Is cardiorespiratory fitness a moderator of the relationship between sugar-sweetened beverage consumption and insulin resistance in schoolchildren?

PURPOSE: The aim of this study was to determine whether cardiorespiratory fitness (CRF) decreases the association between insulin resistance and sugar-sweetened beverage (SSB) consumption in a population-based sample of Spanish schoolchildren. METHODS: This is a cross-sectional study including 430 schoolchildren (51.4% girls), aged 8-12 years, from 10 schools in Cuenca (Spain). Blood samples were drawn to measure fasting insulin levels. Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was also assessed. Data on SSB consumption were gathered using the Children's Eating Habits Questionnaire, which was completed by parents. The CRF level was determined by the 20 m Shuttle Run test and a curvilinear allometric model. RESULTS: Our conditional regression estimates showed that CRF moderated the association of SSB consumption on insulin levels or HOMA-IR. In children who had levels of CRF < 34.4 ml/kg/min ml/kg/min (for insulin levels) or < 33.6 ml/kg/min (for HOMA-IR), the association between SSB consumption and fasting insulin levels or HOMA-IR raised. Among children with CRF levels between 34.4 and 52.1 ml/kg/min (for insulin levels) or 33.6-55.4 ml/kg/min (for HOMA-IR), the association of SSB consumption on insulin level or HOMA-IR neither increased nor decreased. Among children with CRF levels > 52.1 ml/kg/min (for insulin levels) or > 55.4 ml/kg/min (for HOMA-IR), the association of SSB consumption on fasting insulin levels or HOMA-IR decreased. CONCLUSIONS: Our results showed that certain levels of CRF moderate the association between SSB consumption and insulin resistance in a population-based sample of Spanish schoolchildren.

The moderating role of physical fitness in the relationship between sugar-sweetened beverage consumption and adiposity in schoolchildren.

The mediating and moderating associations of cardiorespiratory fitness (CRF) and handgrip strength on the association between dietary patterns and several health outcomes have been previously studied. For instance, handgrip strength has been found as a moderator of the relationship between excess weight and cardiometabolic risk factors in young adults. Similarly, CRF has been shown as a mediator of the association between diet and obesity in children. However, to our knowledge, the role of CRF and handgrip strength on the association between sugar-sweetened beverage (SSB) consumption and adiposity is still unclear. The aim of this study was to determine whether CRF and handgrip strength moderate the association between SSB consumption and adiposity in a population-based sample of Spanish schoolchildren. This cross-sectional study involved 475 schoolchildren (52.0% girls), aged 8-12, from ten schools in Cuenca (Spain). Adiposity was determined as body fat (in kg), which was measured using a bioimpedance analysis system. Data on SSB consumption were gathered by using the Children's Eating Habits Questionnaire, which was completed by parents. The CRF level was determined by the 20-m Shuttle Run test and Nevill's curvilinear allometric model. Handgrip strength was determined using a digital dynamometer with adjustable grip. For each unit (in ml/kg/min) of CRF increased, the association between SSB consumption and adiposity was moderated (B = - 0.09, CI 95% - 0.14 to - 0.04). This significant moderation was also found for each 0.01 unit of increased normalized handgrip strength (B = - 0.07; CI 95% - 0.11 to - 0.02). Similarly, the Johnson-Neymann technique established three different regions. The first region shows that the association of SSB consumption on adiposity in participants who had levels of CRF < 43.4 ml/kg/min or handgrip strength < 0.34 was greater and statistically significant. The second region (43.4-57.4 ml/kg/min for CRF; 0.34-0.58 for normalized handgrip strength) depicted that the association between SSB consumption and adiposity was not statistically significant in those with a CRF level or normalized handgrip strength between the lower and upper thresholds. The third region was found at > 57.4 ml/kg/min (for CRF level) and > 0.58 (for normalized handgrip strength), indicating that the association between SSB consumption and adiposity was lower and statistically significant in children above these moderator values. Our results showed that certain levels of CRF and normalized handgrip strength moderate the association between SSB consumption and adiposity in a sample of Spanish schoolchildren. It might be possible that higher physical fitness level in childhood may contribute to reducing the association between SSB consumption and adiposity.

