Publications by authors named "Jardena J Puder"

95 Publications

The utility of diagnostic tests in the detection and prediction of glucose intolerance in the early and late postpartum period in women after gestational diabetes: a longitudinal cohort study.

Diabetol Metab Syndr 2021 Mar 17;13(1):31. Epub 2021 Mar 17.

Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne Switzerland Avenue de la Sallaz, CH-1011, Lausanne, Switzerland.

Background: Due to diverging international recommendations, the unclear role of HbA1c and the lack of longitudinal data, we investigated the accuracy of diagnostic tests in the early and late postpartum in women with gestational diabetes (GDM) especially to predict future glucose-intolerance.

Methods: This longitudinal cohort included 967 women with GDM from 2011 to 2020. A 75-g oGTT and HbA1c were performed at 4-12 weeks (early) postpartum. FPG and HbA1c were measured at 1 and 3-year (late) postpartum. ADA criteria were used as gold standards. At all time-points (4-12 weeks, 1-year and 3-year postpartum) women with diabetes and prediabetes were grouped together and referred to as glucose-intolerant, because at most 3% of the entire cohort population had diabetes at any time-point.

Results: The prevalence of glucose-intolerance in the early postpartum was higher using FPG and HbA1c (27.5%) than oGTT criteria (18.2%). Only 48-80% of women diagnosed with glucose-intolerance in the early postpartum actually remained intolerant. This was especially low when FPG or oGTT were combined with HbA1c (1-year: ≤ 62% and 3-years: ≤ 50%). Regardless of the test used, 1/3 of women with initially normal glucose-tolerance became glucose-intolerant in the late postpartum. HbA1c was unrelated to iron status/intake, remained stable throughout, but poorly predicted future glucose-intolerance. In the longitudinal analyses, all diagnostic tests in the early postpartum showed acceptable specificities (74-96%) but poor sensitivities (all < 38%) to predict glucose-intolerance after only 10-months. At 1-year postpartum however, the combination of FPG and HbA1c could best predict glucose-intolerance 2-years later.

Conclusions: Combining FPG with HbA1c at 1-year postpartum represents a reliable choice to predict future glucose-intolerance. Given the poor prediction of tests including oGTT in the early postpartum, focus should rather be on continuous long-term screening.
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http://dx.doi.org/10.1186/s13098-021-00650-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7966915PMC
March 2021

Children's moderate-to-vigorous physical activity on weekdays versus weekend days: a multi-country analysis.

Int J Behav Nutr Phys Act 2021 02 10;18(1):28. Epub 2021 Feb 10.

MRC Epidemiology Unit & Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK.

Purpose: The Structured Days Hypothesis (SDH) posits that children's behaviors associated with obesity - such as physical activity - are more favorable on days that contain more 'structure' (i.e., a pre-planned, segmented, and adult-supervised environment) such as school weekdays, compared to days with less structure, such as weekend days. The purpose of this study was to compare children's moderate-to-vigorous physical activity (MVPA) levels on weekdays versus weekend days using a large, multi-country, accelerometer-measured physical activity dataset.

Methods: Data were received from the International Children's Accelerometer Database (ICAD) July 2019. The ICAD inclusion criteria for a valid day of wear, only non-intervention data (e.g., baseline intervention data), children with at least 1 weekday and 1 weekend day, and ICAD studies with data collected exclusively during school months, were included for analyses. Mixed effects models accounting for the nested nature of the data (i.e., days within children) assessed MVPA minutes per day (min/day MVPA) differences between weekdays and weekend days by region/country, adjusted for age, sex, and total wear time. Separate meta-analytical models explored differences by age and country/region for sex and child weight-status.

Results/findings: Valid data from 15 studies representing 5794 children (61% female, 10.7 ± 2.1 yrs., 24% with overweight/obesity) and 35,263 days of valid accelerometer data from 5 distinct countries/regions were used. Boys and girls accumulated 12.6 min/day (95% CI: 9.0, 16.2) and 9.4 min/day (95% CI: 7.2, 11.6) more MVPA on weekdays versus weekend days, respectively. Children from mainland Europe had the largest differences (17.1 min/day more MVPA on weekdays versus weekend days, 95% CI: 15.3, 19.0) compared to the other countries/regions. Children who were classified as overweight/obese or normal weight/underweight accumulated 9.5 min/day (95% CI: 6.9, 12.2) and 10.9 min/day (95% CI: 8.3, 13.5) of additional MVPA on weekdays versus weekend days, respectively.

Conclusions: Children from multiple countries/regions accumulated significantly more MVPA on weekdays versus weekend days during school months. This finding aligns with the SDH and warrants future intervention studies to prioritize less-structured days, such as weekend days, and to consider providing opportunities for all children to access additional opportunities to be active.
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http://dx.doi.org/10.1186/s12966-021-01095-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7877033PMC
February 2021

Assessing the efficacy and impact of a personalised smoking cessation intervention among type 2 diabetic smokers: study protocol for an open-label randomised controlled trial (DISCGO-RCT).

BMJ Open 2020 11 19;10(11):e040117. Epub 2020 Nov 19.

Service of Obstetrics, Department Woman Mother Child, University Hospital of Lausanne, Lausanne, Vaud, Switzerland.

Introduction: Few studies have assessed the efficacy of smoking cessation interventions in individuals with type 2 diabetes, but interventions adapted to the specific needs of this population are warranted. The aim of this study is to assess the efficacy of a smoking cessation intervention in a population of smokers with type 2 diabetes and to measure the metabolic impact of smoking cessation.

Methods And Analysis: The study is an open-label, randomised control trial. Participants recruited from a sanitary region of Switzerland will be randomly allocated to either the intervention or the control arm. The intervention group will have four individual counselling sessions over 12 weeks. Trained research nurses will conduct the behavioural intervention, using motivational interviews and addressing diabetes and gender specificities. The control group will have one short counselling session at baseline and will be given written information on smoking cessation. Both groups will have a follow-up visit at 26 and 52 weeks. Demographic and medical data will be collected at baseline and follow-up, along with blood and urine samples. The primary study outcome is continuous smoking abstinence validated by expired-air carbon monoxide from week 12 to week 52. Secondary study outcomes are continuous and 7-day point prevalence smoking abstinence at 12 and 26 weeks; change in motivation to quit and cigarette consumption; and change in glycosylated haemoglobin levels, body weight, waist circumference and renal function after smoking cessation. In a subsample of 80 participants, change in stool microbiota from baseline will be measured at 3, 8 and 26 weeks after smoking cessation.

