[Insulin Resistance and Abnormalities in Blood Values of Icelandic Children Receiving Obesity Treatment].

INTRODUCTION: Worldwide, the rates of childhood obesity have risen dramatically in recent decades. Obesity may cause serious sequelae during childhood and throughout adulthood. Insulin resistance is prevalent metabolic abnormality in pediatric obesity. The Pediatric Obesity Clinic was established in 2011 at the Children's Medical Center, Landspítali University Hospital. This study aimed to observe metabolic abnormalities and insulin resistance in blood values of children receiving obesity treatment. METHODS: The study included all children (n = 180) who received obesity treatment at The Pediatric Obesity Clinic between 2016 and 2020 and had at least eight out of the nine following serum values analyzed while fasting: HbA1c, glucose, insulin, ALAT, total cholesterol, HDL-cholesterol, triglycerides, TSH and free T4. HOMA-IR value was calculated from insulin and glucose values. Decreased insulin sensitivity was defined as HOMA-IR > 3.42. RESULTS: 84% of the children had at least one abnormality in their tested blood values. 50% had abnormal insulin values and 44% had abnormal ALAT values. 78% had decreased insulin sensitivity, and their mean HOMA-IR was 7.3 (± 5.0), surpassing twice the normal value. CONCLUSION: A large majority of the children undergoing obesity treatment already exhibited signs of metabolic sequelae during their treatment. The prevalence of affected children has increased compared to a similar study conducted in 2013. Of particular concern is the growing number of children with decreased insulin sensitivity. Proper measures must be taken to combat this alarming trend.

Relevance of well-being, resilience, and health-related quality of life to mental health profiles of European adolescents: results from a cross-sectional analysis of the school-based multinational UPRIGHT project.

PURPOSE: The existing evidence suggests that a complete evaluation of mental health should incorporate both psychopathology and mental well-being indicators. However, few studies categorize European adolescents into subgroups based on such complete mental health data. This study used the data on mental well-being and symptoms of mental and behavioral disorders to explore the mental health profiles of adolescents in Europe. METHODS: Data collected from adolescents (N = 3767; mean age 12.4 [SD = 0.9]) from five European countries supplied the information on their mental well-being (personal resilience, school resilience, quality of life, and mental well-being) and mental and behavioral disorder symptoms (anxiety, depression, stress, bullying, cyber-bullying, and use of tobacco, alcohol, or cannabis). Multiple correspondence analysis and cluster analysis were combined to classify the youths into mental health profiles. RESULTS: Adolescents were categorized into three mental health profiles. The "poor mental health" profile (6%) was characterized by low levels of well-being and moderate symptoms of mental disorders. The "good mental health" profile group (26%) showed high well-being and few symptoms of mental disorders, and the "intermediate mental health" profile (68%) was characterized by average well-being and mild-to-moderate symptoms of mental disorders. Groups with higher levels of well-being and fewer symptoms of mental disorders showed lower rates of behavioral problems. Mental well-being indicators strongly contributed to this classification. CONCLUSION: Adolescents with the "intermediate" or "poor" mental health profiles may benefit from interventions to improve mental health. Implications for school-based interventions are discussed. TRIAL REGISTRATION NUMBER (TRN) AND DATE OF REGISTRATION: ClinicalTrials.gov Identifier: NCT03951376. Registered 15 May 2019.

[Health and performance consequences of Relative Energy Deficiency in Sport (RED-s)].

Fulfilling individual energy and nutrient requirements is of great importance for athletes to support overall health and well-being, training adaptation, recovery and injury prevention. Energy availability is the amount of energy left over and available for bodily functions after the energy expended for training is subtracted from the energy taken in from food. The syndrome of Relative Energy Deficiency in Sport (RED-s) refers to the multifactorial health and performance consequences of low energy availability. Potential physiological implications of RED-s include impaired metabolic rate, hormonal disruptions, menstrual dysfunction, reduced bone health, immunity, protein synthesis, and cardiovascular health. These can have short and long term consequences on health and sport performance. Causes of RED-s range from unintentional (e.g. lack of awareness or difficulties with meeting high energy requirements) to more intentional behaviors and further to clinical eating disorders. RED-s prevalence appears to differ between sports and sport disciplines, with highest risk in endurance, aesthetic and weight-class sports. This article summarizes current knowledge of RED-s implications for health and performance, and highlights the importance of early diagnosis and screening. Research on RED-s in Icelandic athletes is warranted as it could support development of national guidelines, prevention and treatment protocols.

The relation between physical activity, fitness, and fatness in adolescents: A mediation analysis.

