How energy balance-related behaviours, temperament, stress and overweight associate: a cross-sectional study of Finnish preschoolers.

OBJECTIVE: This study aimed to (1) examine the clustering of energy balance-related behaviours (EBRB) and (2) investigate whether EBRB clusters, temperament and hair cortisol concentration (HCC) associate with overweight. DESIGN: We assessed food consumption using food records, screen time (ST) using sedentary behaviour diaries, sleep consistency and temperament (negative affectivity, surgency, effortful control) using questionnaires and HCC using hair samples. Accelerometers were used to assess physical activity (PA) intensities, sleep duration and sleep efficiency. Researchers measured each child's weight and height. We used finite mixture models to identify EBRB clusters and multilevel logistic regression models to examine the associations between EBRB clusters, temperament, HCC and overweight. SETTING: The cross-sectional DAGIS survey, data collected in 2015-2016. PARTICIPANTS: Finnish 3-6-year-olds (n 864) recruited through preschools. RESULTS: One-third of the participants were categorised into the cluster labelled 'Unhealthy diet, excessive screen time', characterised by unhealthy dietary choices (e.g. greater consumption of high-fat, high-sugar dairy products) and longer ST. Two-thirds were categorised into the second cluster, labelled 'Healthy diet, moderate screen time'. PA and sleep were irrelevant for clustering. Higher negative affectivity and lower effortful control associated with the 'Unhealthy diet, excessive screen time' cluster. EBRB clusters and HCC did not associate with overweight, but surgency was positively associated with overweight (OR = 1·63, 95 % CI 1·17, 2·25). CONCLUSIONS: Of the EBRB, food consumption and ST seem to associate. As temperament associates with EBRB clusters and overweight, tailored support acknowledging the child's temperament could be profitable in maintaining a healthy weight.

The associations of depressive symptoms and perceived stress with arterial health in adolescents.

Cardiovascular and mental diseases are among the most important global health problems, but little is known on the associations between mental and arterial health in adolescents. Therefore, we investigated the associations of arterial health with depressive symptoms and perceived stress in adolescents. A total of 277 adolescents, 151 boys, 126 girls, aged 15-17 years participated in the study. Depressive symptoms were assessed using the Beck Depression Inventory and perceived stress by the Cohen Perceived Stress Scale. Arterial health was assessed by measures from carotid ultrasonography (carotid intima-media thickness, Young's Elastic Modulus, carotid artery distensibility, stiffness index), impedance cardiography (pulse wave velocity, cardio-ankle vascular index), and pulse contour analysis (reflection index, stiffness index). The data were analyzed using linear regression models adjusted for age and sex. Depressive symptoms or perceived stress were not associated with indices of arterial health in the whole study group (ß = -0.08 to 0.09, p > 0.05), in boys (ß = -0.13 to 0.10, p > 0.05) or in girls (standardized regression coefficient ß = -0.16 to 0.08, p > 0.05). We found no associations of depressive symptoms and perceived stress with arterial health in adolescents. These observations suggest that the association between mental and arterial health problems develop in later life.

Accumulating Sedentary Time and Physical Activity From Childhood to Adolescence and Cardiac Function in Adolescence.

BACKGROUND: Increased physical activity (PA) may mitigate the negative cardiovascular health effects of sedentary behavior in adolescents. However, the relationship of PA and sedentary time from childhood with cardiac function in adolescence remains underexplored. Therefore, we investigated the associations of cumulative sedentary time and PA from childhood to adolescence with cardiac function in adolescence. METHODS AND RESULTS: Participants were 153 adolescents (69 girls) who were aged 6 to 8 years at baseline, 8 to 10 years at 2-year follow-up, and 15 to 17 years at 8-year follow-up. Cumulative sedentary time and PA exposure between baseline and 2-year follow-up and between baseline and 8-year follow-up were measured using a combined accelerometer and heart rate monitor. Cardiac function was assessed using impedance cardiography at 8-year follow-up. The data were analyzed using linear regression analyses adjusted for age and sex. Cumulative moderate to vigorous PA (standardized regression coefficient [ß]=-0.323 [95% CI, -0.527 to -0.119]) and vigorous PA (ß=-0.295 [95% CI, -0.508 to -0.083]) from baseline to 8-year follow-up were inversely associated with cardiac work at 8-year follow-up. Conversely, cumulative sedentary time had a positive association (ß=0.245 [95% CI, 0.092-0.398]). Cumulative vigorous PA from baseline to 8-year follow-up was inversely associated with cardiac work index at 8-year follow-up (ß=-0.218 [95% CI, -0.436 to 0.000]). CONCLUSIONS: Higher levels of sedentary time and lower levels of PA during childhood were associated with higher cardiac work in adolescence, highlighting the importance of increasing PA and reducing sedentary time from childhood.

