Publications by authors named "Lars B Andersen"

81 Publications

Tracking of cardiometabolic risk in a Brazilian schoolchildren cohort: a 3-year longitudinal study.

J Sports Med Phys Fitness 2021 Feb 22. Epub 2021 Feb 22.

Institute of Sport Science, University of Graz, Graz, Austria.

Background: Clustering of cardiometabolic risk factors is a sign of detrimental health. Tracking is a term used to describe a variable longitudinal stability across time. High trackingprovides the chance to determine which cardiometabolic risk factors should be the target of early treatment and prevention efforts. The present study aims to analyze the tracking of cardiometabolic risk factors and clustered cardiometabolic risk score in children across a 3-year time span; and to verify the odds of staying at risk (measured by the clustered score) from baseline to follow-up.

Methods: Longitudinal study that included 354 (155 boys) children, aged 7-12 years at baseline. A clustered score was calculated by summing the systolic blood pressure, waist circumference, triglycerides, glucose, and the TC/HDL-C ratio Z-scores divided by five. A second clustered score was calculated including cardiorespiratory fitness (CRF).

Results: CRF and anthropometric parameters presented high tracking (r≥0.662), whereas the cardiometabolic parameters exhibited low-to-moderate tracking (0.100≤r≤0.571). The clustered scores' tracking was moderate (r≥0.508; r≥0.588 [CRF]). Participants in the higher risk groups at baseline presented 3.81 (95% CI: 2.40; 6.05) and 4.64 (95% CI: 2.85; 7.56), including CRF, times higher chance of remaining at risk three years later. Moreover, participants in the worst profile regarding CRF or anthropometrics at baseline presented at least 4.00 times higher chance of being at risk three years later.

Conclusions: Participants with worst CRF and adiposity had an increased risk of presenting higher clustered risk after three years. Thus, the cardiometabolic risk might reduce by improving CRF and adiposity.
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http://dx.doi.org/10.23736/S0022-4707.20.11479-8DOI Listing
February 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

Physical activity self-reports: past or future?

Br J Sports Med 2021 Feb 3. Epub 2021 Feb 3.

Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria.

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http://dx.doi.org/10.1136/bjsports-2020-103595DOI Listing
February 2021

Exposure to perfluoroalkylated substances (PFAS) in relation to fitness, physical activity, and adipokine levels in childhood: The european youth heart study.

Environ Res 2020 12 29;191:110110. Epub 2020 Aug 29.

Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK, 5230, Odense, Denmark; Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK, 5230, Odense, Denmark.

Background: perfluoroalkylated substances (PFAS) are highly persistent chemicals that are able to alter the human metabolism - potentially via disruption of cell signaling pathways mediated by adipokines. Both adiponectin and leptin are influenced by and exert influence on energy storage and energy expenditure, wherefore associations between PFAS and adipokines may be mediated by fitness and fat mass.

Objectives: the aim of this cross-sectional study was to investigate the association between childhood exposure to PFAS and adipokines (adiponectin and leptin), while considering associations between PFAS and children's level of fitness, physical activity and fat mass to elucidate potential mediation by fitness, physical activity and fat mass.

Methods: 9-year old children from Danish public schools were recruited in the European Youth Heart Study in 1997. For this study only children with valid measures on PFAS (PFOS, PFOA, PFNA, PFDA and PFHxS), adipokines (adiponectin and leptin), fitness, fat mass and co-variates (parity and maternal income) were included (N = 242). Multiple linear regression models with and without conditioning and causal mediation analysis were applied.

Results: this study found inverse associations between PFOA, PFDA and PFHxS and leptin. PFOA was positively associated with adiponectin, whereas PFHxS was inversely associated with adiponectin in boys. Latter association seemed to be mediated by fat mass. Associations with leptin showed indirect effects of fitness and fat mass but were unable to demonstrate significant mediation. Neither PFOS nor PFNA were associated with the outcome.

Discussion: these results may indicate a favorable leptin profile with increasing PFAS, although the results could be driven by residual negative confounding from socio-economic factors and mediation by fitness and fat mass.
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http://dx.doi.org/10.1016/j.envres.2020.110110DOI Listing
December 2020

Tracking of total sedentary time and sedentary patterns in youth: a pooled analysis using the International Children's Accelerometry Database (ICAD).

Int J Behav Nutr Phys Act 2020 05 18;17(1):65. Epub 2020 May 18.

Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, van der Boechorststraat 7, 1081BT, Amsterdam, the Netherlands.

Background: To gain more understanding of the potential health effects of sedentary time, knowledge is required about the accumulation and longitudinal development of young people's sedentary time. This study examined tracking of young peoples' total and prolonged sedentary time as well as their day-to-day variation using the International Children's Accelerometry Database.