OBJECTIVES: To investigate the total, direct and mediated (by fatness) association of physical activity (PA) with fitness. METHODS: Body fat percentage (%Fat), maximal oxygen uptake (VO2max ) and PA were measured directly in 18-year-olds (n=202) and their association analyzed with a linear regression-based mediation analysis after controlling for sex. RESULTS: The total association between PA and VO2max was significant (c=0.66, P<0.001) and was significantly mediated by %Fat (ab=0.25, 95% CI: 0.04-0.49). The direct association was also significant (c=0.41, P<0.001). CONCLUSION: Physical activity is associated with VO2max in 18-year-old adolescents but a little over a third of that association is mediated by %Fat. Regardless of fatness, PA is important for fitness in this age group. Am. J. Hum. Biol. 28:584-586, 2016. © 2015 Wiley Periodicals, Inc.

Body dissatisfaction, disordered eating and exercise behaviours: associations with symptoms of REDs in male and female athletes.

Objectives: Disordered eating and compulsive exercise behaviours are common among athletes and can increase the risk of relative energy deficiency in sport (REDs). Contrarily, the prevalence of muscle dysmorphia and its relationship with REDs are unknown. This cross-sectional study aimed to evaluate associations of all three with REDs symptoms. Methods: Elite and subelite Icelandic athletes (n=83, 67.5% females) answered the Low Energy Availability in Females/Males Questionnaires (LEAF-Q/LEAM-Q), Eating Disorder Examination-Questionnaire Short (EDE-QS), Exercise Addiction Inventory (EAI) and Muscle Dysmorphic Disorder Inventory (MDDI). Body composition was assessed via dual-energy X-ray absorptiometry; resting metabolic rate via indirect calorimetry; and blood samples were drawn for analysis of nutrition and hormonal status. Females were compared based on LEAF-Q total score (≥8 (at risk) vs <8). Simple linear regression was applied to evaluate associations of (a) testosterone with other objective measures and LEAM-Q scores in males; and (b) LEAF-Q/LEAM-Q scores with EDE-QS, EAI and MDDI scores. Results: In total, 8.4% of participants scored above cut-off on EDE-QS, 19.3% on EAI and 13.3% on MDDI. Females with LEAF-Q total score ≥8 had higher median scores on EDE-QS, EAI and MDDI compared with those scoring <8. Testosterone was positively associated with iron and inversely with total iron-binding capacity but was not associated with scoring on any of the administered questionnaires. Conclusion: Drive for muscularity and aesthetic physique may play a role in the complex presentation of REDs. Screening for muscle dysmorphia, in addition to disordered eating and compulsive exercise, could therefore facilitate early detection of REDs.

[Attitudes to food and eating in an Icelandic cohort].

INTRODUCTION: Few studies exist on eating attitudes and well-being of adults in Iceland. In most Western societies great emphasis is placed on a lean and fit body, nevertheless the number of people gaining weigt keeps increasing. Such circumstances may cause discomfort related to food and food choice. The aim of this study was to examine attitudes towards food and eating among Icelandic adults. MATERIAL AND METHODS: We used data from the Icelandic national health survey of 5,861 adults, age 18-79, conducted in 2007. A numerical assessment tool for measuring eating attitude was established, based on answers to questions on eating attitude. We used binary regression models to estimate odds ratios (ORs) for unhealthy eating attitude according to different demographic factors. RESULTS: The prevalence of unhealthy eating attitude according to the measurement tool used in the study was 17% among participants, 22% for women and 11% for men. Unhealthy eating attitude was most prevalent in the age-group 18-29 years (36% of women, 15% of men), among those dissatisfied with their body weight (35% of women, 22% of men) and among those defined as obese (38% of women, 23% of men). CONCLUSION: Our data show that women are more prone to express unhealthy eating attitude compared to men. Those of younger age, with weight dissatisfaction and with high body mass index are positively associated with unhealthy eating attitude, irrespective of gender. KEY WORDS: Diet, Dietary restraint, Public Health, Eating attitude, Body weight satisfaction. Correspondence: Laufey Steingrimsdottir, laufey@hi.is.

Fatness but Not Fitness Relative to the Fat-Free Mass Is Related to C-Reactive Protein in 18 Year-Old Adolescents.