Comparison of actigraphy-measured and parent-reported sleep in association with weight status among preschool children.

This study compared weekday and weekend actigraphy-measured and parent-reported sleep in relation to weight status among preschool-aged children. Participants were 3-6 years old preschoolers from the cross-sectional DAGIS-study with sleep data for ≥2 weekday and ≥2 weekend nights. Parents-reported sleep onset and wake-up times were gathered alongside 24 h hip-worn actigraphy. An unsupervised Hidden-Markov Model algorithm provided actigraphy-measured night time sleep without the guidance of reported sleep times. Waist-to-height ratio and age-and-sex-specific body mass index characterised weight status. Comparison of methods were assessed with consistency in quintile divisions and Spearman correlations. Associations between sleep and weight status were assessed with adjusted regression models. Participants included 638 children (49% girls) with a mean ± SD age of 4.76 ± 0.89. On weekdays, 98%-99% of actigraphy-measured and parent-reported sleep estimates were classified in the same or adjacent quintile and were strongly correlated (rs = 0.79-0.85, p < 0.001). On weekends, 84%-98% of actigraphy-measured and parent-reported sleep estimates were respectively classified and correlations were moderate to strong (rs = 0.62-0.86, p < 0.001). Compared with actigraphy-measured sleep, parent-reported sleep had consistently earlier onset, later wake-up, and greater duration. Earlier actigraphy-measured weekday sleep onset and midpoint were associated with a higher body mass index (respective ß-estimates: -0.63, p < 0.01 and -0.75, p < 0.01) and waist-to-height ratio (-0.004, p = 0.03 and -0.01, p = 0.02). Though the sleep estimation methods were consistent and correlated, actigraphy measures should be favoured as they are more objective and sensitive to identifying associations between sleep timing and weight status compared with parent reports.

Associations of dietary patterns with common infections and antibiotic use among Finnish preschoolers.

Background: Preschoolers suffer frequently from infections. Although nutrition plays a key role in immune function, very little is known about the impact of overall diet on preschoolers' infections. Objective: To assess the associations between dietary patterns, common infections and antibiotic use among Finnish preschoolers. Design: The study included 721 3-6-year-old preschoolers participating in the cross-sectional DAGIS survey. Parents retrospectively reported the number of common colds, gastroenteritis episodes and antibiotic courses their children had acquired during the past year. Food consumption outside preschool hours was recorded using a food frequency questionnaire. Dietary patterns were derived from the consumption frequencies using principal component analysis. Associations between the thirds of the dietary pattern scores and the outcomes were analysed using logistic and negative binomial regression models. Results: Prevalence of common colds was lower in moderate and high adherence to the sweets-and-treats pattern than in low adherence (prevalence ratio [PR]: 0.89, 95% confidence interval [CI]: 0.80-1.00, and PR: 0.88, 95% CI: 0.79-0.99, respectively) and higher in high adherence to the health-conscious pattern than in low adherence (PR: 1.13, 95% CI: 1.01-1.27) after adjusting for age, sex, number of children living in the same household, frequency of preschool attendance, family's highest education and probiotic use. The risk of ≥1 gastroenteritis episode and the prevalence of antibiotic courses were lower in moderate adherence to the sweets-and-treats pattern than in low adherence (odds ratio [OR]: 0.63, 95% CI: 0.44-0.92 and PR: 0.77, 95% CI: 0.59-1.00, respectively). Conclusions: The results were unexpected. Parents who were most health-conscious of their children's diet might also have been more aware of their children's illness.

The role of parental congruence in pre-school children's screen time, moderated by parental education.

AIM: This study investigated whether parental congruency regarding screen time (ST) is associated with ST in pre-school children. In addition, we investigated whether parental education levels moderated this relationship. METHODS: A cross-sectional study was conducted in 2015-2016 in Finland (N = 688). Parents completed a questionnaire reporting their children's sedentary behaviour, their parental congruency regarding ST rules, and their educational level. Associations were examined using linear regression. RESULTS: Children of parents with higher congruence regarding ST rules engaged in less ST, this was moderated by parental education levels. Children whose parents had a high level of education and parents' who strongly agree or somewhat agree on ST rules was negatively associated with ST. Furthermore, children whose parents had a medium level of education and parents' who strongly agree on ST rules was negatively associated with ST. CONCLUSION: Children of parents who agree on ST rules engaged in less ST compared with children of parents who do not agree on ST rules. Providing advice to parents regarding parental congruency could be the focus of future interventions.