Ethics And Dissemination: Ethical approval has been obtained by the competent ethics committee (Commission cantonale d'éthique de la recherche sur l'être humain, CER-VD 2017-00812). The results of the study will be disseminated through publications in peer-reviewed journals and conference presentations.

Trial Registration Numbers: ClinicalTrials.gov NCT03426423 and SNCTP000002762; Pre-results.
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http://dx.doi.org/10.1136/bmjopen-2020-040117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7678377PMC
November 2020

Mental health and its associations with glucose-lowering medication in women with gestational diabetes mellitus. A prospective clinical cohort study.

Psychoneuroendocrinology 2021 Feb 1;124:105095. Epub 2020 Dec 1.

Obstetric Service, Woman-Mother-Child Department, Lausanne University Hospital, Avenue Pierre-Decker 2, 1011 Lausanne, Switzerland. Electronic address:

Aims: Mental health symptoms are frequent in women with gestational diabetes mellitus (GDM) and may influence glycemic control. We therefore investigated if mental health symptoms (high depression and low well-being scores) predicted a need for glucose-lowering medication and if this use of medication influenced the trajectory of mental health during pregnancy and in the postpartum period.

Methods: We included 341 pregnant women from a cohort of GDM women in a Swiss University Hospital. The World Health Organization Well-being Index-Five was collected at the first and last GDM and at the postpartum clinical visits and the Edinburgh Postnatal Depression Scale at the first GDM and the postpartum clinical visits. Medication intake was extracted from participants' medical records. We conducted linear and logistic regressions with depression as an interaction factor.

Results: Mental health symptoms did not predict a need for medication (all p ≥ 0.29). Mental health improved over time (both p ≤ 0.001) and use of medication did not predict this change (all p ≥ 0.40). In women with symptoms of depression, medication was associated with less improvement in well-being at the postpartum clinical visit (p for interaction=0.013).

Conclusions: Mental health and glucose-lowering medication did not influence each other in an unfavourable way in this cohort of women with GDM.
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http://dx.doi.org/10.1016/j.psyneuen.2020.105095DOI Listing
February 2021

Predictors and consequences of weight retention in the early and late postpartum period in women with gestational diabetes.

Diabetes Res Clin Pract 2020 Jul 2;165:108238. Epub 2020 Jun 2.

Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland. Electronic address:

Aims: To assist preventive strategies, we investigated the predictors and consequences of postpartum weight retention (PPWR) in the early and late postpartum period in women with gestational diabetes (GDM).

Methods: 862 women with GDM between 2011 and 2019 were prospectively included. We investigated PPWR at 6-8 weeks (n = 862) and at 1-year (n = 259) postpartum. Potential predictors included gestational weight gain (GWG), weight, BMI, and glucose control parameters during and after pregnancy.

Results: Mean PPWR at 6-8 weeks and 1-year postpartum were 4.6 ± 5.7 kg and 4.0 ± 7.4 kg. The proportion of women with PPWR at 6-8 weeks and at 1-year postpartum were 81% and 66.4% respectively. At 6-8 weeks postpartum, women with PPWR had higher pre-pregnancy weight, 7.5 ± 0.2 kg higher GWG and higher postpartum weight (all p ≤ 0.02), without presenting metabolic differences. At 1-year postpartum, there were no differences in anthropometric parameters before and during pregnancy between women with or without PPWR, except for a 4 ± 0.4 kg higher GWG (p < 0.001). However, women with PPWR had increased postpartum weight and BMI, higher fasting glucose and more pronounced increase in Δfasting glucose and ΔHbA1c at 1-year postpartum (all p ≤ 0.03). GWG predicted higher PPWR at both 6-8 weeks and at 1-year postpartum (all p < 0.001).

Conclusion: Women with PPWR had increased anthropometric parameters and adverse metabolic consequences at 1-year postpartum. GWG was the most relevant predictor of PPWR.
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http://dx.doi.org/10.1016/j.diabres.2020.108238DOI Listing
July 2020

Cardiac vagal tone in preschool children: Interrelations and the role of stress exposure.

Int J Psychophysiol 2020 06 14;152:102-109. Epub 2020 Apr 14.

Clinical Psychology and Psychotherapy, Department of Psychology, University of Fribourg, Fribourg, Switzerland. Electronic address:

Introduction: Cardiac vagal tone has been understood as the biological correlate of emotion regulation and can be divided into emotion regulation (tonic cardiac vagal tone (TCVT)) and the flexibility to adapt to changing conditions (phasic cardiac vagal tone (PCVT)). There is evidence that TCVT influences PCVT dynamics in adults and that stress exposure impacts on cardiac vagal tone in adults and older children. The aim of the study was to investigate the impact of TCVT on PCVT dynamics in preschoolers and to identify the influence of stress exposures on cardiac vagal tone.

Method: Measures of heart rate variability including baseline (TCVT), during an age-adapted stress task (PCVT stress reactivity) and during recovery (PCVT recovery) were assessed in 222 children aged 2-6 years of the SPLASHY study. Further, parents were asked to complete questionnaires on early stress exposure (including pregnancy, birth and early life) and current stress exposure (including family stress and parenting).

Results: Preschool children with high TCVT showed less PCVT reactivity (p < 0.001) and more increase of vagal tone (PCVT) during early recovery (p = 0.016). Further only child's low birth weight was a relevant stress exposure impacting on early and late PCVT recovery (p = 0.03/p = 0.005). None of the other early or late stress exposure conditions, nor the accumulation of stress exposures influenced TCVT or PCVT dynamics in these healthy preschoolers.

Discussion: TCVT impacts on PCVT dynamics in a lab-based stress task in healthy preschool children and only low birth weight is related to more change during early and to less late PCVT recovery.
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http://dx.doi.org/10.1016/j.ijpsycho.2020.04.006DOI Listing
June 2020

Variations in accelerometry measured physical activity and sedentary time across Europe - harmonized analyses of 47,497 children and adolescents.

Int J Behav Nutr Phys Act 2020 03 18;17(1):38. Epub 2020 Mar 18.

Department of Sports Medicine, Norwegian School of Sport Sciences, PO Box 4014, Ullevål Stadion, 0806, Oslo, Norway.

Background: Levels of physical activity and variation in physical activity and sedentary time by place and person in European children and adolescents are largely unknown. The objective of the study was to assess the variations in objectively measured physical activity and sedentary time in children and adolescents across Europe.