Methods: Longitudinal accelerometer data of 5991 children (aged 4-17y) was used from eight studies in five countries. Children were included if they provided valid (≥8 h/day) accelerometer data on ≥4 days, including ≥1 weekend day, at both baseline and follow-up (average follow-up: 2.7y; range 0.7-8.2). Tracking of total and prolonged (i.e. ≥10-min bouts) sedentary time was examined using multilevel modelling to adjust for clustering of observations, with baseline levels of sedentary time as predictor and follow-up levels as outcome. Standardized regression coefficients were interpreted as tracking coefficients (low: < 0.3; moderate: 0.3-0.6; high: > 0.6).

Results: Average total sedentary time at study level ranged from 246 to 387 min/day at baseline and increased annually by 21.4 min/day (95% confidence interval [19.6-23.0]) on average. This increase consisted almost entirely of prolonged sedentary time (20.9 min/day [19.2-22.7]). Total (standardized regression coefficient (B) = 0.48 [0.45-0.50]) and prolonged sedentary time (B = 0.43 [0.41-0.45]) tracked moderately. Tracking of day-to-day variation in total (B = 0.04 [0.02-0.07]) and prolonged (B = 0.07 [0.04-0.09]) sedentary time was low.

Conclusion: Young people with high levels of sedentary time are likely to remain among the people with highest sedentary time as they grow older. Day-to-day variation in total and prolonged sedentary time, however, was rather variable over time.
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http://dx.doi.org/10.1186/s12966-020-00960-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7236462PMC
May 2020

Dynamic Balance, but Not Precision Throw, Is Positively Associated with Academic Performance in Children.

Int J Environ Res Public Health 2020 04 17;17(8). Epub 2020 Apr 17.

Faculty of Education, Arts and Sport; Western Norway University of Applied Sciences, Campus Sogndal, 6861 Sogndal, Norway.

We analyzed the longitudinal association between dynamic balance and throwing skill with academic performance and whether waist circumference mediated these relationships. The current one-year longitudinal study followed 1020 first (mean age 7.87 ± 0.34 years) through fifth grade (mean age 11.87 ± 0.37 years) children, measured twice in 2010 and 2011. Dynamic balance and precision throw were measures of motor competence. Waist circumference was measured with a measuring tape at the umbilicus level. Academic performance was assessed by a combined score of standardized Danish language and math tests. Structural equation modeling was used for analysis. All coefficients are standardized. Balance was associated with academic performance when both sexes were combined (β = 0.126, 95% CI: 0.074 to 0.179), and waist circumference partially mediated the relationship (β = 0.021, 95% CI: 0.008 to 0.034). For boys, balance was associated with academic performance, but waist circumference did not mediate the association. For girls, balance presented direct, mediated (via waist circumference), and total associations with academic performance. Dynamic balance is an important gross motor function that was longitudinally related to academic performance, and waist circumference partially mediated the relationship. Precision throw was not found to be associated with academic performance in both sexes combined or when analyzed separately.
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http://dx.doi.org/10.3390/ijerph17082790DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215805PMC
April 2020

Metabolic risk associated with liver enzymes, uric acid, and hemoglobin in adolescents.

Pediatr Res 2020 12 14;88(6):945-949. Epub 2020 Mar 14.

Department of Life Sciences, Graduate Program in Health Promotion, University of Santa Cruz do Sul, Rio Grande do Sul, Brazil.

Background: The associations of renal, hepatic, and hematologic markers with metabolic risk (MR) have already been shown in adolescents. However, it is still controversial which marker best predicts metabolic changes in youth. The aim of this study was to verify the association of MR with alanine aminotransferase (ALT), aspartate aminotransferase (AST), uric acid, and hemoglobin (Hb) in adolescents.

Methods: We evaluated 1713 Brazilian adolescents aged 10 to 17 years. MR was calculated using a continuous metabolic risk score, including the sum of Z-scores of waist circumference, systolic blood pressure, fasting glucose, high-density lipoproteins, triglycerides, and cardiorespiratory fitness. Cutoff points were set for MR prediction for five metabolic components (ALT, AST, AST/ALT ratio, uric acid, and Hb).

Results: MR was strongly associated with increased uric acid (odds ratio [OR]: 2.50; 95% confidence interval [CI]: 1.74-3.59), ALT (OR: 2.64; 95% CI: 1.63-4.27), and AST levels (OR: 2.53; 95% CI: 1.24-5.18). Uric acid was shown to be the best predictor for MR (sensitivity: 55.79%; specificity: 61.35%; area under the curve: 0.616).

Conclusion: Elevated hepatic, renal, and hematological markers were associated with MR in adolescents, especially ALT, AST, and uric acid levels.

Impact: Elevated hepatic, renal, and hematological markers were associated with metabolic risk in adolescents, especially ALT, AST, and uric acid levels. It is still controversial which marker best predicts metabolic changes in adolescents. In addition, association of Hb with metabolic risk is under-studied in this population. It is important to further investigate the relationship between elevated Hb and hepatic markers, since there are key aspects not addressed yet. Our results highlight the importance of creating public health policies aimed to child and adolescent population, to prevention of metabolic disorders from an early age.
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http://dx.doi.org/10.1038/s41390-020-0832-7DOI Listing
December 2020

Higher circulating plasma polychlorinated biphenyls (PCBs) in fit and lean children: The European youth heart study.