Longitudinal associations of movement behaviours with body composition and physical fitness from 4 to 9 years of age: structural equation and mediation analysis with compositional data.

BACKGROUND: The associations of movement behaviours (physical activity [PA], sedentary behaviour [SB], and sleep) with body composition and physical fitness from pre-school to childhood, as well as the direction of the associations, could provide important information for healthy lifestyle promotion in children. This study investigated the longitudinal and bidirectional associations of movement behaviours with body composition and physical fitness measured at 4 and 9 years of age. METHODS: This longitudinal study included baseline (n = 315, 4.5 [SD = 0.1] years) and follow-up data (n = 231, 9.6 [SD = 0.1] years) from the MINISTOP study. Movement behaviours were measured for 7 days using wrist-worn accelerometers, body composition with air-displacement plethysmography, and physical fitness with the ALPHA health-related fitness test battery. Cross-lagged panel models and mediation analyses were performed in combination with compositional data analysis. RESULTS: We did not observe direct associations of the movement behaviours at 4 years with either body composition or physical fitness at 9 years (all P > 0.05). However, fat mass index at 4 years was negatively associated with vigorous PA (VPA), relative to remaining behaviours (VPA, ß = - 0.22, P = 0.002) and light PA (LPA), relative to SB and sleep (ß = - 0.19, P = 0.016) at 9 years. VPA (relative to remaining), moderate PA (MPA) (relative to LPA, SB, and sleep), and SB (relative to sleep) tracked from 4 to 9 years (all ß ≥ 0.17, all P < 0.002), and these behaviours shared variance with fat mass index (all|ß| ≥ 0.19, all P < 0.019), and aerobic, motor, and muscular fitness (all|ß| ≥ 0.19, all P < 0.014) at 9 years. Mediation analysis suggested that the tracking of VPA (relative to remaining behaviours) from 4 to 9 years was negatively associated with fat mass index (ß ≥ - 0.45, P = 0.012), and positively with aerobic fitness at 9 years (ß ≥ 1.64, P = 0.016). CONCLUSION: PA and SB tracked from the pre-school years into childhood. Fat mass index at 4 years of age was negatively associated with VPA (relative to remaining behaviours) and LPA (relative to SB and sleep) at 9 years of age. The tracking of VPA was associated with lower fat mass index and higher aerobic fitness at 9 years of age. These findings suggest that higher levels of VPA in pre-school age, if maintained throughout childhood, may support the development of healthy body composition and aerobic fitness levels in later childhood.

Cross-sectional associations between physical fitness and biomarkers of inflammation in children-The PANIC study.

BACKGROUND: Systemic low-grade inflammation has been proposed as an underlying pathophysiological mechanism for cardiometabolic diseases. We investigated the associations of physical fitness with a systemic low-grade inflammatory state in a population sample of children. METHODS: Altogether 391 children aged 6-9 years were examined. Cardiorespiratory fitness (maximal power output, Wmax ) was assessed by a maximal cycle ergometer test and neuromuscular fitness by hand grip strength, sit-up, standing long jump, 50-meter shuttle run, static balance, sit-and-reach, and box and block tests. Body fat percentage (BF%) and lean mass (LM) were assessed by dual-energy X-ray absorptiometry (DXA). High sensitivity C-reactive protein (hs-CRP), leptin, leptin receptor, high molecular weight adiponectin (HMW-adiponectin), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and glycoprotein acetyls (GlycA) were assessed from fasting blood samples. The modified inflammatory score (IS) was calculated using the population-specific z-scores and formula (z hs-CRP + z leptin + z IL-6 + z TNF-α + z GlycA)-z leptin receptor-z HMW-adiponectin. The data were analyzed using linear regression analyses. RESULTS: Higher Wmax /kg of body mass (ß = -0.416, 95% CI = -0.514 to -0.318), higher number of completed sit-ups (ß = -0.147, 95% CI = -0.244 to -0.049), a longer distance jumped in the standing long jump test (ß = -0.270, 95% CI = -0.371 to -0.169), and a shorter time in the 50-meter shuttle run test (ß = 0.123, 95% CI = 0.022 to 0.223) were associated with lower IS. None of these associations remained statistically significant after adjustment for BF%. CONCLUSIONS: Higher physical fitness is associated with a more favorable inflammatory biomarker profile in children. However, the associations were explained by BF%.

Effects of the DAGIS randomized controlled trial on home environment and children's food consumption according to the degree of implementation.