Methods: Six databases were systematically searched to identify pan-European and national data sets on physical activity and sedentary time assessed by the same accelerometer in children (2 to 9.9 years) and adolescents (≥10 to 18 years). We harmonized individual-level data by reprocessing hip-worn raw accelerometer data files from 30 different studies conducted between 1997 and 2014, representing 47,497 individuals (2-18 years) from 18 different European countries.

Results: Overall, a maximum of 29% (95% CI: 25, 33) of children and 29% (95% CI: 25, 32) of adolescents were categorized as sufficiently physically active. We observed substantial country- and region-specific differences in physical activity and sedentary time, with lower physical activity levels and prevalence estimates in Southern European countries. Boys were more active and less sedentary in all age-categories. The onset of age-related lowering or leveling-off of physical activity and increase in sedentary time seems to become apparent at around 6 to 7 years of age.

Conclusions: Two third of European children and adolescents are not sufficiently active. Our findings suggest substantial gender-, country- and region-specific differences in physical activity. These results should encourage policymakers, governments, and local and national stakeholders to take action to facilitate an increase in the physical activity levels of young people across Europe.
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http://dx.doi.org/10.1186/s12966-020-00930-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7079516PMC
March 2020

Motor Competence and Physical Activity in Early Childhood: Stability and Relationship.

Front Public Health 2020 21;8:39. Epub 2020 Feb 21.

Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.

Normal motor development and adequate levels of physical activity engagement during the early years of life form the foundation of long-term psychological and physiological health. This is one of the very few studies that investigate the stability and relationships of motor competence and physical activity in preschool children. Baseline and 12 month follow-up data of physical activity and motor competence of 550 preschool children aged 2-6 years from the Swiss Preschoolers' Health Study were used for this work. Physical activity data, expressed in counts per minute for total physical activity and minutes per day for time spent moderately-to-vigorously physically active, were collected over 1 week using accelerometers. Motor competence was assessed with the Zurich Neuromotor Assessment. Both motor competence and physical activity were age- and sex-adjusted. To examine the individual stability of physical activity and motor competence and reciprocal cross-sectional and longitudinal effects between these two domains, a latent variable cross-lagged panel model where motor competence was represented through a latent construct was examined using structural equation modeling. A weak cross-sectional correlation of motor competence with total physical activity ( = 0.24) and moderate-to-vigorous physical activity ( = 0.23) was found. Motor competence exhibited high stability (β = 0.82) in the preschool years and physical activity was moderately stable with estimates ranging from β = 0.37 for total physical activity to β = 0.48 for moderate-to-vigorous physical activity. In contrast to the autoregressive coefficients denoting individual stability, both cross-lagged effects were negligible indicating that physical activity was not a determinant of motor competence or vice versa. Motor competence and physical activity developed independently of each other in early childhood. Although measures of quantity and intensity of physical activity were not related to motor development, specific movement experiences and practice-which are not reflected by accelerometry-may be needed for skill development. Future research should focus on examining what type of physical activity is important for motor development and how to assess it, and also whether the relationship between physical activity and motor competence evolves over time. Current Controlled Trials ISRCTN41045021 (date of registration: 21.03.14).
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http://dx.doi.org/10.3389/fpubh.2020.00039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047434PMC
February 2020

Potentially modifiable predictors of adverse neonatal and maternal outcomes in pregnancies with gestational diabetes mellitus: can they help for future risk stratification and risk-adapted patient care?

BMC Pregnancy Childbirth 2019 Dec 4;19(1):469. Epub 2019 Dec 4.

Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.

Background: Gestational diabetes mellitus (GDM) exposes mothers and their offspring to short and long-term complications. The objective of this study was to identify the importance of potentially modifiable predictors of adverse outcomes in pregnancies with GDM. We also aimed to assess the relationship between maternal predictors and pregnancy outcomes depending on HbA1c values and to provide a risk stratification for adverse pregnancy outcomes according to the prepregnancy BMI (Body mass index) and HbA1c at the 1st booking.

Methods: This prospective study included 576 patients with GDM. Predictors were prepregnancy BMI, gestational weight gain (GWG), excessive weight gain, fasting, 1 and 2-h glucose values after the 75 g oral glucose challenge test (oGTT), HbA1c at the 1st GDM booking and at the end of pregnancy and maternal treatment requirement. Maternal and neonatal outcomes such as cesarean section, macrosomia, large and small for gestational age (LGA, SGA), neonatal hypoglycemia, prematurity, hospitalization in the neonatal unit and Apgar score at 5 min < 7 were evaluated. Univariate and multivariate regression analyses and probability analyses were performed.

Results: One-hour glucose after oGTT and prepregnancy BMI were correlated with cesarean section. GWG and HbA1c at the end pregnancy were associated with macrosomia and LGA, while prepregnancy BMI was inversely associated with SGA. The requirement for maternal treatment was correlated with neonatal hypoglycemia, and HbA1c at the end of pregnancy with prematurity (all p < 0.05). The correlations between predictors and pregnancy complications were exclusively observed when HbA1c was ≥5.5% (37 mmol/mol). In women with prepregnancy BMI ≥ 25 kg/m and HbA1c ≥ 5.5% (37 mmol/mol) at the 1st booking, the risk for cesarean section and LGA was nearly doubled compared to women with BMI with < 25 kg/m and HbA1c <  5.5% (37 mmol/mol).

Conclusions: Prepregnancy BMI, GWG, maternal treatment requirement and HbA1c at the end of pregnancy can predict adverse pregnancy outcomes in women with GDM, particularly when HbA1c is ≥5.5% (37 mmol/mol). Stratification based on prepregnancy BMI and HbA1c at the 1st booking may allow for future risk-adapted care in these patients.
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http://dx.doi.org/10.1186/s12884-019-2610-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6894261PMC
December 2019

Substituting prolonged sedentary time and cardiovascular risk in children and youth: a meta-analysis within the International Children's Accelerometry database (ICAD).

Int J Behav Nutr Phys Act 2019 10 31;16(1):96. Epub 2019 Oct 31.

Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway.

Background: Evidence on the association between sitting for extended periods (i.e. prolonged sedentary time (PST)) and cardio-metabolic health is inconsistent in children. We aimed to estimate the differences in cardio-metabolic health associated with substituting PST with non-prolonged sedentary time (non-PST), light (LIPA) or moderate-to-vigorous physical activity (MVPA) in children.

Methods: Cross-sectional data from 14 studies (7 countries) in the International Children's Accelerometry Database (ICAD, 1998-2009) was included. Accelerometry in 19,502 participants aged 3-18 years, together with covariate and outcome data, was pooled and harmonized. Iso-temporal substitution in linear regression models provided beta coefficients (95%CI) for substitution of 1 h/day PST (sedentary time accumulated in bouts > 15 min) with non-PST, LIPA or MVPA, for each study, which were meta-analysed.