Environ Int 2020 03 18;136:105481. Epub 2020 Jan 18.

Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Røyrgata 6, NO-6856 Sogndal, Norway; Department of Sport Medicine, Norwegian School of Sport Sciences, Sognsveien 220, NO-0863 Oslo, Norway.

Background: Lipophilic compounds such as polychlorinated biphenyls (PCBs) are primarily stored in adipose tissue, but exercise-induced lipolysis is able to release PCBs from the adipose tissue into the circulation. The plasma concentration, distribution and metabolism of PCBs can thus vary much among individuals due to inter-human variations in lifestyle behavior and pharmacokinetics.

Objectives: We examined the observational relationship of circulating plasma PCB concentrations with cardiorespiratory fitness, engagement in vigorous physical activity and fat mass in a healthy Danish child population.

Methods: Data on ∑PCB (PCB138, PCB153 and PCB180), cardiorespiratory fitness, skinfold thickness and objectively measured physical activity of 509 children derived from the Danish sub-study of The European Youth Heart Study.

Results: Higher fitness and greater leanness were associated with elevated plasma ∑PCB in both boys and girls. The associations were independent of each other and persisted after controlling for socio-economic status and duration of breastfeeding. We observed an almost three-fold increase in plasma ∑PCB level in the most fit/least fat children relative to the least fit/most fat children. The association between fatness and ∑PCB was strongest for boys as girls, and especially pubertal girls, displayed lower decrease in plasma ∑PCB with higher fat mass.

Discussion: Our findings suggest that increased lipolysis stimulates the release of PCBs into the vasculature. The consequence is higher plasma levels of PCB in very fit and lean subjects. This scenario is likely to cause negative confounding in epidemiological observations of PCB and cardio-metabolic health. At the same time adipose tissue may play a dual role in promoting adverse health and providing a relatively safe place to store PCB.
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http://dx.doi.org/10.1016/j.envint.2020.105481DOI Listing
March 2020

Associations between accelerometry measured physical activity and sedentary time and the metabolic syndrome: A meta-analysis of more than 6000 children and adolescents.

Pediatr Obes 2020 01 10;15(1):e12578. Epub 2019 Nov 10.

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

Background: Metabolic syndrome is increasingly prevalent in the pediatric population. To prevent an early onset, knowledge about its association with modifiable lifestyle factors is needed.

Objectives: To estimate the prevalence of the metabolic syndrome and examine its cross-sectional associations with physical activity and sedentary time.

Methods: Participants were 6009 children and adolescents from 8 studies of the International Children's Accelerometry Database. Physical activity and sedentary time were measured by accelerometer. Metabolic syndrome was defined based on International Diabetes Federation criteria. Logistic regression models adjusted for sex, age and monitor wear time were used to examine the associations between physical activity, sedentary time and the metabolic syndrome in each study and effect estimates were combined using random-effects meta-analysis.

Results: The overall prevalence of the metabolic syndrome was 2.9%. In crude models, a 10 min increase in moderate-to-vigorous intensity physical activity and vigorous-intensity physical activity were inversely associated with the metabolic syndrome [OR 0.88, 95% CI 0.82-0.94, OR 0.80, 95% CI 0.70-0.92]. One hour increase in sedentary time was positively associated with the metabolic syndrome [OR 1.28, 95% CI 1.13-1.45]. After adjustment for sedentary time, the association between moderate-to-vigorous-intensity physical activity and the metabolic syndrome remained significant [OR 0.91, 95% CI 0.84-0.99]. Sedentary time was not associated with the metabolic syndrome after adjustment for moderate-to-vigorous intensity physical activity [OR 1.14 95% CI 0.96-1.36].

Conclusions: Physical activity of at least moderate intensity but not sedentary time is independently associated with the metabolic syndrome.
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http://dx.doi.org/10.1111/ijpo.12578DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003500PMC
January 2020

Effects of the Active Smarter Kids (ASK) physical activity intervention on cardiometabolic risk factors in children: A cluster-randomized controlled trial.

Prev Med 2020 01 22;130:105868. Epub 2019 Oct 22.

Western Norway University of Applied Sciences, Center for Physically Active Learning, Faculty of Education, Arts and Sports, Sogndal, Norway.