BACKGROUND: Combining process evaluation data with effectiveness data and examining the possible mediators of intervention effects elicits valuable knowledge about how and for whom these interventions are effective. The aim of this study was to examine whether the parental degree of implementation (DOI) of a home-involving preschool intervention affected children's food consumption via home mediators. METHODS: The five-month Increased Health and Wellbeing in Preschools (DAGIS) intervention involved 476 participating children aged 3-6 years and was conducted in 2017-2018. Parents reported children's food consumption (g/day) outside childcare hours, the availability of foods at home, role modelling of food consumption, and the norms related to food consumption. In addition, parents reported the extent to which they had implemented the intervention program at home. Mediation analyses were conducted to examine the effect of low and high DOI compared to control group on the change in children's consumption of fruit and vegetables (FV), sugary everyday foods, sugary treats, and sugar-sweetened beverages (SSB) via food availability in the home, parental role modelling and parental norms. RESULTS: Compared to the control group, there was a direct effect of a high DOI on diminishing consumption of SSB (B -27.71, 95% CI -49.05, -4.80). No indirect effects were detected. In the high DOI group, a change in parental norm was associated with increased FV consumption showing an indirect effect (B 4.31, 95% CI 0.23, 10.59). In the low DOI group, there was an indirect effect via decreased food availability leading to decreased sugary everyday food consumption (B -2.17, 95% CI -5.09,  -0.09). CONCLUSIONS: Combining process evaluation and effectiveness data revealed a decrease in children's SSB consumption only in the high DOI group, as well as indirect effects on children's consumption of FV and sugary everyday foods. In order to gain more intervention effects, further studies are required in order to examine parental facilitators and barriers to the implementation of interventions and how to impact effectively the determinants of the targeted behavior. TRIAL REGISTRATION: ISRCTN57165350 (8 January, 2015).

Cross-sectional associations between cardiorespiratory fitness and NMR-derived metabolic biomarkers in children - the PANIC study.

Objective: Cardiorespiratory fitness has been inversely associated with cardiovascular risk across the lifespan. Some studies in adults suggest that higher cardiorespiratory fitness is associated with cardioprotective metabolite profile, but the evidence in children is lacking. Therefore, we investigated the cross-sectional association of cardiorespiratory fitness with serum nuclear magnetic resonance derived metabolic biomarkers in children. Methods: A population sample of 450 children aged 6-8 years was examined. Cardiorespiratory fitness was assessed by a maximal exercise test on a cycle ergometer and quantified as maximal power output normalised for lean body mass assessed by dual-energy X-ray absorbtiometry. Serum metabolites were assessed using a high throughput nuclear magnetic resonance platform. The data were analysed using linear regression analyses adjusted for age and sex and subsequently for body fat percentage (BF%) assessed by DXA. Results: Cardiorespiratory fitness was directly associated with high density lipoprotein (HDL) cholesterol (ß=0.138, 95% CI=0.042 to 0.135, p=0.005), average HDL particle diameter (ß=0.102, 95% CI=0.004 to 0.199, p=0.041), and the concentrations of extra-large HDL particles (ß=0.103, 95% CI=0.006 to 0.201, p=0.038), large HDL particles (ß=0.122, 95% CI=0.025 to 0.220, p=0.014), and medium HDL particles (ß=0.143, 95% CI=0.047 to 0.239, p=0.004) after adjustment for age and sex. Higher cardiorespiratory fitness was also associated with higher concentrations of ApoA1 (ß=0.145, 95% CI=0.047 to 0.242, p=0.003), glutamine (ß=0.161, 95% CI=0.064 to 0.257, p=0.001), and phenylalanine (ß=0.187, 95% CI=0.091 to 0.283, p<0.001). However, only the direct associations of cardiorespiratory fitness with the concentrations of HDL cholesterol (ß=0.114, 95% CI=0.018 to 0.210, p=0.021), medium HDL particles (ß=0.126, 95% CI=0.030 to 0.223, p=0.010), ApoA1 (ß=0.126, 95% CI=0.030 to 0.223, p=0.011), glutamine (ß=0.147, 95% CI=0.050 to 0.224, p=0.003), and phenylalanine (ß=0.217, 95% CI=0.122 to 0.311, p<0.001) remained statistically significant after further adjustment for BF%. Conclusions: Higher cardiorespiratory fitness was associated with a cardioprotective biomarker profile in children. Most associations were independent of BF% suggesting that the differences in serum metabolites between children are driven by cardiorespiratory fitness and not adiposity.

Comparing estimates of physical activity in children across different cut-points and the associations with weight status.