Results: Modelling substitution of 1 h/day of PST with non-PST suggested reductions in standardized BMI, but estimates were > 7-fold greater for substitution with MVPA (- 0.44 (- 0.62; - 0.26) SD units). Only reallocation by MVPA was beneficial for waist circumference (- 3.07 (- 4.47; - 1.68) cm), systolic blood pressure (- 1.53 (- 2.42; - 0.65) mmHg) and clustered cardio-metabolic risk (- 0.18 (- 0.3; - 0.1) SD units). For HDL-cholesterol and diastolic blood pressure, substitution with LIPA was beneficial; however, substitution with MVPA showed 5-fold stronger effect estimates (HDL-cholesterol: 0.05 (0.01; 0.10) mmol/l); diastolic blood pressure: - 0.81 (- 1.38; - 0.24) mmHg).

Conclusions: Replacement of PST with MVPA may be the preferred scenario for behaviour change, given beneficial associations with a wide range of cardio-metabolic risk factors (including adiposity, HDL-cholesterol, blood pressure and clustered cardio-metabolic risk). Effect estimates are clinically relevant (e.g. an estimated reduction in waist circumference of ≈1.5 cm for 30 min/day replacement). Replacement with LIPA could be beneficial for some of these risk factors, however with substantially lower effect estimates.
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http://dx.doi.org/10.1186/s12966-019-0858-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822444PMC
October 2019

Association of physical activity with adiposity in preschoolers using different clinical adiposity measures: a cross-sectional study.

BMC Pediatr 2019 10 31;19(1):397. Epub 2019 Oct 31.

Obstetric Service, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.

Background: More research is needed about the association between physical activity (PA), sedentary behaviour (SB), and adiposity in preschoolers, particularly using more direct clinical measures of adiposity. Therefore, the main objective of this study was to investigate the association between objectively measured PA and different clinical adiposity measures in a large sample of preschoolers.

Methods: Four hundred sixty-three predominantly normal-weight (77%) 2-6-year-old preschool children participated in the Swiss Preschoolers' Health Study (SPLASHY). Physical activity was measured using accelerometers and was analyzed using 15-s (uni-axial) epoch length using validated cut-offs. Adiposity measures included body mass index (BMI), the sum of four skinfolds, and waist circumference (WC). Multilevel linear regression modeling, adjusted for age, sex and wear time, was used to assess the association between PA and SB with BMI, WC, and skinfold thickness.

Results: Total PA and different PA intensities were positively and SB was inversely associated with BMI in the total sample and in the normal-weight children (p < 0.05). Total PA was inversely associated with skinfold thickness in overweight and obese children (p < 0.05), while there was only a weak association for vigorous PA (p > 0.05). Moderate and moderate-to-vigorous PA were positively, and SB was negatively associated with WC in the total sample and in the normal-weight children (p < 0.05). Additional adjustment for potential sociocultural and biological confounding variables attenuated some of the results.

Conclusions: In this very young and predominantly normal-weight population, PA is positively related to BMI and WC, but this relationship is not observed in overweight and obese children. In this latter population, PA is inversely, and SB is positively related to skinfold thickness. Skinfold thickness could represent a useful and simple clinical measure of body fat in preschoolers. The role of vigorous PA in the prevention of early childhood obesity should be further investigated in future studies.

Trial Registration: ISRCTN ISRCTN41045021 . Retrospectively registered 06 May 2014.
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http://dx.doi.org/10.1186/s12887-019-1764-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824011PMC
October 2019

Intuitive eating is associated with improved health indicators at 1-year postpartum in women with gestational diabetes mellitus.

J Health Psychol 2019 Aug 22:1359105319869814. Epub 2019 Aug 22.

1 Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, Switzerland.

We evaluated the associations between intuitive eating during and after pregnancy with metabolic health at 1-year postpartum in women with gestational diabetes mellitus and in high-risk gestational diabetes mellitus subgroups. One hundred seventeen women who consented and completed the French intuitive eating questionnaire during and after pregnancy were included. We found an association between intuitive eating during and after pregnancy with lower body mass index, weight retention, fasting glucose, and HbA1c at 1-year postpartum in women with gestational diabetes mellitus and in high-risk gestational diabetes mellitus subgroups with overweight/obese or with prediabetes in the postpartum period. Our results suggest that intuitive eating could be an effective intervention for weight and glucose control in women with gestational diabetes mellitus.
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http://dx.doi.org/10.1177/1359105319869814DOI Listing
August 2019

Prospective associations between maternal stress during pregnancy and fasting glucose with obstetric and neonatal outcomes.

J Psychosom Res 2019 10 6;125:109795. Epub 2019 Aug 6.

Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.

Objective: This prospective study investigated associations between maternal stress exposure and maternal psychological stress measures during pregnancy with obstetric and neonatal outcomes. We also tested whether any observed associations would be moderated by increasing glucose levels, as increased glycaemia is also associated with adverse obstetric and neonatal outcomes.

Methods: 203 women between 24 and 30 weeks gestation completed validated questionnaires assessing pregnancy-related major events and major life events, maternal perceived stress, and depression, anxiety, and stress symptoms. Glucose was measured using fasting morning blood samples. Instrumental delivery represented an obstetric outcome. Neonatal outcomes included Apgar score, large and small for gestational age weight, cord blood pH, NICU hospitalization, and neonatal hypoglycaemia.

Results: Regarding the obstetric outcome, pregnancy-related major life events OR = 1.346 (1.016-1.783; p = .016) were related to more incidences of instrumental delivery. Regarding neonatal outcomes, exposure to major life events in the last 12 months was associated with lower cord blood pH values B = -0.155 (-0.059 to -0.002; p = .036) and with more incidences of hypoglycaemia OR = 0.165 (0.012-0.169; p = .04). Maternal psychological stress measures were related to more incidences of instrumental delivery OR = 1.018 (1.003-1.032; p = .013). Maternal stress perception was associated with higher cord blood pH values B = 0.155 (0-0.003; p = .046) and fewer NICU hospitalisations OR = -0.170 (-0.009 to -0.001; p = .019). Some of these associations between life events and stress perceptions with neonatal outcomes were moderated by fasting glucose levels.