Obesity risk in 10-year-old children, based on attributes observed at 4 years of age, provides evidence on how to target interventions to lower obesity rates in mid-childhood.

Introduction: Introduction: although in Chile 75 % of obese preschool children participate in a primary health intervention, obesity rates have increased. Objective: to determine the risk of children being obese in 5th grade (10 yrs), according to biological and social attributes observed when they attended prekindergarten (PK) at 4 yrs, to determine which preschoolers should be prioritized for targeting. Method: a retrospective cohort study including 55,623 participants. The variables collected when children attended PK were age, sex, weight, height, maternal educational level and employment status, the child´s relationship with persons living at home, person in charge of the child after school, and number of household members, plus weight, height, and age in 5th grade. To determine the risk of being obese in 5th grade we did two logistic regression models-the first one included all PK children and the above variables, while the second model considered additionally the presence of obesity in PK. The rest of the variables were the same. Results: the risk of children being obese in 5th grade (10 yrs) was 1.43 times higher if their mothers had ≤ 8 yrs of schooling, 1.13 times higher if they lived with a grandparent, and slightly higher if their mothers had an occupation (1.04 times). Boys had a significantly higher risk (1.74 times). Obesity at 4 yrs constituted the highest obesity risk later on (5.3 times). Conclusions: targeting obese 4-year-old boys who participate in a primary health intervention, whose mothers have low education and who live with a grandparent, may lower obesity rates in mid-childhood.

Introducción: Introducción: aunque, en Chile, el 75 % de los preescolares obesos participan en un programa de salud primaria, la obesidad infantil ha aumentado. Objetivo: determinar el riesgo de obesidad en escolares de 5º básico (10 años), según las características biológicas y sociales observadas en prekínder (PK) a los 4 años, para determinar qué preescolares debieran ser priorizados para intervenir. Método: cohorte retrospectiva de 55.623 participantes. Las variables recolectadas en PK fueron: edad, sexo, peso, estatura, nivel educacional y situación laboral de la madre, relación del preescolar con miembros del hogar, persona que cuida al escolar y número de miembros del hogar, además de peso, estatura y edad en 5º básico. El riesgo de obesidad en 5º básico se determinó a través de 2 modelos de regresión logística: el primero incluyó a todos los preescolares en PK y las variables mencionadas anteriormente, y el segundo consideró adicionalmente la presencia de obesidad en PK. El resto de las variables fueron las mismas. Resultados: el riesgo de que los escolares presenten obesidad en 5º básico (10 años) fue 1,43 veces mayor si sus madres tenían ≤ 8 años de escolaridad, 1,13 veces mayor si vivían con un abuelo y ligeramente mayor si sus madres estaban ocupadas (1,04 veces). Los hombres tenían un riesgo significativamente mayor (1,74 veces). La obesidad a los 4 años constituyó el mayor riesgo de obesidad posteriormente (5,3 veces). Conclusión: centrar la atención en los niños obesos de 4 años que participen en una intervención de atención primaria, cuyas madres tengan menor educación y que vivan con un abuelo podría reducir la prevalencia de la obesidad.

The effectiveness of a high-intensity interval games intervention in schoolchildren: A cluster-randomized trial.

The aim of this study was to assess the effectiveness of a high-intensity interval training (HIIT) intervention based on playground games (MOVI-daFit!) on improvements in adiposity, physical fitness, and cardiometabolic risk factors in schoolchildren. A cluster-randomized controlled trial (RCT) was performed that included 562 schoolchildren (9-11 years) from 10 schools in Cuenca, Spain. The intervention consisted of four 60-min sessions per week in the school setting. Analyses were conducted on the intention-to-treat basis. Changes in physical fitness parameters (cardiorespiratory fitness: main outcome), body composition, blood pressure, and biochemical cardiometabolic risk parameters were analyzed using both mixed linear and logistic regression models, controlling for baseline covariates, Tanner stages, health dietary score index, body mass index, and cluster factor school. In boys, no significant differences in any outcome measure were noted except for the standing long jump test (10.13 cm; 95% CI 2.94 to 17.32; p = 0.006) between the intervention group (IG) and the control group (CG). Improvements in mean arterial pressure (-1.68 mmHg; 95% CI -3.28 to -0.08; p = 0.039), the triglyceride/HDL-c ratio (-0.36 mg/dl; 95% CI -0.59 to -0.13; p = 0.002), C-reactive protein (-0.23 mg/L; 95% CI -0.43 to -0.03), VO2 max (1.44 ml/kg/min; 95% CI 0.52 to 2.36, p = 0.002), 20-m shuttle run test (3.64 laps; 95% CI 0.51 to 6.78), and standing long jump test (7.04 cm; 95% CI 1.21 to 12.87; p = 0.018) were observed in girls in the IG compared with those in the CG. Body composition parameters did not change significantly in either boys or girls. Additionally, children with lower fitness levels obtained greater improvements than children with higher fitness levels. In conclusion, MOVI-daFit! may represent a good strategy for incorporating HIIT into playground games, although its implementation may need to be improved to extend the benefits to children and enhance its adherence.

