Educational attainment and mental health conditions: a within-sibship Mendelian randomization study.

Importance: Observational studies have demonstrated consistent protective effects of higher educational attainment (EA) on the risk of suffering mental health conditions (MHC). Determining whether these beneficial effects are causal is challenging given the potential role of dynastic effects and demographic factors (assortative mating and population structure) in this association. Objective: To evaluate to what extent the relationship between EA and various MHC is independent from dynastic effects and demographic factors. Design: Within-sibship Mendelian randomization (MR) study. Setting: One-sample MR analyses included participants' data from the Trøndelag Health Study (HUNT, Norway) and UK Biobank (United Kingdom). For two-sample MR analyses we used summary statistics from publicly available genome-wide-association-studies. Participants: 61 880 siblings (27 507 sibships). Exposure: Years of education. Main outcomes: Scores for symptoms of anxiety, depression and neuroticism using the Hospital Anxiety Depression Scale (HADS), the 7-item Generalized Anxiety Disorder Scale (GAD-7), the 9-item Patient Health Questionnaire (PHQ-9), and the Eysenck Personality Questionnaire, as well as self-reported consumption of psychotropic medication. Results: One standard deviation (SD) unit increase in years of education was associated with a lower symptom score of anxiety (-0.20 SD [95%CI: -0.26, -0.14]), depression (-0.11 SD [-0.43, 0.22]), neuroticism (-0.30 SD [-0.53, -0.06]), and lower odds of psychotropic medication consumption (OR: 0.60 [0.52, 0.69]). Estimates from the within-sibship MR analyses showed some attenuation, which however were suggestive of a causal association (anxiety: -0.17 SD [-0.33, -0.00]; depression: -0.18 SD [-1.26, 0.89]; neuroticism: -0.29 SD [-0.43, -0.15]); psychotropic medication consumption: OR, 0.52 [0.34, 0.82]). Conclusions and Relevance: Associations between EA and MHC in adulthood, although to some extend explained by dynastic effects and demographic factors, overall remain robust, indicative of a causal effect. However, larger studies are warranted to improve statistical power and further validate our conclusions. Key points: Question: Are the protective effects of higher educational attainment on the risk of suffering mental health conditions independent from familial (i.e.,dynastic effects) and demographic factors (i.e., assortative mating and population structure)?Findings: Although to some extend explained by familial and demographic factors, overall the protective effects of higher educational attainment remain robust.Meaning: Our findings are consistent with those of previous observational studies, which suggests that higher educational attainment may causally reduce the risk of suffering a mental health condition.

Associations of lipoprotein particle profile and objectively measured physical activity and sedentary time in schoolchildren: a prospective cohort study.

BACKGROUND: Our understanding of the mechanisms through which physical activity might benefit lipoprotein metabolism is inadequate. Here we characterise the continuous associations between physical activity of different intensities, sedentary time, and a comprehensive lipoprotein particle profile. METHODS: Our cohort included 762 fifth grade (mean [SD] age = 10.0 [0.3] y) Norwegian schoolchildren (49.6% girls) measured on two separate occasions across one school year. We used targeted proton nuclear magnetic resonance (1H NMR) spectroscopy to produce 57 lipoprotein measures from fasted blood serum samples. The children wore accelerometers for seven consecutive days to record time spent in light-, moderate-, and vigorous-intensity physical activity, and sedentary time. We used separate multivariable linear regression models to analyse associations between the device-measured activity variables-modelled both prospectively (baseline value) and as change scores (follow-up minus baseline value)-and each lipoprotein measure at follow-up. RESULTS: Higher baseline levels of moderate-intensity and vigorous-intensity physical activity were associated with a favourable lipoprotein particle profile at follow-up. The strongest associations were with the larger subclasses of triglyceride-rich lipoproteins. Sedentary time was associated with an unfavourable lipoprotein particle profile, the pattern of associations being the inverse of those in the moderate-intensity and vigorous-intensity physical activity analyses. The associations with light-intensity physical activity were more modest; those of the change models were weak. CONCLUSION: We provide evidence of a prospective association between time spent active or sedentary and lipoprotein metabolism in schoolchildren. Change in activity levels across the school year is of limited influence in our young, healthy cohort. TRIAL REGISTRATION: ClinicalTrials.gov , # NCT02132494 . Registered 7th April 2014.