The onset of cardiometabolic diseases are recognized to occur in childhood. We aimed to investigate the effect of a school-based cluster-randomized controlled trial of physical activity (PA) on single and clustered cardiometabolic risk factors. We included 1129 fifth-grade children from 57 schools (≥seven children in each class) in Sogn and Fjordane County, Norway, randomized to 28 intervention schools and 29 control schools. The PA intervention was conducted between November 2014 and June 2015. Cardiometabolic risk factors were waist circumference (WC), systolic blood pressure (SBP), total cholesterol (TC):high-density lipoprotein (HDL)-ratio, triglycerides (TG), homeostatic model assessment (HOMA)-score, and cardiorespiratory fitness (CRF). PA was measured by accelerometry. No significant intervention effects were found for single or clustered cardiometabolic risk factors. However, in children with the less favorable baseline values, beneficial effects were found for SBP (p = 0.07 for group ∗ tertile interaction), TC:HDL ratio (p = 0.03 for group ∗ tertile interaction) and the clustered cardiometabolic risk score (p = 0.01 for group ∗ tertile interaction). Compared to boys, girls had a greater effect of the intervention on WC (p = 0.03 for group ∗ sex interaction) and CRF (p < 0.001 for group ∗ sex interaction). The majority of the children had high PA levels, thus limited potential for change, and we found no effects of the PA intervention on cardiometabolic risk in the total sample. However, the intervention had a significantly enhanced effect on fatness and fitness of girls compared to boys. Furthermore, the data suggest that children with the least favorable cardiometabolic risk profile and therefore most in need of change can benefit from school-based PA interventions. Trial registration number: Clinicaltrials.gov ID no.: NCT02132494.
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http://dx.doi.org/10.1016/j.ypmed.2019.105868DOI Listing
January 2020

Plasma proatrial natriuretic peptide associates with lipid oxidation during exercise and cardiorespiratory fitness in healthy young adults.

Peptides 2019 12 21;122:170156. Epub 2019 Sep 21.

Department of Medicine, Amager Hvidovre Hospital in Glostrup, University of Copenhagen, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

Atrial natriuretic peptide (ANP) is known for its natriuretic, diuretic, and vasodilatory properties. However, ANP also has metabolic effects stimulating lipolysis and lipid oxidation. Overweight individuals have decreased circulating ANP concentrations. It has been proposed that this potential ANP deficiency could have biological consequences in overweight-related disorders, including decreased lipolysis and lipid oxidation. The purpose of this study was to investigate the relationships between ANP, exercise-induced lipid oxidation, and cardiorespiratory fitness in 562 20-28-year-old healthy community-based women and men. We measured fasting plasma concentrations of mid-regional proANP (MR-proANP), a stable marker of ANP secretion, the respiratory exchange ratio (RER) during sub-maximal exercise, which provides an estimate of lipid oxidation, and maximal oxygen consumption (VO-max) at the end of a maximal exercise test, which is a measure of cardiorespiratory fitness. An increase of 10 pmol/L in fasting plasma MR-proANP concentrations was related to an increase in relative VO-max of 0.78 (95% CI 0.36-1.09) ml O/min/kg and a decrease in RER of -0.0094 (-0.014 to -0.0045) in age- and sex-adjusted analysis (P < 0.001). Further adjusted for body mass index, a rise of 10 pmol/L in fasting plasma MR-proANP concentrations was associated with a rise in relative VO-max of 0.60 (0.28-0.92) ml O/min/kg and a fall in RER of -0.0096 (-0.015 to -0.0048) (P < 0.001). Fasting plasma MR-proANP concentrations associate with lipid oxidation during exercise and cardiorespiratory fitness in healthy young adults. The data support the existence of important connections between the endocrine heart, hemodynamics, and metabolism.
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http://dx.doi.org/10.1016/j.peptides.2019.170156DOI Listing
December 2019

Cardiometabolic risk factor levels in Norwegian children compared to international reference values: The ASK study.

PLoS One 2019 19;14(8):e0220239. Epub 2019 Aug 19.

Center for Physically Active Learning, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Sogndal, Norway.

Objective: To investigate cardiometabolic risk factor levels in a group of Norwegian 10-year-old children compared to international values and examine the association between cardiorespiratory fitness (CRF) and the reference-standardized clustered risk score.

Methods: 913 children (49% girls) were included from the Active Smarter Kids (ASK) study. Body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC) to HDL-C ratio, triglyceride (TG), glucose, insulin, homeostatic model assessment (HOMA) score and CRF, were standardized according to international age-and sex-specific reference values.

Results: The Norwegian children had significantly more favorable WC, DBP, glucose, HDL-C and CRF levels compared to the international reference values, but similar or less favorable levels of other cardiometabolic risk factors. CRF was the variable that differed the most from the international values (mean (95% CI) 1.20 (1.16 to 1.24) SD). The clustered risk score (excluding CRF) was higher in the Norwegian children, but decreased to below international levels when including CRF (mean (95% CI) - 0.08 (- 0.12 to -0.05) SD). CRF had a significant inverse association with the clustered risk score (excluding CRF) (β - 0.37 SD, 95% CI -0.43 to -0.31).

Conclusions: Norwegian children have substantially higher CRF levels than international standards, and including CRF in clustered risk scores reduces overall risk in Norwegian children below that of international levels. CRF is associated with improved cardiometabolic health in children.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0220239PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699667PMC
March 2020

Association of copeptin, a surrogate marker for arginine vasopressin secretion, with insulin resistance: Influence of adolescence and psychological stress.