Predictive Ability of Waist Circumference and Waist-to-Height Ratio for Cardiometabolic Risk Screening among Spanish Children.

An excess of fat mass has been associated with adverse cardiometabolic risk factors. Different anthropometric measures have been proposed as alternative non-invasive measures for obesity-related cardiometabolic risk. To evaluate the magnitude of association between waist circumference (WC) and waist-to-height ratio (WtHR) with cardiometabolic risk factors and metabolic syndrome and to determine the WtHR cutoff associated with a more favorable cardiometabolic risk profile in Spanish children, data were taken from a cross-sectional survey conducted in 2010 among 848 schoolchildren aged 8-11 years from 20 public schools in the province of Cuenca (Spain). Anthropometric variables, glucose, insulin, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), systolic (SBP) and diastolic blood pressure (DBP) and metabolic syndrome (MetS) were also analyzed. WtHR and WC had a good accuracy for TG, insulin, and MetS. The diagnostic odds ratio ranged from 2.95 to 9.07 for WtHR and from 5.30 to 27.40 for WC. The main result of the present study suggests that both WtHR and WC could be used as a screening tool to identify children with cardiometabolic abnormalities.

Estudio de seguimiento de la prevalencia de delgadez y sobrepeso de una cohorte de escolares de 4 a 6 años de Castilla-La Mancha.

Introducción y objetivos: los objetivos del presente estudio fueron: a) estimar la prevalencia de sobrepeso/obesidad y delgadez en escolares nacidos en 2007 y 2008 de Castilla-La Mancha, España, en los años 2013 y 2015; y b) analizar la persistencia en las mismas categorías de estatus ponderal entre 2013 y 2015 en esta cohorte de escolares.Material y métodos: estudio de seguimiento en el que se analizaron los datos antropométricos de los escolares nacidos en 2007 y 2008 en los años 2013 (4-6 años) y 2015 (6-8 años). Se invitó a participar a todos los escolares de 21 colegios de las provincias de Cuenca y Ciudad Real que cursaban tercero de Educación Infantil o primero de Educación Primaria en 2013. En todos ellos se determinaron, además de variables sociodemográficas, peso, talla y porcentaje de grasa corporal por bioimpedancia eléctrica.Resultados: la prevalencia de delgadez, sobrepeso y obesidad en la medición basal fue de 20,7%, 12% y 8,2% respectivamente. Dos años después, la prevalencia de delgadez disminuyó hasta 14,7% y la de sobrepeso y obesidad aumentó hasta 15,4% y 8,4% respectivamente. Por otro lado, el 78,8% de los escolares permanecía en 2015 en la misma categoría ponderal que en 2013.Conclusiones: el aumento en la prevalencia de sobrepeso/obesidad de los escolares parece estar remitiendo, al mismo tiempo que el incremento en la prevalencia de bajo peso ha aumentado sustancialmente. Por último, los escolares tienden a mantener el estatus ponderal previo al rebote adiposo durante la edad escolar.

[PREVALENCE OF THINNESS, OVERWEIGHT AND OBESITY AMONG 4-TO-6-YEAR-OLD SPANISH SCHOOLCHILDREN IN 2013; SITUATION IN THE EUROPEAN CONTEXT]. / PREVALENCIA DE DELGADEZ, SOBREPESO Y OBESIDAD EN ESCOLARES ESPAÑOLES DE 4-6 AÑOS EN 2013; SITUACIÓN EN EL CONTEXTO EUROPEO.