This study aimed to compare sedentary time (SED) and intensity-specific physical activity (PA) estimates and the associations of SED and PA with body mass index (BMI) and waist circumference (WC) using three different sets of cut-points in preschool-aged children. A total of 751 children (4.7 ± 0.9 years, boys 52.7%) wore an ActiGraph GT3X+BT accelerometer on their hip for 7 days (24 h). Euclidean norm -1 G with negative values rounded to zero (ENMO) and activity counts from vertical axis (VACounts) and vector magnitude (VMCounts) were derived. Estimates of SED and light, moderate, vigorous, and moderate-to-vigorous PA (MVPA) were calculated for commonly used cut-points by Hildebrand et al., Butte et al., and Evenson et al. Furthermore, the prevalence of meeting the PA recommendation, 180 min/day of which at least 60 min/day being MVPA, were assessed for the cut-points. Multilevel mixed analysis was used to examine associations of SED and PA with BMI and WC. In accordance with the results, SED and PA intensity estimates differed largely across cut-points (i.e., SED = 22-341 min/day; light PA = 52-257 min/day; moderate PA = 5-18 min/day; vigorous PA = 7-17 min/day; MVPA = 13-35 min/day), and the prevalence of children meeting the PA recommendation varied from 4% to 70%. Associations of SED and PA with BMI or WC varied between the cut-points. Our results indicate that SED and PA estimates in preschool-aged children between studies using these cut-points are poorly comparable. Methods facilitating accelerometer-derived PA estimate comparison between studies are highly warranted.

Body Mass Index, Physical Activity, and Body Image in Adolescents.

Body image dissatisfaction is a concern for adolescents' mental and physical well-being, and the role of body mass index (BMI) and physical activity (PA) in it is still unclear. This study investigates the associations of BMI and PA with body image, separately for boys and girls, in a large sample of Finnish adolescents. We also examine the associations of BMI with body image in varying PA levels. A total of 10,496 adolescents (girls 52.6%) were included in the analyses. Body image was assessed using a pictorial tool, and categorized as wishing for a smaller body, being satisfied, and wishing for a bigger body. BMI (kg/m2) was categorized as thin, normal weight, and overweight/obese. Self-reported PA was divided into three similar-sized categories as low, moderate, and high PA levels. Adjusted ordinal regression analyses were conducted. Our results show that adolescents with thinness had higher odds of wishing for a bigger body compared to their normal-weight peers, while adolescents with overweight/obesity had smaller odds of wishing for a bigger body. Adolescents in low and middle PA levels had lower odds of wishing for a bigger body compared to adolescents in the high PA level. Yet, the PA level modified the associations between BMI and body image, especially in adolescents with thinness and more so in girls than in boys. These findings highlight the need to pay attention to healthy weight gain and PA in adolescents to support their body image satisfaction.

Revisiting the cross-sectional and prospective association of physical activity with body composition and physical fitness in preschoolers: A compositional data approach.

BACKGROUND: Information is limited for the benefits of physical activity (PA) in preschoolers. Previous research using accelerometer-assessed PA may be affected for multicollinearity issues. OBJECTIVES: This study investigated the cross-sectional and prospective associations of sedentary behaviour (SB) and PA with body composition and physical fitness using compositional data analysis. METHODS: Baseline PA and SB were collected in 4-year-old (n = 315) using wrist-worn GT3X+ during seven 24 h-periods. Body composition (air-displacement plethysmography) and physical fitness (PREFIT test battery) were assessed at baseline and at the 12-month follow-up. RESULTS: Increasing vigorous PA at expenses of lower-intensity behaviours for 4-year-old was associated with body composition and physical fitness at cross-sectional and longitudinal levels. For example, reallocating 15 min/day from lower intensities to vigorous PA at baseline was associated with higher fat-free mass index (+0.45 kg/m2 , 95% confidence intervals [CI]: 0.18-0.72 kg/m2 ), higher upper-body strength (+0.6 kg, 95% CI: 0.1-1.19 kg), higher lower-body strength (+8 cm, 95% CI: 3-13 cm), and shorter time in completing the motor fitness test (-0.4 s, 95% CI: -0.82 to [-0.01] s) at the 12-month follow-up. Pairwise reallocations of time indicated that the behaviour replaced was not relevant, as long as vigorous PA was increased. CONCLUSIONS: More time in vigorous PA may imply short- and long-term benefits on body composition and physical fitness in preschoolers. These findings using compositional data analysis corroborate our previously published results using isotemporal substitution models.

Associations of physical activity, sedentary time, and diet quality with biomarkers of inflammation in children.