Peptides 2019 05 16;115:8-14. Epub 2019 Feb 16.

Department of Medicine, Amager and Hvidovre Hospital in Glostrup, University of Copenhagen, Glostrup, Denmark; Department of Medicine O, Endocrine Unit, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark.

In middle-aged and elderly individuals, circulating copeptin concentrations, a surrogate marker for arginine vasopressin (AVP) secretion, associates with insulin resistance (IR). Whether this association is present in adolescents and young adults is unclear. Because psychological stress associates with higher circulating copeptin concentrations and IR, it has been speculated that increased AVP secretion could be a link between psychological stress and IR. We measured plasma copeptin concentrations in 351 14-16-year-old adolescents and 617 20-28-year-old young adults from the Danish site of the European Youth Heart Study, a population-based cardiovascular risk factor study in adolescents and young adults. IR was determined by the homeostatic model assessment method. Among the young adults, we used symptoms of depression, evaluated by means of the Major Depression Inventory (MDI) scale, as a measure of psychological stress. We applied linear regressions to examine associations, expressed as unstandardized regression coefficients (B) with 95% confidence intervals (CIs), between variables of interest, stratified by age group and adjusting for age, sex and Tanner stages. Copeptin and IR were log-transformed. Among the young adults, copeptin associated with IR (B (95%CI) = 0.19 (0.11 to 0.27), P < 0.001). This association was not found among the adolescents (B=-0.01 (-0.12 to 0.09), P = 0.78). MDI score associated with IR (B = 0.010 (0.004 to 0.016), P < 0.001) and copeptin (B=0.010 (0.004 to 0.015); P<0.002) in the young adults. Adjusted for copeptin, the strength of the association between MDI score and IR somewhat diminished (to B=0.008). In conclusion, adolescence and psychological stress appear to influence the association between copeptin and IR.
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http://dx.doi.org/10.1016/j.peptides.2019.02.005DOI Listing
May 2019

Reference values for cardiometabolic risk scores in children and adolescents: Suggesting a common standard.

Atherosclerosis 2018 11 6;278:299-306. Epub 2018 Oct 6.

Western Norway University of Applied Sciences, Department of Sport, Food and Natural Sciences, PO BOX 133, N-6856, Sogndal, Norway.

Background And Aims: International reference values for cardiometabolic risk variables, to allow for standardization of continuous risk scores in children, are not currently available. The aim of this study was to provide international age- and gender-specific reference values for cardiometabolic risk factors in children and adolescents.

Methods: Cohorts of children sampled from different parts of Europe (North, South, Mid and Eastern) and from the United States were pooled. In total, 22,479 observations (48.7% European vs. 51.3% American), 11,234 from girls and 11,245 from boys, aged 6-18 years were included in the study. Linear mixed-model regression analysis was used to analyze the associations between age and each cardiometabolic risk factor.

Results: Reference values for 14 of the most commonly used cardiometabolic risk variables in clustered risk scores were calculated and presented by age and gender: systolic blood pressure (SBP), diastolic blood pressure (DBP), waist circumference (WC), body mass index (BMI), sum of 4 skinfolds (sum4skin), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), TC:HDL-C ratio, glucose, insulin, homeostatic model assessment-score (HOMA-score), and cardiorespiratory fitness (CRF).

Conclusions: This study suggests a common standard to define cardiometabolic risk in children. Adapting this approach makes single risk factors and clustered cardiometabolic disease risk scores comparable to the reference material itself and comparable to cardiometabolic risk values in studies using the same strategy. This unified approach therefore increases the prospect to estimate and compare prevalence and trends of cardiometabolic risk in children when using continuous cardiometabolic risk scores.
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http://dx.doi.org/10.1016/j.atherosclerosis.2018.10.003DOI Listing
November 2018

Effects of physical activity interventions on cognitive and academic performance in children and adolescents: a novel combination of a systematic review and recommendations from an expert panel.

Br J Sports Med 2019 May 30;53(10):640-647. Epub 2018 Jul 30.

Department of Public and Occupational Health and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.

Objective: To summarise the current evidence on the effects of physical activity (PA) interventions on cognitive and academic performance in children, and formulate research priorities and recommendations.

Design: Systematic review (following PRISMA guidelines) with a methodological quality assessment and an international expert panel. We based the evaluation of the consistency of the scientific evidence on the findings reported in studies rated as of high methodological quality.

Data Sources: PubMed, PsycINFO, Cochrane Central, Web of Science, ERIC, and SPORTDiscus.

Eligibility Criteria For Selecting Studies: PA-intervention studies in children with at least one cognitive or academic performance assessment.