INTRODUCTION AND OBJECTIVES: both, weight excess and thinness, are related with several health disorders that could continue into adulthood. The objectives of this study were to estimate the prevalence of thinness, overweight and obesity in 4-to-6-year-old schoolchildren in the provinces of Cuenca and Ciudad Real (Spain), using both the International Obesity Task Force and the World Health Organization criteria; and to compare this prevalence with those provided for other European studies. METHODS: a cross-sectional study was performed in 1 585 schoolchildren in September 2013. Weight and height measurements were performed by previously trained nurses with standardized procedures. Weight status was defined according to the International Obesity Task Force and the World Health Organization criteria. RESULTS: when the International Obesity Task Force criteria were used prevalence of thinness, overweight and obesity was 20.51%, 11.84% and 8.58%, respectively; and 3.97%, 13.92% and 10.79% when the World Health Organization criteria were utilized. No statistically significant differences by sex or province in any category of weight status were found. The prevalence of thinness decreased as age increases. Conversely, thinness prevalence decreased and overweight/obesity prevalence was significantly higher in older schoolchildren. The prevalence of overweight in this study is similar to other Mediterranean countries. CONCLUSIONS: the prevalence of overweight seems to level off, although it remains a public health priority. The increase in the prevalence of thinness has become an emergent problem that could claim for public health interventions.

Introducción y objetivos: tanto el exceso de peso como la delgadez se relacionan con diversos problemas de salud que pueden continuar hasta la edad adulta. Los objetivos de este estudio fueron estimar la prevalencia de delgadez, sobrepeso y obesidad en escolares de 4-6 años de las provincias de Cuenca y Ciudad Real (España), mediante criterios del Grupo Internacional de Trabajo sobre Obesidad y de la Organización Mundial de la Salud, y comparar estas cifras con otros estudios europeos. Métodos: estudio observacional-transversal que incluyó a 1.585 escolares realizado en septiembre de 2013. Las mediciones de peso y talla fueron realizadas por enfermeras entrenadas y mediante procedimientos estandarizados. El estatus ponderal se definió según los criterios del Grupo Internacional de Trabajo sobre Obesidad y la Organización Mundial de la Salud. Resultados: según criterios del Grupo Internacional de Trabajo sobre Obesidad, la prevalencia de delgadez, sobrepeso y obesidad fue del 20,51%, 11,84% y 8,58%, respectivamente; y del 3,97%, 13,92% y 10,79% cuando se utilizaron los criterios de la Organización Mundial de la Salud. No se encontraron diferencias estadísticamente significativas por sexo ni provincia para ninguna categoría de estatus ponderal. Para ambos criterios, la prevalencia de delgadez fue menor a medida que aumentaba la edad, mientras que la prevalencia de sobrepeso/obesidad fue mayor. Conclusiones: la prevalencia de exceso de peso podría haber tocado techo en España, aunque continúa siendo un importante problema de salud pública. El aumento de la prevalencia de bajo peso debería ocupar un lugar relevante en las intervenciones de salud pública.

Moderate-to-vigorous physical activity as a mediator between sedentary behavior and cardiometabolic risk in Spanish healthy adults: a mediation analysis.

BACKGROUND: Public health strategies for cardiovascular prevention highlight the importance of physical activity, but do not consider the additional potentially harmful effects of sedentary behavior. This study was conducted between 2010 and 2012 and analyzed between 2013 and 2014. The aim of the study was to analyze the relationship between sedentary behavior and cardiometabolic risk factors in the Spanish adult population and to examine whether this relationship is mediated by moderate-to-vigorous physical activity (MVPA). METHODS: The cross-sectional study included 1122 healthy subjects belonging to the EVIDENT study. Sedentary behavior was objectively measured over 7 days using Actigraph accelerometers. We assessed waist circumference (WC), triglycerides-to-HDL-C ratio (TG/HDL-C), and mean arterial pressure (MAP), and undertook homeostasis model assessment (HOMA-IR). Linear regression models were fitted according to Baron and Kenny procedures for mediation analysis. RESULTS: TG/HDL-C and HOMA-IR were significantly higher in adults who spent more minutes in sedentary activities after adjusting for potential covariates. However when MVPA was added to the ANCOVA models as covariate the effect of sedentary time on HOMA-IR disappeared. In addition, MVPA acted as a full mediator of the relationship between sedentary time and HOMA-IR. In contrast, subjects with lower levels of MVPA presented worse cardiometabolic profiles than those from higher MVPA categories, even after controlling for sedentary time and other potential confounders. CONCLUSIONS: These results suggest that both MVPA and sedentary time should be considered when developing cardiometabolic risk guidelines. TRIAL REGISTRATION: NCT01083082 .