We investigated the associations of physical activity (PA), sedentary time (ST), and diet quality with biomarkers of inflammation in 390 children (192 girls, 198 boys) aged 6-8 years. PA energy expenditure (PAEE), light PA, moderate PA (MPA), vigorous PA (VPA), moderate-to-vigorous PA (MVPA), and ST were assessed by combined movement and heart rate sensor. Finnish Children Healthy Eating Index was calculated using data from 4 d food records. Body fat percentage (BF%) was measured by dual-energy X-ray absorptiometry. High-sensitivity C-reactive protein (Hs-CRP), leptin, interleukin-6 (IL-6), adiponectin, tumour necrosis factor-α, and glycoprotein acetyls were measured from fasting blood samples. PAEE, MPA, VPA, and MVPA were inversely associated with hs-CRP (ß=-191 to -139, 95% CI=-0.294 to -0.024), leptin (ß=-0.409 to -0.301, 95% CI=-0.499 to -0.107), IL-6 (ß=-0.136 to -0.104, 95% CI=-0.240 to -0.001) and PAEE, MPA, and MVPA were inversely associated with glycoprotein acetyls (ß=-0.117 to -0.103, 95% CI=-0.213 to -0.001). ST was directly associated with hs-CRP (ß=0.170, 95% CI=0.070-0.269), leptin (ß=0.355, 95% CI=0.265-0.445), and IL-6 (ß=0.105, 95% CI=0.005-0.205). VPA was inversely associated with hs-CRP, leptin, and IL-6 in children with higher BF% (ß=-0.344 to -0.181, 95% CI=-0.477 to -0.033) but not among children with lower BF% (ß=-0.007-0.033, 95% CI=-0.183-0.184). In conclusion, PA was inversely and ST directly associated with circulating levels of biomarkers of inflammation among children. Furthermore, we observed that PA was inversely associated with these biomarkers for inflammation in children with a higher BF%. HighlightsSystemic inflammation, as indicated by increased circulating concentrations of biomarkers for inflammation, may be important in causal pathways leading to insulin resistance, sub-clinical atherosclerosis, and eventually clinical manifestations of cardiovascular diseases.Higher levels of physical activity and lower levels of sedentary time were associated with more favourable inflammatory profile.Body fat percentage modified these associations and especially vigorous intensity physical activity was inversely associated with biomarkers of inflammation on children with higher body fat percentage but not in children with lower body fat percentage.

Longitudinal and cross-sectional associations of adherence to 24-hour movement guidelines with cardiometabolic risk.

This study aimed to examine (1) adherence to 24 h movement guidelines over a 2 years follow-up in children aged 6-8 years and (2) association of this adherence with cardiometabolic risk factors. Physical activity and sleep were assessed by a monitor combining heart rate and accelerometry measurements. Screen time was reported by the parents. Body fat percentage, waist circumference, blood glucose, serum insulin, plasma lipids, and blood pressure were assessed, and a cardiometabolic risk score was calculated using z-scores. Children were classified as meeting the guidelines if they had on average ≥60 min/day of moderate-to-vigorous physical activity during the valid days; ≤120 min/day of screen time; and 9-11 h/day of sleep. In total, 485 children had valid data at baseline or at 2 years follow-up. Analyses were conducted using adjusted logistic and linear regression models. Most children adhered to the 24 h movement guidelines at baseline, but the adherence decreased over the 2 years follow-up. Meeting physical activity guidelines individually, or in combination with screen time and/or sleep, was longitudinally associated with a lower cardiometabolic risk score, insulin and waist circumference, and cross-sectionally additionally with lower diastolic blood pressure and higher high-density lipoprotein cholesterol. However, these associations became statistically non-significant after adjustment for body fat. In conclusion, meeting 24 h movement guidelines at baseline increases the odds of meeting them at 2 years follow-up in school-aged children. Furthermore, meeting 24 h movement guidelines is associated with lower levels of cardiometabolic risk factors, but these associations are partly explained by lower body fat. Thus, promoting movement behaviors, especially physical activity, and healthy weight in early childhood is important in supporting cardiometabolic health in children.

Self-reported (IFIS) versus measured physical fitness, and their associations to cardiometabolic risk factors in early pregnancy.