Results: Eleven (19%) of 58 included intervention studies received a high-quality rating for methodological quality: four assessed effects of PA interventions on cognitive performance, six assessed effects on academic performance, and one on both. All high-quality studies contrasted the effects of additional/adapted PA activities with regular curriculum activities. For cognitive performance 10 of 21 (48%) constructs analysed showed statistically significant beneficial intervention effects of PA, while for academic performance, 15 of 25 (60%) analyses found a significant beneficial effect of PA. Across all five studies assessing PA effects on mathematics, beneficial effects were reported in six out of seven (86%) outcomes. Experts put forward 46 research questions. The most pressing research priority cluster concerned the causality of the relationship between PA and cognitive/academic performance. The remaining clusters pertained to PA characteristics, moderators and mechanisms governing the 'PA-performance' relationship and miscellaneous topics.

Conclusion: There is currently inconclusive evidence for the beneficial effects of PA interventions on cognitive and overall academic performance in children. We conclude that there is strong evidence for beneficial effects of PA on maths performance.The expert panel confirmed that more 'high-quality' research is warranted. By prioritising the most important research questions and formulating recommendations we aim to guide researchers in generating high-quality evidence. Our recommendations focus on adequate control groups and sample size, the use of valid and reliable measurement instruments for physical activity and cognitive performance, measurement of compliance and data analysis.

Prospero Registration Number: CRD42017082505.
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http://dx.doi.org/10.1136/bjsports-2017-098136DOI Listing
May 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

The longitudinal relationship between motor competence and measures of fatness and fitness from childhood into adolescence.

J Pediatr (Rio J) 2019 Jul - Aug;95(4):482-488. Epub 2018 May 18.

Western Norway University of Applied Sciences, Sogndal, Norway; Norwegian School of Sport Sciences, Department of Sports Medicine, Oslo, Norway.

Objectives: To examine longitudinal (seven years) relationships among cardiorespiratory fitness (VO), body fatness, and motor competence.

Method: Data were collected as part of the Copenhagen School Child Intervention Study (CoSCIS). Body fatness was assessed by the sum of four skinfolds. VO was measured directly in a continuous running protocol. Motor competence was assessed using the Körperkoordinationtest für Kinder. This study used multilevel linear mixed models to evaluate the reciprocal longitudinal association between body fatness, VO, and motor competence. All regressions were stratified by sex and adjusted by intervention and pubertal status. All variable coefficients were standardized.

Results: A reciprocal relationship was observed between children's motor competence with body fatness and VO at the seven-year follow-up (6-13 years of age). Children with higher motor competence at baseline had a lower risk of having higher body fatness (β=-0.45, 95% CI: -0.52 to -0.38; β=-0.35, 95% CI: -0.42 to -0.28) and higher VO (β=0.34, 95% CI: 0.27-0.40; β=0.27, 95% CI: 0.20-0.33) during childhood. Alternatively, higher body fatness or lower levels of VO at baseline were associated with lower motor competence during childhood.

Conclusions: These data suggest motor competence, body fatness, and VO demonstrate reciprocal relationships across childhood (6-13 years of age). Interventions addressing motor competence, cardiorespiratory fitness, and body fatness in early childhood are recommended, as intervention effects are likely to be enhanced because of the mutual reciprocal associations between these three variables.
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http://dx.doi.org/10.1016/j.jped.2018.02.010DOI Listing
May 2020

Testing physical function in children undergoing intense cancer treatment-a RESPECT feasibility study.

Pediatr Blood Cancer 2018 08 9;65(8):e27100. Epub 2018 May 9.

Department of Pediatrics and Adolescent Medicine, The Juliane Marie Center, University Hospital (Rigshospitalet), Copenhagen, Denmark.

Background: The physical function of children with cancer is reduced during treatment, which can compromise the quality of life and increase the risk of chronic medical conditions. The study, "REhabilitation, including Social and Physical activity and Education in Children and Teenagers with cancer" (Clinicaltrials.gov: NCT01772862) examines the efficacy of multimodal rehabilitation strategies introduced at cancer diagnosis. This article addresses the feasibility of and obstacles to testing physical function in children with cancer.

Methods: The intervention group comprised 46 males and 29 females aged 6-18 years (mean ± SD: 11.3 ± 3.1 years) diagnosed with cancer from January 2013 to April 2016. Testing at diagnosis and after 3 months included timed-up-and-go, sit-to-stand, flamingo balance, handgrip strength, and the bicycle ergometer cardiopulmonary exercise test (CPET).

Results: Of the 75 children, 92% completed a minimum of one test; two children declined testing and four were later included. Completion was low for CPET (38/150, 25%) but was high for handgrip strength (122/150, 81%). Tumor location, treatment-related side effects, and proximity to chemotherapy administration were primary obstacles for testing physical function. Children with extracranial solid tumors and central nervous system tumors completed significantly fewer tests than those with leukemia and lymphoma. Children with leukemia demonstrated reduced lower extremity function, that is, 24% reduction at 3 months testing in timed-up-and-go (P = 0.005) and sit-to-stand (P = 0.002), in contrast with no reductions observed in the other diagnostic groups.