Cross-sectional and prospective associations between aerobic fitness and lipoprotein particle profile in a cohort of Norwegian schoolchildren.

BACKGROUND AND AIMS: The associations between aerobic fitness and traditional measures of lipid metabolism in children are uncertain. We investigated whether higher levels of aerobic fitness benefit lipoprotein metabolism by exploring associations with a comprehensive lipoprotein particle profile. METHODS: In our prospective cohort study, we used targeted proton nuclear magnetic resonance (1H NMR) spectroscopy to profile 57 measures of lipoprotein metabolism from fasting serum samples of 858 fifth-grade Norwegian schoolchildren (49.0% girls; mean age 10.0 years). Aerobic fitness was measured using an intermittent shuttle run aerobic fitness test. We used multiple linear regression adjusted for potential confounders to examine cross-sectional and prospective associations between aerobic fitness and lipoprotein particle profile. RESULTS: Higher levels of aerobic fitness were associated with a favourable lipoprotein particle profile in the cross-sectional analysis, which included inverse associations with all measures of very low-density lipoprotein (VLDL) particles (e.g., -0.06 mmol·L-1 or -0.23 SD units; 95% CI = -0.31, -0.16 for VLDL cholesterol concentration). In the prospective analysis, the favourable pattern of associations persisted, though the individual associations tended to be more consistent with those of the cross-sectional analysis for the VLDL subclass measures compared to the low-density lipoproteins and high-density lipoproteins. Adjustment for adiposity attenuated the associations in both cross-sectional and prospective models. Nevertheless, an independent effect of aerobic fitness remained for some measures. CONCLUSIONS: Improving children's aerobic fitness levels should benefit lipoprotein metabolism, though a concomitant reduction in adiposity would likely potentiate this effect.

Associations of physical activity and sedentary time with lipoprotein subclasses in Norwegian schoolchildren: The Active Smarter Kids (ASK) study.

BACKGROUND AND AIMS: Physical activity is favourably associated with certain markers of lipid metabolism. The relationship of physical activity with lipoprotein particle profiles in children is not known. Here we examine cross-sectional associations between objectively measured physical activity and sedentary time with serum markers of lipoprotein metabolism. METHODS: Our cohort included 880 children (49.0% girls, mean age 10.2 years). Physical activity intensity and time spent sedentary were measured objectively using accelerometers. 30 measures of lipoprotein metabolism were quantified using nuclear magnetic resonance spectroscopy. Multiple linear regression models adjusted for age, sex, sexual maturity and socioeconomic status were used to determine associations of physical activity and sedentary time with lipoprotein measures. Additional models were adjusted for adiposity. Isotemporal substitution models quantified theoretical associations of replacing 30 min of sedentary time with 30 min of moderate- to vigorous-intensity physical activity (MVPA). RESULTS: Time spent in MVPA was associated with a favourable lipoprotein profile independent of sedentary time. There were inverse associations with a number of lipoprotein measures, including most apolipoprotein B-containing lipoprotein subclasses and triglyceride measures, the ratio of total to high-density lipoprotein (HDL) cholesterol, and non-HDL cholesterol concentration. There were positive associations with larger HDL subclasses, HDL cholesterol concentration and particle size. Reallocating 30 min of sedentary time to MVPA had broadly similar associations. Sedentary time was only partly and weakly associated with an unfavourable lipoprotein profile. CONCLUSIONS: Physical activity of at least moderate-intensity is associated with a favourable lipoprotein profile in schoolchildren, independent of time spent sedentary, adiposity and other confounders.

Physical Activity in the Prevention of Weight Gain: the Impact of Measurement and Interpretation of Associations.