Gender differences on effectiveness of a school-based physical activity intervention for reducing cardiometabolic risk: a cluster randomized trial.

BACKGROUND: Studies that have examined the impact of a physical activity intervention on cardiometabolic risk factors have yielded conflicting results. The objective of this study was to assess the impact of a standardized physical activity program on adiposity and cardiometabolic risk factors in schoolchildren. METHODS: Cluster randomized trial study of 712 schoolchildren, 8-10 years, from 20 public schools in the Province of Cuenca, Spain. The intervention (MOVI-2) consisted of play-based and non-competitive activities. MOVI-2 was conducted during two 90-minute sessions on weekdays and one 150-minute session on Saturday mornings every week between September 2010 and May 2011. We measured changes in adiposity (overweight/obesity prevalence, body mass index [BMI], triceps skinfold thickness [TST], body fat %, fat-free mass, waist circumference) and other cardiometabolic risk factors (LDL-cholesterol, triglycerides/HDL-cholesterol ratio, insulin, C-reactive protein and blood pressure). The analyses used mixed regression models to adjust for baseline covariates under cluster randomization. RESULTS: Among girls, we found a reduction of adiposity in intervention versus control schools, with a decrease in TST (-1.1 mm; 95% confidence interval [CI] -2.3 to -0.7), body fat % (-0.9%; 95% CI -1.3 to -0.4), waist circumference (-2.7 cm; 95% CI -4.5 to -0.9), and an increase in fat-free mass (0.3 kg; 95% CI 0.01 to 0.6). The intervention also led to lower serum LDL-cholesterol and insulin levels. Among boys, a reduction in waist circumference (-1.4 cm; 95% CI -2.6 to -0.1; P = 0.03), and an increase in fat-free mass (0.5 kg; 95% CI 0.2 to 0.9; P = 0.003) was associated with the intervention versus control schools. The prevalence of overweight/obesity or underweight, BMI, and other cardiometabolic risk factors was not modified by the intervention. No important adverse events were registered. CONCLUSIONS: An extracurricular intervention of non-competitive physical activity during an academic year, targeting all schoolchildren regardless of body weight, is a safe and effective measure to reduce adiposity in both genders and to improve cardiometabolic risk profile in girls. TRIAL REGISTRATION: Clinical trials NCT01277224.

Physical activity, fitness, and metabolic syndrome in young adults.

PURPOSE: Our objective was to analyze the association between different intensities of physical activity (PA), physical fitness, and metabolic syndrome (MS) in young adults. METHODS: Cross-sectional study including 275 university students, 18-30 years old, from Cuenca, Spain. We evaluated (a) physical activity using accelerometry, (b) aerobic capacity (VO2max), and (c) muscle strength, by a muscle strength index calculated as the sum of the standardized z score of handgrip dynamometry/weight and standing broad jump. An MS index was estimated by summing standardized z scores of waist circumference, ratio of triglycerides to high-density lipoprotein, mean arterial blood pressure, and HOMA-IR. RESULTS: The mean scores of MS index and HOMAIR were significantly higher and the VO2max significantly lower for individuals who did not perform 20 min or more per week of vigorous physical activity. However, those who performed 250 min/week of moderate physical activity showed no significant differences in either VO2max or the MS index when compared with individuals who did not perform this level of activity. The MS index was lower in those with medium-high levels of aerobic capacity. In addition, individuals with medium-high levels of muscular fitness showed lower waist circumference and a lower MS index. CONCLUSIONS: VO2max and muscle strength are negatively associated with metabolic risk. 20-min/week of vigorous physical activity was associated with lower cardiometabolic risk in young adults; moderate physical activity did not show association with lower cardiometabolic risk.