Conclusion: Children with cancer are generally motivated to participate in physical function tests. Future studies should address diagnosis specific obstacles and design testing modalities that facilitate physical function tests in this target group.
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http://dx.doi.org/10.1002/pbc.27100DOI Listing
August 2018

School-based study found that physical activity and aerobic fitness predicted increases in total body fat and abdominal fat at a mean age of 9.8 years.

Acta Paediatr 2018 10 26;107(10):1810-1817. Epub 2018 Mar 26.

Department of Translational Medicine, Unit of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Lund, Sweden.

Aim: We assessed whether baseline measurements of physical activity, aerobic fitness, body fat and abdominal fat were predictors of changes in body fat measurements over a two-year period.

Methods: The study comprised of 204 children aged 9.8 ± 0.6 years with a normal body mass distribution, who recruited from four schools in middle-class areas of Malmö, Sweden, from 2001 to 2004. Peak oxygen uptake and physical activity were measured at baseline. Body fat was measured by dual-energy X-ray absorptiometry at baseline and two years later.

Results: Physical activity, aerobic fitness and total body fat or abdominal fat were predictors of change in total body fat or abdominal fat over a period of two years. Changes in the percentage of body fat were not related to any of the baseline measurements.

Conclusion: Our two-year follow-up of children with a mean age of 9.8 years at baseline showed that physical activity, aerobic fitness and body fat or abdominal fat predicted changes in total body fat or abdominal fat, but not the percentage of body fat.
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http://dx.doi.org/10.1111/apa.14289DOI Listing
October 2018

Galectin-3 levels relate in children to total body fat, abdominal fat, body fat distribution, and cardiac size.

Eur J Pediatr 2018 Mar 11;177(3):461-467. Epub 2018 Jan 11.

Department of Medical Imaging and Physiology, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden.

Galectin-3 has recently been proposed as a novel biomarker for cardiovascular disease in adults. The purpose of this investigation was to assess relationships between galectin-3 levels and total body fat, abdominal fat, body fat distribution, aerobic fitness, blood pressure, left ventricular mass, left atrial size, and increase in body fat over a 2-year period in a population-based sample of children. Our study included 170 children aged 8-11 years. Total fat mass and abdominal fat were measured by dual-energy x-ray absorptiometry (DXA). Body fat distribution was expressed as abdominal fat/total fat mass. Maximal oxygen uptake was assessed by indirect calorimetry during a maximal exercise test and scaled to body mass. Systolic and diastolic blood pressure and pulse pressure were measured. Left atrial size, left ventricular mass, and relative wall thickness were measured by echocardiography. Frozen serum samples were analyzed for galectin-3 by the Proximity Extension Assay technique. A follow-up DXA scan was performed in 152 children 2 years after the baseline exam. Partial correlations, with adjustment for sex and age, between galectin-3 versus body fat measurements indicated weak to moderate relationships. Moreover, left atrial size, left ventricular mass, and relative wall thickness and pulse pressure were also correlated with galectin-3. Neither systolic blood pressure nor maximal oxygen uptake was correlated with galectin-3. There was also a correlation between galectin-3 and increase in total body fat over 2 years, while no such correlations were found for the other fat measurements.

Conclusion: More body fat and abdominal fat, more abdominal body fat distribution, more left ventricular mass, and increased left atrial size were all associated with higher levels of galectin-3. Increase in total body fat over 2 years was also associated with higher levels of galectin-3. What is Known: • Galectin-3 has been linked to obesity and been proposed to be a novel biomarker for cardiovascular disease in adults. • Information on this subject in children is very scarce. What is New: • The present study demonstrates a relationship between galectin-3 levels and total body fat, abdominal fat, body fat distribution, cardiac size and geometry, and increase in total body fat over 2 years in young children.
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http://dx.doi.org/10.1007/s00431-017-3079-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816767PMC
March 2018

Cystatin B, cathepsin L and D related to surrogate markers for cardiovascular disease in children.

PLoS One 2017 17;12(11):e0187494. Epub 2017 Nov 17.

Dept of Translational Medicine, Unit of Medical Imaging and Physiology, Skåne University Hospital, Lund University, Malmö, Sweden.

Objective: This study investigated potential associations between novel biomarkers for cardiovascular disease and other surrogate markers for health.

Methods: Community sample of 170 (92 boys and 78 girls) children aged 8-11 years. Total fat mass (TBF) and abdominal fat (AFM) were measured by Dual-energy x-ray absorptiometry (DXA). Total body fat was also expressed as percentage of total body mass (BF%), and body fat distribution was calculated as AFM/TBF. Maximal oxygen uptake (VO2PEAK), systolic and diastolic blood pressure (SBP and DBP) and pulse pressure (PP) were measured. Echocardiography was performed. Left atrial size (LA) and left ventricular mass (LVM) were measured. A follow-up DXA scan was available in 152 children (84 boys and 68 girls). Frozen serum samples were analyzed for cystatin B, cathepsin L and cathepsin D.