PURPOSE OF REVIEW: To what extent do different methods of physical activity measurement and statistical analysis influence the reported associations between physical activity and weight gain? RECENT FINDINGS: The obesity epidemic has led to a focus on lifestyle approaches to the prevention of weight gain. Physical activity is one such approach. A number of studies have reported beneficial associations between higher levels of physical activity and weight gain at the population level. However, limitations of physical activity measurement and analytical models in some of these studies are likely to have resulted in overestimation of the strength of association. Understanding the limitations of assessment methods and analytical models used in epidemiological research should facilitate more realistic appraisal for physical activity to prevent weight gain at the population level and inform approaches to future research.

The biomechanical differences between barefoot and shod distance running: a systematic review and preliminary meta-analysis.

BACKGROUND: Distance running continues to experience increased participation in the Western world, although it is associated with high injury rates. Barefoot running has been increasingly proposed as a means to prevent overuse injury due to various biomechanical differences, including reduced joint loading rates and altered kinematics and muscle activity patterns compared to shod running. OBJECTIVE: The aim of this review was to systematically evaluate biomechanical differences between running barefoot and shod, including the quality of available evidence, in order to provide guidance on the phenomenon of barefoot running to the running and sports medicine communities. DATA SOURCES: A comprehensive search of MEDLINE, Web of Knowledge and EMBASE from inception to January 2013 was performed. STUDY SELECTION: Trials evaluating injury-free recreational or competitive adults who participate in long-distance running (≥5 km), where a comparison of barefoot and shod running lower-limb kinetics, kinematics and/or electromyography were included. Studies examining sprinting and studies of single-subject design were excluded. STUDY APPRAISAL AND SYNTHESIS METHODS: Following initial searching, two reviewers identified a shortlist of relevant studies based on title and abstract, with the full text of these studies being tested against the inclusion criteria. References of included studies were examined and citation tracking was performed in Web of Knowledge. Two independent reviewers evaluated the methodological quality of each included study using a modified version of the Downs and Black quality index. Results of the quality assessment were used to identify high- and low-quality studies, data pooling was completed where possible and levels of evidence were determined based on the van Tulder criteria. RESULTS: Eighteen studies were identified, all of low methodological quality. Effect size (ES) calculation was possible for 12 studies. Pooled results indicate moderate evidence that barefoot running is associated with reduced peak ground reaction force (GRF), increased foot and ankle plantarflexion and increased knee flexion at ground contact compared with running in a neutral shoe. Limited evidence indicates barefoot running is associated with reduced impact GRF, reduced peak knee flexion and varus joint moments, and a higher stride frequency compared to a neutral shoe. Very limited to limited evidence also indicates power absorption at the knee is decreased while being increased at the ankle whilst barefoot running. Additionally, the effects of barefoot running on loading rate appear dependent on strike pattern adopted, with a forefoot strike pattern found to reduce loading rate, whilst a rearfoot strike pattern increases loading rate when running barefoot compared to shod. LIMITATIONS: Key methodological weaknesses that must be addressed in future research were identified. Of particular note were absence of investigator blinding, infrequent intervention randomisation, small sample sizes and lack of evaluation following habituation. Two studies could not be retrieved because of publication in a non-English-language journal. Of particular note is that the validity of the body of work is compromised by the lack of evaluation after habituation, or re-training, of previously shod rearfoot-striking runners to barefoot forefoot-striking running styles. CONCLUSIONS: There has been a great deal of publicity for barefoot running, and many claims made about its effects and risks. Despite a large amount of biomechanical data available for meta-analysis, clear guidance for clinical practice is limited because of the low methodological quality of the associated studies. Preliminary biomechanical differences identified suggest barefoot running may be associated with positive biomechanical changes in regards to injury prevention, although this may be dependent on strike pattern adopted. Further research employing more robust methodology, which addresses weaknesses highlighted in this review, is needed to confirm current preliminary evidence. Additionally, prospective research would have higher validity were the biomechanical effects of habituating to barefoot running fully examined alongside an evaluation of prevention of repetitive use injury.