Physical fitness is a strong marker of health, but objective fitness measurements are not always feasible. The International FItness Scale (IFIS) for self-reported fitness is a simple-to-use tool with demonstrated validity and reliability; however, validation in pregnancy needs to be confirmed. Also, its association with cardiometabolic health in pregnant women is unknown. Hence, we examined (1) the validity of the IFIS with objectively measured fitness, and (2) the associations of self-reported versus objectively measured cardiorespiratory fitness (CRF) and muscular strength with cardiometabolic risk factors in early pregnancy. Women (n = 303) from the HealthyMoms trial were measured at gestational week 14 for: CRF (6-min walk test); upper-body muscular strength (handgrip strength test); self-reported fitness (IFIS), body composition (air-displacement plethysmography); blood pressure and metabolic parameters (lipids, glucose, insulin). Higher self-reported fitness was associated with better measured fitness (ANOVA overall p < 0.01 for all fitness types), indicating the usefulness of the IFIS in pregnancy. Furthermore, higher self-reported overall fitness and CRF were associated with lower cardiometabolic risk scores (ANOVA p < 0.001), with similar results shown for measured CRF (ANOVA p < 0.001). The findings suggest that IFIS could be useful to stratify pregnant women in appropriate fitness levels on a population-based level where objective measurement is not possible.

Physical Activity Among Preadolescents Modifies the Long-Term Association Between Sedentary Time Spent Using Digital Media and the Increased Risk of Being Overweight.

BACKGROUND: This study aimed to examine whether sedentary digital media use in preadolescence increases the risk of being overweight 3 years later, and whether this association differs based on preadolescents' leisure-time physical activity (LTPA) levels. METHODS: The authors conducted a 3-year follow-up study among 4661 participants with a mean (SD) age of 11 (1) years at baseline and 14 (1) years at follow-up. A web-based questionnaire assessed sedentary digital media use and LTPA. The authors categorized baseline LTPA duration into 3 levels: 0 to 5 (low), 6 to 8 (moderate), and ≥9 (high) hours per week. In addition, the authors categorized adolescents as normal weight or overweight/obese at follow-up. RESULTS: Greater amounts of sedentary digital media use at baseline associated with an increased risk of being overweight 3 years later even after adjusting for confounders. This only held for preadolescents with low baseline LTPA (OR = 1.14; 95% confidence interval, 1.05-1.24), but not among those with moderate (OR = 1.02; 0.91-1.15) or high (OR = 0.96; 0.85-1.08) LTPA. CONCLUSIONS: Preadolescent LTPA modified the long-term association between sedentary digital media use and being overweight; specifically, 6 hours per week or more of LTPA mitigated the increased risk of being overweight associated with higher amounts of digital media use.

Associations of body composition and physical fitness with gestational diabetes and cardiovascular health in pregnancy: Results from the HealthyMoms trial.

The aim of this study was to examine associations of body composition (fat mass index, % fat mass, fat-free mass index, body mass index) and physical fitness (cardiorespiratory fitness and handgrip strength) with gestational diabetes and cardiovascular health in early pregnancy. This cross-sectional study utilized baseline data (n = 303) collected in early pregnancy from the HealthyMoms trial. Body composition was measured using air-displacement plethysmography, cardiorespiratory fitness was assessed by means of the 6-min walk test and handgrip strength using a dynamometer. Logistic regression was used to estimate odds ratios (ORs) for gestational diabetes as well as high (defined as 1 SD above the mean) blood pressure, homeostatic model assessment for insulin resistance (HOMA-IR), and metabolic syndrome score (MetS score) per 1 SD increase in body composition and fitness variables. Fat mass index, % fat mass and body mass index were all strongly associated with gestational diabetes (ORs: 1.72-2.14, P ≤ 0.003), HOMA-IR (ORs: 3.01-3.80, P < 0.001), blood pressure (ORs: 1.81-2.05, P < 0.001) and MetS score (ORs: 3.29-3.71, P < 0.001). Associations with fat-free mass index were considerably weaker (ORs: 1.26-1.82, P = 0.001-0.15) and were strongly attenuated after adjustments for fat mass index (ORs: 0.88-1.54, P = 0.039-0.68). Finally, greater cardiorespiratory fitness was associated with lower risk of high HOMA-IR and MetS score (ORs: 0.57-0.63, P ≤ 0.004) although these associations were attenuated when accounting for fat mass index (ORs: 1.08-1.11, P ≥ 0.61). In conclusion, accurately measured fat mass index or % fat mass were strongly associated with gestational diabetes risk and markers of cardiovascular health although associations were not stronger than the corresponding ones for body mass index. Fat-free mass index had only weak associations with gestational diabetes and cardiovascular health which support that the focus during clinical care would be on excess fat mass and not fat-free mass.

Temperament, physical activity and sedentary time in preschoolers - the DAGIS study.