Conclusion: Maternal pregnancy events as well as stress, depression and anxiety symptoms have a negative impact on obstetric outcomes and maternal life events are associated with negative neonatal outcomes. Higher fasting glucose levels moderate some of the relationships between stress and neonatal outcomes.
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http://dx.doi.org/10.1016/j.jpsychores.2019.109795DOI Listing
October 2019

Correction to: A closer look at the relationship among accelerometer-based physical activity metrics: ICAD pooled data.

Int J Behav Nutr Phys Act 2019 08 8;16(1):62. Epub 2019 Aug 8.

Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA.

Following publication of the original article [1], the author reported that the name of the collaborator group was missing from the author group.
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http://dx.doi.org/10.1186/s12966-019-0828-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6686467PMC
August 2019

International Comparison of the Levels and Potential Correlates of Objectively Measured Sedentary Time and Physical Activity among Three-to-Four-Year-Old Children.

Int J Environ Res Public Health 2019 05 31;16(11). Epub 2019 May 31.

Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol BS8 2BN, UK.

Physical activity (PA) patterns track from childhood through to adulthood. The study aimed to determine the levels and correlates of sedentary time (ST), total PA (TPA), and moderate-to-vigorous PA (MVPA) in preschool-aged children. We conducted cross-sectional analyses of 1052 children aged three-to-four-years-old from six studies included in the International Children's Accelerometry Database. Multilevel linear regression models adjusting for age, gender, season, minutes of wear time, and study clustering effects were used to estimate associations between age, gender, country, season, ethnicity, parental education, day of the week, time of sunrise, time of sunset, and hours of daylight and the daily minutes spent in ST, TPA, and MVPA. Across the UK, Switzerland, Belgium, and the USA, children in our analysis sample spent 490 min in ST per day and 30.0% and 21.2% of children did not engage in recommended daily TPA (≥180 min) and MVPA (≥60 min) guidelines. There was evidence for an association between all 10 potential correlates analyzed and at least one of the outcome variables; average daily minutes spent in ST, TPA and/or MVPA. These correlates can inform the design of public health interventions internationally to decrease ST and increase PA in preschoolers.
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http://dx.doi.org/10.3390/ijerph16111929DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6603940PMC
May 2019

Intuitive eating is associated with weight and glucose control during pregnancy and in the early postpartum period in women with gestational diabetes mellitus (GDM): A clinical cohort study.

Eat Behav 2019 08 25;34:101304. Epub 2019 May 25.

Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland. Electronic address:

Introduction: High pre-pregnancy weight and body mass index (BMI) increase the risk of gestational diabetes mellitus (GDM) and diabetes after pregnancy. To tackle weight and metabolic health problems, there is a need to investigate novel lifestyle approaches. Outside of pregnancy, higher adherence to intuitive eating (IE) is associated with lower BMI and improved glycemic control. This study investigated the association between IE and metabolic health during pregnancy and in the early postpartum period among women with GDM.

Methods: Two-hundred and fourteen consecutive women aged ≥18, diagnosed with GDM between 2015 and 2017 and completed the "Eating for Physical rather than Emotional Reasons (EPR)" and "Reliance on Hunger and Satiety cues (RHSC) subscales" of the French Intuitive Eating Scale-2 (IES-2) questionnaire at the first GDM clinic visit were included in this study.

Results: Participants' mean age was 33.32 ± 5.20 years. Their weight and BMI before pregnancy were 68.18 ± 14.83 kg and 25.30 ± 5.19 kg/m respectively. After adjusting for confounding variables, the cross-sectional analyses showed that the two subscales of IES-2 at the first GDM visit were associated with lower weight and BMI before pregnancy, and lower weight at the first GDM visit (β = -0.181 to -0.215, all p ≤ 0.008). In addition, the EPR subscale was associated with HbA1c and fasting plasma glucose at the first GDM visit (β = -0.170 and to -0.196; all p ≤ 0.016). In the longitudinal analyses, both subscales of IES-2 at first GDM visit were associated with lower weight at the end of pregnancy, BMI and fasting plasma glucose at 6-8 weeks postpartum (β = -0.143 to -0.218, all p ≤ 0.040) after adjusting for confounders.

Conclusions: Increase adherence to IE could represent a novel approach to weight and glucose control during and after pregnancy in women with GDM.
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http://dx.doi.org/10.1016/j.eatbeh.2019.101304DOI Listing
August 2019

[Preconception care in patients with diabetes].

Rev Med Suisse 2019 May;15(653):1143-1146

Service d'obstétrique CHUV, 1011 Lausanne.

In patients with diabetes, pregnancy is associated with high maternal and fetal risks, especially in unplanned pregnancies. Current evidence confirms that timely family planning and interdisciplinary care and management starting at the preconceptional period can optimize metabolic control and significantly reduce these risks. The purpose of this article is to summarize the different aspects to consider as well as provide tools to use when preparing patients with diabetes for a pregnancy.
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May 2019

Accelerometer-derived physical activity estimation in preschoolers - comparison of cut-point sets incorporating the vector magnitude vs the vertical axis.

BMC Public Health 2019 May 6;19(1):513. Epub 2019 May 6.

Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland.

Background: ActiGraph accelerometers are a widely used tool to objectively measure physical activity (PA) behavior in young children and several validated cut-point sets exist to estimate time spent in different PA intensities (sedentary time, light PA, moderate-to-vigorous PA). Applying different cut-point sets leads to large and meaningful differences in results. So far, only cut-point sets validated for the vertical axis have been compared and only the influence on time spent in moderate-to-vigorous PA has been analyzed.

Methods: A range of validated cut-point sets with their respective epoch length was applied to analyze cross-sectional data of the Swiss Preschoolers' Health Study (SPLASHY): 1) Vertical axis in combination with an epoch length of 15 s (VA-15), 2) Vertical axis in combination with an epoch length of 60 s (VA-60) and 3) Vector magnitude in combination with an epoch length of 60 s (VM-60). PA was measured for eight consecutive days using ActiGraph accelerometers (wGT3X-BT). Three days were required to be included in the analysis (minimum two weekdays and one weekend-day with at least ten hours recording per day).

Results: Four hundred forty-five preschoolers (mean age 3.9 ± 0.5 years; 46% girls) had valid accelerometer measurements. A longer epoch (VA-60 vs VA-15) resulted in 2% less sedentary time (ST), 18% more light PA (LPA) and 51% less moderate-to-vigorous PA (MVPA); using the vector magnitude compared to the vertical axis (VM-60 vs VA-60) resulted in 34% less ST, 27% more LPA and 63% more MVPA (all p ≤ 0.001). Comparing all three sets of cut-points, ST ranged from 4.0 to 6.2 h, LPA from 5.1 to 7.6 h and MVPA from 0.8 to 1.6 h.