INTRODUCTION: The interaction between fatness, fitness, and C-reactive protein (CRP) in adolescents is not well characterized but may be important to prevent low grade inflammation. The purpose of this study was to assess the relationship between adiposity, different expressions of fitness, and CRP in late adolescence using direct measures of fitness and fatness. METHODS: Anthropometric measurements were taken on 245 eighteen-year-old participants (116 girls). Fasting CRP, glucose, and insulin were measured and homeostatic model assessment (HOMA) calculated. Body composition was estimated via dual energy X-ray absorptiometry. Fitness was assessed with maximal oxygen uptake (VO2max) during a treadmill test and also expressed relative to the fat-free mass (VO2maxFFM). RESULTS: Prevalence of overweight/obesity based on body mass index (BMI) was 20.7% and 25.6% among girls and boys, respectively (p = 0.407), but 42.5% and 58.1% when based on body fat percentage (%fat, p = 0.015). Higher proportion of boys (81.3%) than girls (54.5%) were highly fit (p<0.001), but the percentage of girls with high levels of CRP was greater (12.1% vs 6.2%, p = 0.028). Adiposity, indicated with BMI, waist circumference, fat mass, android fat mass (aFM), or %fat, was positively associated with CRP independent of VO2max (r = 0.13-0.18, p<0.05) and VO2maxFFM (r = 0.24-0.32, p<0.001). VO2max, was negatively associated with CRP independent only of BMI and waist circumference (r = -0.21, p = 0.001), but not %fat, fat mass or aFM (r = -0.08 to -0.12, p>0.05). VO2maxFFM was unrelated to CRP with (r = -0.07 to -0.11, p>0.05) or without (r = -0.10, p = 0.142) adjustment for adiposity. Additional adjustment for HOMA did not change any of the relationships, although the coefficients were attenuated. CONCLUSIONS: Fatness has a greater association with CRP than fitness in late adolescence. However, VO2maxFFM, which is truly independent of adiposity, is unrelated to CRP, indicating that the effects of fitness might be mediated via the fatness component embedded in fitness expressed relative to body mass.

[Importance of waist circumference measurements when following children with obesity: Serious abnormalities in blood values of Iceandic children with obesity]. / Mikilvægi mittismáls við eftirlit barna með offitu. Alvarleg frávik í blóðgildum hjá íslenskum börnum með offitu.

INTRODUCTION: Childhood obesity is a growing health problem worldwide. Body mass index (BMI) has been used as the main measurement of obesity for years but its quality for children has been questioned. In 2011 the Health School was formed at the Childrens Medical Center at Landspitali University Hospital for treatment of obese children and their families. The aim of this study was to find the best predictor of blood test abnormalities and to get a clear picture of abnormalities in blood values in the group of obese children referred to the Health School. METHODS: All children referred to the Health School from January 1st 2011 until March 15th 2013 were retrospectively studied (n=181). Information was gathered on height, weight, BMI, waist circumference and available blood variables. RESULTS: Abnormal blood values were found in 54 cases (47%). Of the children where information was available, four (4%) had Non-Alchoholic Fatty Liver Disease (NAFLD) and 28 (28%) had a raised fasting insulin levels whereof 8 (8%) needed treatment. One child had both NAFLD and raised fasting insulin. CONCLUSION: Abnormal blood values are common in obese children. Waist circumference appears to have a better predictive value of these abnormalities than BMI-SDS. Waist circumference could be used to screen for children who need physician supervision because of risk of metabolic disorders. Waist circumference adds important information to the risk assessment of obese children. This study emphasises the importance of care givers measuring waist circumference in obese children.

[Family-based behavioral treatment for obese children - results and two year follow up]. / Fjölskydumidud atferlismedferd fyrir of feit börn.

INTRODUCTION: Childhood obesity has become a worldwide epidemic and Icelandic children have not been exempt from increasing rates of obesity. Epstein´s family-based behavioral treatment for childhood obesity has demonstrated favorable outcomes in research settings, but research in clinical settings has been called for. The objective of this study was to replicate and confirm the effects observed in the US research setting. MATERIAL AND METHODS: Participants were 84 obese children (age-range: 8-13 years) and a participating parent. Sixty-one families completed a 12 week treatment lasting 18 weeks, and were followed for one and two years post-treatment. Measurements at baseline and end of treatment included height and weight, daily activity, daily fruit and vegetable consumption, blood pressure, blood profiles and measures of psychological well-being. Measurements also included parental height, weight and depression scores. RESULTS: Among treatment completers BMI-SDS (body-mass index standard deviation score) decreased significantly from pre- to post- treatment (F(2.60)=110.31, p<0.001) which was maintained at one-year (F(2.60)=1.33, p=0.253) and two-years (F(2.60)= 3,19, p=0.079) post treatment. There was a significant reduction in blood pressure (upper: t(59)=-2.01, p<0.05, lower: t(59)=-4.00, p<0.001). Among a subsample (n=23) of participants, significant reductions were observed in fasting insulin levels, (t(22)=6.1, p<0.05), triglycerides (t(22)=0.31, p<0.05) and total cholesterol (t(22)=0.35, p<0.05). Significant improvements were observed for measures of psychological well-being (depressive symptoms: (F(1.59)=6.67, p<0.05); anxiety: (F(1,57)= 4.54, p%lt;0.05) and children´s self-concept (F(1.59)=19.2, p<0.001). A significant reduction was observed in parental BMI scores from pre- to post- treatment (F(1.59)= 71.54, p%lt;0.001) but a significant increase was evident at one year post-treatment (F(1.59)=41.87, p%lt;0.001). Improvements were observed for measures of parental depression from pre- to post- treatment (F(1.60)= 12.93, p<0.01). CONCLUSION: Epstein´s family-based behavioural treatment showed promising effects on weight status, and emotional as well as physical markers, both in the short and long term in a clinical sample of obese Icelandic children.