BACKGROUND: Identifying individual characteristics linked with physical activity (PA) and sedentary time (SED) can assist in designing health-enhancing interventions for children. We examined cross-sectional associations of temperament characteristics with 1) PA and SED and 2) meeting the PA recommendation in Finnish children. METHODS: Altogether, 697 children (age: 4.7 ± 0.9 years, 51.6% boys) within the Increased Health and Wellbeing in Preschools (DAGIS) study were included. Parents responded to the Very Short Form of the Children's Behavior Questionnaire consisting of three temperament dimensions: surgency, negative affectivity, and effortful control. PA and SED were assessed for 7 days (24 h per day) using a hip-worn ActiGraph accelerometer, and the daily minutes spent in light PA (LPA), moderate PA (MPA), vigorous PA (VPA), and SED were calculated. The PA recommendation was defined as having PA at least 180 min/day, of which at least 60 min/day was in moderate-to-vigorous PA. Adjusted linear and logistic regression analyses were applied. RESULTS: Surgency was associated with LPA (B = 3.80, p = 0.004), MPA (B = 4.87, p < 0.001), VPA (B = 2.91, p < 0.001), SED (B = - 11.45, p < 0.001), and higher odds of meeting the PA recommendation (OR = 1.56, p < 0.001). Effortful control was associated with MPA (B = - 3.63, p < 0.001), VPA (B = - 2.50, p < 0.001), SED (B = 8.66, p < 0.001), and lower odds of meeting the PA recommendation (OR = 0.61, p = 0.004). Negative affectivity was not associated with PA, SED, or meeting the PA recommendation. CONCLUSION: Children's temperament should be considered when promoting PA in preschoolers. Special attention should be paid to children scoring high in the temperament dimension effortful control.

Effectiveness of a Smartphone App to Promote Healthy Weight Gain, Diet, and Physical Activity During Pregnancy (HealthyMoms): Randomized Controlled Trial.

BACKGROUND: Excessive gestational weight gain (GWG) during pregnancy is a major public health concern associated with negative health outcomes for both mother and child. Scalable interventions are needed, and digital interventions have the potential to reach many women and promote healthy GWG. Most previous studies of digital interventions have been small pilot studies or have not included women from all BMI categories. We therefore examined the effectiveness of a smartphone app in a large sample (n=305) covering all BMI categories. OBJECTIVE: To investigate the effectiveness of a 6-month intervention (the HealthyMoms app) on GWG, body fatness, dietary habits, moderate-to-vigorous physical activity (MVPA), glycemia, and insulin resistance in comparison to standard maternity care. METHODS: A 2-arm parallel randomized controlled trial was conducted. Women in early pregnancy at maternity clinics in Östergötland, Sweden, were recruited. Eligible women who provided written informed consent completed baseline measures, before being randomized in a 1:1 ratio to either an intervention (n=152) or control group (n=153). The control group received standard maternity care while the intervention group received the HealthyMoms smartphone app for 6 months (which includes multiple features, eg, information; push notifications; self-monitoring; and feedback features for GWG, diet, and physical activity) in addition to standard care. Outcome measures were assessed at Linköping University Hospital at baseline (mean 13.9 [SD 0.7] gestational weeks) and follow-up (mean 36.4 [SD 0.4] gestational weeks). The primary outcome was GWG and secondary outcomes were body fatness (Bod Pod), dietary habits (Swedish Healthy Eating Index) using the web-based 3-day dietary record Riksmaten FLEX, MVPA using the ActiGraph wGT3x-BT accelerometer, glycemia, and insulin resistance. RESULTS: Overall, we found no statistically significant effect on GWG (P=.62); however, the data indicate that the effect of the intervention differed by pre-pregnancy BMI, as women with overweight and obesity before pregnancy gained less weight in the intervention group as compared with the control group in the imputed analyses (-1.33 kg; 95% CI -2.92 to 0.26; P=.10) and completers-only analyses (-1.67 kg; 95% CI -3.26 to -0.09; P=.031]). Bayesian analyses showed that there was a 99% probability of any intervention effect on GWG among women with overweight and obesity, and an 81% probability that this effect was over 1 kg. The intervention group had higher scores for the Swedish Healthy Eating Index at follow-up than the control group (0.27; 95% CI 0.05-0.50; P=.017). We observed no statistically significant differences in body fatness, MVPA, glycemia, and insulin resistance between the intervention and control group at follow up (P≥.21). CONCLUSIONS: Although we found no overall effect on GWG, our results demonstrate the potential of a smartphone app (HealthyMoms) to promote healthy dietary behaviors as well as to decrease weight gain during pregnancy in women with overweight and obesity. TRIAL REGISTRATION: ClinicalTrials.gov NCT03298555; https://clinicaltrials.gov/ct2/show/NCT03298555. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/13011.