Conclusions: Estimated time spent in different PA intensities was strongly influenced by the choice of cut-point sets. Both, axis selection and epoch length need to be considered when comparing different studies especially when they relate PA behavior to health. The differences in the prevalence of children fulfilling PA guidelines highlight the relevance of these findings.

Trial Registration: Current Controlled Trials ISRCTN41045021 (date of registration: 21.03.2014).
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http://dx.doi.org/10.1186/s12889-019-6837-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6501292PMC
May 2019

A closer look at the relationship among accelerometer-based physical activity metrics: ICAD pooled data.

Int J Behav Nutr Phys Act 2019 04 29;16(1):40. Epub 2019 Apr 29.

Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA.

Background: Accelerometers are widely used to assess child physical activity (PA) levels. Using the accelerometer data, several PA metrics can be estimated. Knowledge about the relationships between these different metrics can improve our understanding of children's PA behavioral patterns. It also has significant implications for comparing PA metrics across studies and fitting a statistical model to examine their health effects. The aim of this study was to examine the relationships among the metrics derived from accelerometers in children.

Methods: Accelerometer data from 24,316 children aged 5 to 18 years were extracted from the International Children's Accelerometer Database (ICAD) 2.0. Correlation coefficients between wear time, sedentary behavior (SB), light-intensity PA (LPA), moderate-intensity PA (MPA), vigorous-intensity PA (VPA), moderate- and vigorous-intensity PA (MVPA), and total activity counts (TAC) were calculated.

Results: TAC was approximately 22X10 counts higher (p < 0.01) with longer wear time (13 to 18 h/day) as compared to shorter wear time (8 to < 13 h/day), while MVPA was similar across the wear time categories. MVPA was very highly correlated with TAC (r = .91; 99% CI = .91 to .91). Wear time-adjusted correlation between SB and LPA was also very high (r = -.96; 99% CI = -.96, - 95). VPA was moderately correlated with MPA (r = .58; 99% CI = .57, .59).

Conclusions: TAC is mostly explained by MVPA, while it could be more dependent on wear time, compared to MVPA. MVPA appears to be comparable across different wear durations and studies when wear time is ≥8 h/day. Due to the moderate to high correlation between some PA metrics, potential collinearity should be addressed when including multiple PA metrics together in statistical modeling.
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http://dx.doi.org/10.1186/s12966-019-0801-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489360PMC
April 2019

Influence of Acute Physical Activity on Stress Reactivity in Obese and Normal Weight Children: A Randomized Controlled Trial.

Obes Facts 2019 7;12(1):115-130. Epub 2019 Mar 7.

Obstetric Service, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.

Objective: Physical activity (PA) may influence acute stress reactivity in children differently depending on their weight. This randomized controlled trial investigated the impact of acute PA and of BMI status (overweight/obese (OB/OW) and normal weight (NW) on stress reactivity.

Method: 50 prepubertal children (24 OW/OB and 26 NW) were randomly assigned to the PA or sedentary arm (SED) for 30 min followed by a stress task. Salivary cortisol, blood pressure (BP), and heart rate (HR) were measured.

Results: An interaction effect between the randomization arms and weight status on salivary cortisol was found after the stress task (p = 0.04). Cortisol increased in the SED, but not in the PA arm (p = 0.004 for differences in time course) of NW children. Time course did not differ between both arms in OW/OB children (p = 0.7). OW/OB SED children had a flat cortisol course, and levels were reduced compared to the NW SED or the OW/OB PA children (p ≤ 0.03). Systolic BP increased only in the SED arm (p = 0.01). HR was higher in the PA than in the SED arm during stress (p < 0.001) and showed different time courses (p = 0.006).

Conclusion: PA impacted on acute stress reactivity and influenced stress reactivity differently in NW and OW/OB children.
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http://dx.doi.org/10.1159/000494294DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6465711PMC
February 2020

Childcare Correlates of Physical Activity, Sedentary Behavior, and Adiposity in Preschool Children: A Cross-Sectional Analysis of the SPLASHY Study.

J Environ Public Health 2018 11;2018:9157194. Epub 2018 Nov 11.

Obstetric Service, Lausanne University Hospital, Lausanne, Switzerland.

Background: The childcare (CC) environment can influence young children's physical activity (PA), sedentary behavior (SB), and adiposity. The aim of the study was to identify a broad range of CC correlates of PA, SB, and adiposity in a large sample of preschoolers.

Methods: 476 preschool children (mean age 3.9 yrs; 47% girls) participated in the Swiss Preschoolers' Health Study (SPLASHY). PA and SB were measured by accelerometry. Outcome measures included total PA (TPA), moderate-to-vigorous PA (MVPA), SB, body mass index (BMI), and skinfold thickness (SF). PA measures consisted of both daily PA during CC attendance days and overall daily PA (CC and non-CC days).

Results: We identified the following CC correlates for higher TPA and/or higher MVPA or lower SB during CC attendance days: older age, sex (boys), more frequent child-initiated interactions during CC, mixing different ages within a group, and the presence of a written PA policy in the CC (all ≤ 0.02). The CC correlates for overall TPA and/or MVPA or lower overall SB including both CC and non-CC days were the following: older age, sex (boys), more frequent child-initiated interactions during CC, mixing different ages within a group, less parental PA involvement in the CC, and having a larger surface area in CC (all ≤ 0.046). Correlates for lower SF were sex (boys) and parental PA involvement in the CC (all ≤ 0.02), and, for lower BMI, only increased age (=0.001) was a correlate.

Conclusions: More frequent child-initiated interactions and mixing different ages in CC, the presence of a written PA policy, and a larger CC surface are correlates of PA and SB during CC attendance days and/or of overall PA. Parental involvement in CC PA projects was a correlate for reduced body fat. These novel factors are mostly modifiable and can be tackled/addressed in future interventions.
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http://dx.doi.org/10.1155/2018/9157194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311763PMC
April 2019

Predictors of Executive Functions in Preschoolers: Findings From the SPLASHY Study.

Front Psychol 2018 29;9:2060. Epub 2018 Oct 29.

Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland.

