity has been measured using objective methods. METHODS: Subjects were 2185 children aged 9 and 15 yr from Denmark, Portugal, Estonia, and Norway. Physical activity data were obtained using MTI (formerly CSA) accelerometers. The primary outcome variable was established as the child's activity level (accelerometer counts per minute). Children wore the accelerometer for 3 or 4 d, which included at least 1 weekend day. RESULTS: Boys were more active than girls at age 9 (784 +/- 282 vs 649 +/- 204 counts.min-1) and 15 yr (615 +/- 228 vs 491 +/- 163 counts.min-1). With respect to time engaged in moderate-intensity activity, gender differences were apparent at age 9 (192 +/- 66 vs 160 +/- 54 min.d-1) and age 15 (99 +/- 45 vs 73 +/- 32 min.d-1). At age 9, the great majority of boys and girls achieved current health-related physical activity recommendations (97.4% and 97.6%, respectively). At age 15, fewer children achieved the guidelines and gender differences were apparent (boys 81.9% vs girls 62.0%). CONCLUSIONS: Accelerometers are a feasible and accurate instrument for use in large epidemiological studies of children's activity. Boys tend to be more active than girls, and there is a marked reduction in activity over the adolescent years. The great majority of younger children achieve current physical activity recommendations, whereas fewer older children do so-especially older girls.

Both low and high activities of platelet monoamine oxidase increase the probability of becoming a smoker.

Platelet monoamine oxidase (MAO) activity is a marker of personality and psychiatric vulnerability, but the direct inhibitory action of tobacco constituents on the enzyme distorts the association. In the present investigation, data from a prospective longitudinal study of smoking behaviour and platelet MAO activity in adolescents at ages 15 and 18 years were sequentially analysed using a second-order multiple logistic regression analysis. The odds of regular smoking at 18 years increased significantly with increasing absolute deviation of platelet MAO activity at 15 years from the mean. That is, both low and high platelet MAO activity at 15 years predicted a higher probability of becoming a smoker. These data suggest that smoking is associated with low platelet MAO activity not only because of the direct inhibitory effect of tobacco constituents on the enzyme, but also because subjects with low platelet MAO activity are more likely to become smokers. Furthermore, the possible association between above-average platelet MAO activity and behavioural phenotypes should be reexamined.

Low platelet MAO activity associated with high dysfunctional impulsivity and antisocial behavior: evidence from drunk drivers.

RATIONALE: Low platelet monoamine oxidase (MAO) activity is associated with problem drinking and other deviant behaviors. Since the majority of alcohol abusers are smokers, and tobacco smoke has a direct inhibitory effect on the enzyme, these associations may not be meaningful. OBJECTIVE: The authors compared platelet MAO activity and impulsivity in police-referred subjects caught driving while intoxicated and in control subjects, controlling for smoking. METHODS: Platelet MAO activity was measured radioenzymatically and impulsivity scores obtained from questionnaires. Smoking status was self-reported. RESULTS: Subjects caught driving while intoxicated had significantly higher dysfunctional impulsivity and lower platelet MAO activity than control subjects. This difference in platelet MAO activity between the two groups was significant in non-smokers and ex-smokers. CONCLUSIONS: These findings demonstrate that platelet MAO activity is lower in subjects with socially deviant behavior, and the association of low platelet MAO and problem drinking is not an artifact of smoking.

Association between substance use, personality traits, and platelet MAO activity in preadolescents and adolescents.

This study examined the relationship between alcohol/illicit drug use, the Five-Factor Model (FFM) personality traits, aggressiveness (Agg), and hyperactivity (Hyp), and platelet monoamine oxidase (MAO) activity in a population-derived representative sample of preadolescents and adolescents (n=1172). Alcohol and illicit drug use was self-reported. The FFM personality inventories were filled in by mothers of the participants, and Agg and Hyp were rated by their class teachers. Higher scores in extraversion (E), Agg, and Hyp and lower scores in conscientiousness (C) together with older age were significant predictors of more frequent alcohol use in adolescents. No significant association was found between alcohol illicit drug use, and platelet MAO activity.

Effects of partial locus coeruleus denervation and chronic mild stress on behaviour and monoamine neurochemistry in the rat.

It has been proposed that lesions of the ascending noradrenergic projections render animals more vulnerable to stress. In this study, the effects of partial denervation of the locus coeruleus (LC) by DSP-4 (10 mg/kg) treatment, chronic mild stress (CMS) and their combination were examined. DSP-4 was administered to rats 1 week before the onset of CMS, which was applied for 5 weeks. In the forced swimming test, the immobility time was decreased by both DSP-4 and CMS. In the open field test, the number of defecations was increased after DSP-4 treatment plus CMS. Partial LC denervation decreased the levels of noradrenaline (NA) by 34%, increased NA turnover, and decreased the density of beta-adrenoceptors in the cerebral cortex. CMS decreased the binding affinity of beta-adrenoceptors, an effect not observed in the DSP-4 treated animals. In conclusion, 6 weeks after partial LC denervation NA turnover is increased in the cortex, and the effect of CMS on emotionality is enhanced.