[The effects of 6 months' multimodal training on functional performance, strength, endurance, and body mass index of older individuals. Are the benefits of training similar among women and men?]. / Áhrif 6 mánaða fjölþættrar þjálfunar á hreyfigetu, vöðvakraft, þol og líkamsþyngdar stuðul eldri einstaklinga. Eru áhrif þjálfunar sambærileg hjá konum og körlum?

INTRODUCTION: Good functional performance in elderly people greatly improves their changes of independence and well-being. Conversely, bad functional performance can impair their capability of managing the activities of daily life.. The main goal of this study was to investigate the effects of a 6-months' multimodal training intervention on the physical performance of males and females, possible gender differences and the outcome 6 and 12 months after its completion. MATERIAL AND METHODS: This study examined 71-90 year old healthy seniors (n=117) participating in the AGES Reykjavik Study. It was a randomized and controlled cross-over trial, conducted in three 6-months' phases (time-points). After enrollment and baseline assessments, the study group was divided in two. Group 1 received 6-months' training while group 2 served as a control. In the second 6 months' phase, group 1 received no formal training while group 2 did. In the third phase, neither group received training. The groups' physical conditions were assessed after each phase. RESULTS: After 6-months' training, 32% improvement was seen in physical activity among males (p<0.001) and 39% among females (p<0.001). In physical performance, 5% improvement was seen for males (p<0.01) and 7% for females (p<0.001). Strength increased by 8% for males (p<0.001) and 13% for females (p<0.001). For both sexes, about 10% increase was seen in dynamic balance in the 8-foot up-and-go test (p<0.001) and 5-6% in walking distance for both sexes in the six minutes walking test (p<0.001). For both sexes, body mass index decreased by about 2% (p<0.001). No difference was seen between the sexes.in the training results. Both sexes retained long-term effects of the training on physical performance and dynamic balance for at least 12 months. CONCLUSIONS: Multimodal training intervention has positive effects on physical performance in older individuals, the sexes respond similarly to the training and retain achieved improvement for at least 12 months. The research indicates that moderate and systemic training for this age group could be a part of conventional health service for this age group.

[Body composition, aerobic fitness, physical activity and metabolic profile among 18 year old Icelandic high-school students]. / Holdafar, uthald, hreyfing og efnaskiptasnid medal 18 ara islenskra framhaldsskolanema.

OBJECTIVE: The purpose of the study was to examine metabolic risk factors among 18 year old high-school students and compare students attending vocational and traditional schools. MATERIAL AND METHODS: Participants (147 boys and 130 girls) were randomly selected. Physical activity (PA) was measured with pedometers and aerobic fitness (fitness) with maximal oxygen uptake test on a treadmill. Height, weight, waist circumference (WC), and body mass index (BMI) were measured and percentage body fat (%Fat) assessed with dual energy X-ray absorptiometry. Resting blood pressure (BP) and serum lipids and glucose were measured. RESULTS: According to BMI, 23% of the students were overweight/obese, 20% had elevated WC, and 51% increased %Fat. In addition, 11% of the students had high-density lipoprotein below recommended levels, and 8% had low-density lipoprotein and 9% triglycerides above advised values. Finally, 10% had borderline or high systolic BP. In contrast, 84% of the students had fair or higher levels of fitness, although only 34% reached recommended levels of daily PA. According to %Fat, a higher proportion of boys (33%) than girls (22%) were classified as obese (p=0.042) but a higher proportion of boys (57%) were very fit (57 vs. 24%, p<<0.001). Vocational students had lower levels of fitness (Cohen´s d (Cd)=0.7) and PA (Cd=0.7), and higher %Fat (Cd=0.5), WC (Cd=0.6), and BP (Cd=0.3, p<0.05). CONCLUSION: Although fitness among 18 year old Icelandic high-school students seems generally good, their PA is low and %Fat elevated. Serum lipids and systolic BP are also increased in about 10% of the teenagers. Vocational students measure worse on most metabolic risk factors than traditional students.