Executive functions (EFs) have been reported to play a crucial role in children's development, affecting their academic achievement, health, and quality of life. This study examined individual and interpersonal predictors for EFs in 555 typically developing preschool children aged 2-6 years. Children were recruited from 84 child care centers in the German- and French-speaking parts of Switzerland within the Swiss Preschoolers' Health Study (SPLASHY). A total of 20 potential predictors were assessed at the first measurement (T1). These included eight demographic/biological predictors, such as socioeconomic status, preterm birth, physical activity, and motor skills; six psychological predictors, such as hyperactivity, visual perception, and emotionality; and six interpersonal predictors, such as parenting style and stress, presence of siblings, and days spent in the child care center. The predictive value of these variables on EFs 1 year later (T2) was assessed using both standard multiple regression analysis and penalized regression to avoid overfitting due to the number of potential predictors. Female sex (β = 0.14), socio-economic status (β = 0.15), fine motor skills (β = 0.17), visual perception at T1 (β = 0.16), and EFs at T1 (β = 0.30) were all associated with EFs at T2, exhibiting small to medium effect sizes. All predictors together accounted for 31% of the variability in EFs. However, none of the interpersonal predictors were significant. Thus, we conclude that most of the factors that can predict EFs in preschool age are individual variables, and these tend to be more difficult to influence than interpersonal factors. In fact, children from families with low socio-economic status may be particularly vulnerable to poor EFs. Furthermore, encouraging fine motor skills early in life may support the development of EFs.
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http://dx.doi.org/10.3389/fpsyg.2018.02060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6216414PMC
October 2018

Prevalence and Predictors of Behavioral Problems in Healthy Swiss Preschool Children Over a One Year Period.

Child Psychiatry Hum Dev 2019 06;50(3):439-448

Department of Clinical Psychology and Psychotherapy, University of Fribourg, Rue P.A. de Faucigny 2, 1700, Fribourg, Switzerland.

Behavioral problems impair children's health but prevalence rates are scarce and persistence rates vary due to divergence in age ranges, assessment methods and varying environmental factors. The aim of this study was to assess prevalence rates of behavioral problems, their persistence over a 1-year period, and the impact of child- and parent-related factors on behavioral problems. 555 2-6-year-old healthy preschool children were assessed at baseline and 382 of the initial sample at 1-year follow-up. Assessment included questionnaires concerning behavioral problems and their potential predictors (e.g. socio-economic status or parenting style). Altogether, nearly 7% of these children showed clinically relevant behavioral problems, and 3% showed persistent symptoms. Low SES, inconsistent parenting and corporal punishment were positively associated with behavioral problems. The prevalence rates of behavioral problems in Swiss preschoolers are similar to other European countries, but persistence is still rather low within preschool age. These findings need further confirmation in longitudinal studies.
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http://dx.doi.org/10.1007/s10578-018-0849-xDOI Listing
June 2019

Physiological stress measures in preschool children and their relationship with body composition and behavioral problems.

Dev Psychobiol 2018 12 30;60(8):1009-1022. Epub 2018 Sep 30.

Endocrinology, Diabetes & Metabolism Service, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.

Background: The relationship between physiological stress measures and body composition or behavioral problems in older children remains controversial, and data in young children are lacking. The aim of the study was to investigate this relationship in predominantly healthy preschool children.

Method: Physiological stress measures were assessed using diurnal salivary alpha-amylase (sAA) and salivary cortisol, nail cortisol and parasympathetic activation (PNS) by overnight heart rate variability, and body composition (body mass index, skinfold thickness) and behavior problems (using the Strengths and Difficulties Questionnaire) in 324 children aged 2-6 years of the SPLASHY study.

Results: Parasympathetic nervous system was inversely related to body fat, to emotional, and to peer problems. Diurnal sAA was related to hyperactivity problems and moderated the relationship of cortisol and hyperactivity problems. Cortisol was not related to any other health problems.

Discussion: The relationship of PNS with body composition and behavioral problems might highlight the protective role of the parasympathetic system early in life.
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http://dx.doi.org/10.1002/dev.21782DOI Listing
December 2018

Age-Adapted Stress Task in Preschoolers Does not Lead to Uniform Stress Responses.

J Abnorm Child Psychol 2019 04;47(4):571-587

Department of Clinical Psychology and Psychotherapy, University of Fribourg, Rue P.A. de Faucigny 2, 1700, Fribourg, Switzerland.

Acute stress response measures serve as an indicator of physiological functioning, but have previously led to contradictory results in young children due to age-related cortisol hypo-responsivity and methodological inconsistencies in assessment. The aim of this study was to investigate stress responses during a validated age-adapted socio-evaluative stress task in children aged 2-6 years in a child care environment and to detect socio-demographic, task- and child-related characteristics of stress responses. Stress responses were assessed in 323 children for salivary cortisol and salivary alpha amylase (sAA), and in 328 children for changes in heart rate variability (HRV). These data were then associated with socio-demographic (e.g. SES), task-related (e.g. task length) and child-related characteristics (e.g. self-regulation) of stress responses using multilevel models. Analyses revealed elevated sympathetic reactivity (sAA: Coeff=0.053, p=0.004) and reduced HRV (Coeff=-0.465, p<0.001), but no hypothalamic-pituitary-adrenal (HPA) response (Coeff=0.017, p=0.08) during the stress task. Child's age (Coeff=-5.82, p<0.001) and movement during the task (Coeff=-0.17, p=0.015) were associated with acute cortisol release, while diurnal sAA was associated with acute sAA release (Coeff=0.24, p<0.001). Age (Coeff=-0.15, p=0.006) and duration of the task (Coeff=0.13, p=0.015) were further associated with change of HRV under acute stress condition. Children showed inconsistent stress responses which contradicts the assumption of a parallel activation of both stress systems in a valid stress task for young children and might be explained by a pre-arousal to the task of young children in a child care setting. Further results confirm that child- and task-related conditions need to be considered when assessing stress responses in these young children.
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http://dx.doi.org/10.1007/s10802-018-0475-xDOI Listing
April 2019

Comparison of the dose-response pharmacodynamic profiles of detemir and glargine in severely obese patients with type 2 diabetes: A single-blind, randomised cross-over trial.

PLoS One 2018 16;13(8):e0202007. Epub 2018 Aug 16.

Division of Endocrinology, Diabetes and Metabolism, University Hospital Lausanne, Lausanne, Switzerland.

Background: Despite their widespread use in this population, data on the pharmacodynamic (PD) properties of the insulin analogs detemir and glargine in severely obese patients with type 2 diabetes are lacking.

Methods: The primary objective of the study was to compare the PD properties of two different doses of the basal insulin analogs detemir and glargine in patients with type 2 diabetes and a BMI > 35 kg/m2. PD data were derived from euglycemic clamp studies over 30 hours and each subject was studied for four times after the subcutaneous injection of a lower (0.8 U/kg body weight) and higher (1.6 U/kg body weight) dose of both detemir and glargine using a single-blind, randomised cross-over design.

Results: Six male and four female patients with type 2 diabetes and a mean BMI of 43.2±5.1 kg/m2 (mean age 55.7±2 years, mean HbA1c 7.2±0.3%) completed the study. The total GIRAUC0-30 (mean difference 1224 mg/kg, 95%CI 810-1637, p = 0.00001), GIRAUC0-24 (mean difference 1040 mg/kg, 95%CI 657-1423; p = 0.00001), GIRAUC24-30 (mean difference 181 mg/kg, 95%CI 64-298; p = 0.004), GIRmax (mean difference 0.93 mg/kg/min, 95%CI 0.22-1.64, p = 0.01) and time to GIRmax (+1.9 hours, 95%CI 0.5-3.2; p = 0.009) were higher after the higher doses of both insulins, without significant differences between detemir and glargine. However, during the last 6 hours of the clamp the GIRAUC24-30 was significantly increased with glargine (mean difference 122 mg/kg, 95%CI 6-237, p = 0.043), reflecting a more pronounced late glucose lowering effect.

Conclusions: A clear dose-response relationship can be demonstrated for both insulin analogs, even at very high doses in severely obese patients with type 2 diabetes. Compared to detemir, glargine has a more pronounced late glucose lowering effect 24-30 h after its injection.

Trial Registration: Controlled-Trials.com ISRCTN57547229.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202007PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6095527PMC
January 2019

Physical activity intensity, bout-duration, and cardiometabolic risk markers in children and adolescents.

Int J Obes (Lond) 2018 09 13;42(9):1639-1650. Epub 2018 Jul 13.

Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK.

Objectives: To determine the role of physical activity intensity and bout-duration in modulating associations between physical activity and cardiometabolic risk markers.

Methods: A cross-sectional study using the International Children's Accelerometry Database (ICAD) including 38,306 observations (in 29,734 individuals aged 4-18 years). Accelerometry data was summarized as time accumulated in 16 combinations of intensity thresholds (≥500 to ≥3000 counts/min) and bout-durations (≥1 to ≥10 min). Outcomes were body mass index (BMI, kg/m), waist circumference, biochemical markers, blood pressure, and a composite score of these metabolic markers. A second composite score excluded the adiposity component. Linear mixed models were applied to elucidate the associations and expressed per 10 min difference in daily activity above the intensity/bout-duration combination. Estimates (and variance) from each of the 16 combinations of intensity and bout-duration examined in the linear mixed models were analyzed in meta-regression to investigate trends in the association.

Results: Each 10 min positive difference in physical activity was significantly and inversely associated with the risk factors irrespective of the combination of intensity and bout-duration. In meta-regression, each 1000 counts/min increase in intensity threshold was associated with a -0.027 (95% CI: -0.039 to -0.014) standard deviations lower composite risk score, and a -0.064 (95% CI: -0.09 to -0.038) kg/m lower BMI. Conversely, meta-regression suggested bout-duration was not significantly associated with effect-sizes (per 1 min increase in bout-duration: -0.002 (95% CI: -0.005 to 0.0005) standard deviations for the composite risk score, and -0.005 (95% CI: -0.012 to 0.002) kg/m for BMI).

Conclusions: Time spent at higher intensity physical activity was the main determinant of variation in cardiometabolic risk factors, not bout-duration. Greater magnitude of associations was consistently observed with higher intensities. These results suggest that, in children and adolescents, physical activity, preferably at higher intensities, of any bout-duration should be promoted.
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http://dx.doi.org/10.1038/s41366-018-0152-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6160399PMC
September 2018

[Type 1 diabetes, physical activity and novel technology].

Rev Med Suisse 2018 May;14(609):1139-1144

Service d'endocrinologie, diabétologie et métabolisme, CHUV, 1011 Lausanne.

Physical activity is recommended for all patients with diabetes, but it is important to be particularly attentive in patients with type 1 diabetes. Because of their treatment, these patients have a higher risk of hypoglycemia. The challenge for both caregivers and the patient is to find the best possible strategy to practice the desired physical activity without any significant hypo- or hyperglycemia. Thus, an adaptation of the insulin and/or nutritional treatment is necessary, depending on the type, intensity and duration of the physical activity. Moreover, many technological devices are now available that can improve patient care, but they also have some limitations to take into account. Allover, an interdisciplinary approach is highly recommended, both for a specific or a regular physical activity practice.
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May 2018

Cross-Sectional Associations of Reallocating Time Between Sedentary and Active Behaviours on Cardiometabolic Risk Factors in Young People: An International Children's Accelerometry Database (ICAD) Analysis.

Sports Med 2018 Oct;48(10):2401-2412

Department of Sports Medicine, Norwegian School of Sport Sciences, Ullevål Stadion, 0806, Oslo, Norway.

Introduction: Sedentary time and time spent in various intensity-specific physical activity are co-dependent, and increasing time spent in one behaviour requires decreased time in another.

Objective: The aim of the present study was to examine the theoretical associations with reallocating time between categories of intensities and cardiometabolic risk factors in a large and heterogeneous sample of children and adolescents.

Methods: We analysed pooled data from 13 studies comprising 18,200 children and adolescents aged 4-18 years from the International Children's Accelerometry Database (ICAD). Waist-mounted accelerometers measured sedentary time, light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA). Cardiometabolic risk factors included waist circumference (WC), systolic blood pressure (SBP), fasting high- and low-density lipoprotein cholesterol (HDL-C and LDL-C), triglycerides, insulin, and glucose. Associations of reallocating time between the various intensity categories with cardiometabolic risk factors were explored using isotemporal substitution modelling.

Results: Replacing 10 min of sedentary time with 10 min of MVPA showed favourable associations with WC, SBP, LDL-C, insulin, triglycerides, and glucose; the greatest magnitude was observed for insulin (reduction of 2-4%), WC (reduction of 0.5-1%), and triglycerides (1-2%). In addition, replacing 10 min of sedentary time with an equal amount of LPA showed beneficial associations with WC, although only in adolescents.

Conclusions: Replacing sedentary time and/or LPA with MVPA in children and adolescents is favourably associated with most markers of cardiometabolic risk. Efforts aimed at replacing sedentary time with active behaviours, particularly those of at least moderate intensity, appear to be an effective strategy to reduce cardiometabolic risk in young people.
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http://dx.doi.org/10.1007/s40279-018-0909-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132434PMC
October 2018