Results: Partial correlations between cystatin B versus lnTBF, lnBF%, lnAFM, AFM/TBF, VO2PEAK and PP were; r = 0.38, 0.36, 0.38, 0.29, -0.25 and 0.25, P = 0.001 or less for all. Weaker predominantly non-significant correlations were found for cathepsin L, whereas cathepsin D was not related to any surrogate markers for health. No significant correlations were found between biomarkers and change in body fat over 2 years.

Conclusion: Findings from this community-based cohort of young children show that surrogate markers for cardiovascular disease such as total fat mass, percent body fat, abdominal fat, body fat distribution, maximal oxygen uptake and pulse pressure were all associated with cystatin B. This was not found for cathepsin L or cathepsin D.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0187494PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693439PMC
December 2017

Effect of Low- Versus High-Intensity Exercise Training on Biomarkers of Inflammation and Endothelial Dysfunction in Adolescents With Obesity: A 6-Month Randomized Exercise Intervention Study.

Pediatr Exerc Sci 2018 02 23;30(1):96-105. Epub 2017 Nov 23.

7 Federal University of São Paulo-Santos.

Purpose: To investigate the effects of a low- versus high-intensity aerobic training on biomarkers of inflammation and endothelial dysfunction in adolescents with obesity.

Methods: Sixty-two adolescents with obesity [age = 15 (14) y, body mass index = 34.87 (4.22) kg·m] were randomized to receive either a high-intensity training (HIT, n = 31) or a low-intensity training (LIT, n = 31) for 24 weeks. All participants also received nutritional, psychological, and clinical counseling. Leptin, total and subtype leukocyte counts, tumor necrosis factor-alpha, interleukin-6, myeloperoxidase, soluble intercellular adhesion molecule-1, and soluble vascular cell adhesion molecule-1 were obtained at baseline and after 24 weeks.

Results: HIT reduced neutrophils [from 4.4 (1.9) to 3.6 (1.3) µL × 10; P = .01] and monocytes [from 7.2 (2.5) to 5.2 (1.8) µL × 10; P < .01], but LIT increased neutrophils [from 4.5 (1.7) to 5.2 (3.3) µL × 10; P = .01]. Although tumor necrosis factor-alpha increased in LIT [from 13.3 (7.5) to 17.7 (10.8) pg·mL; P = .01], it decreased in HIT [from 12.4 (7.5) to 11.3 (6.2) pg·mL; P = .01]. No changes in leukocyte counts, soluble intercellular adhesion molecule-1, soluble vascular cell adhesion molecule-1, and homeostasis assessment model for insulin resistance were observed.

Conclusions: Both HIT and LIT improved the inflammatory profile. The study, however, indicated that the number of biomarkers and the magnitude of changes were higher in the HIT compared with LIT.
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http://dx.doi.org/10.1123/pes.2017-0067DOI Listing
February 2018

Bystander capability to activate speaker function for continuous dispatcher assisted CPR in case of suspected cardiac arrest.

Resuscitation 2017 06 4;115:52-55. Epub 2017 Apr 4.

Prehospital Emergency Medical Services, Region Zealand, Denmark.

Background: The European Resuscitation Council Guidelines 2015 recommend bystanders to activate their mobile phone speaker function, if possible, in case of suspected cardiac arrest. This is to facilitate continuous dialogue with the dispatcher including (if required) cardiopulmonary resuscitation instructions. The aim of this study was to measure the bystander capability to activate speaker function in case of suspected cardiac arrest.

Method: In 87days, a systematic prospective registration of bystander capability to activate the speaker function, when cardiac arrest was suspected, was performed. For those asked, "can you activate your mobile phone's speaker function", audio recordings were examined and categorized into groups according to the bystanders capability to activate speaker function on their own initiative, without instructions, or with instructions from the emergency medical dispatcher. Time delay was measured, in seconds, for the bystanders without pre-activated speaker function.

Results: 42.0% (58) was able to activate the speaker function without instructions, 2.9% (4) with instructions, 18.1% (25) on own initiative and 37.0% (51) were unable to activate the speaker function. The median time to activate speaker function was 19s and 8s, with and without instructions, respectively.

Conclusion: Dispatcher assisted cardiopulmonary resuscitation with activated speaker function, in cases of suspected cardiac arrest, allows for continuous dialogue between the emergency medical dispatcher and the bystander. In this study, we found a 63.0% success rate of activating the speaker function in such situations.
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http://dx.doi.org/10.1016/j.resuscitation.2017.04.002DOI Listing
June 2017

Associations of Proatrial Natriuretic Peptide with Components of the Metabolic Syndrome in Adolescents and Young Adults from the General Population.

Am J Hypertens 2017 Jun;30(6):561-568

Department of Medicine, Amager Hvidovre Hospital Glostrup, University of Copenhagen, Glostrup, Denmark.

Background: In middle-aged and elderly populations, circulating natriuretic peptide concentrations are negatively associated with several components of the metabolic syndrome. Whether these negative associations are also present in healthy adolescents and young adults from the general population are unknown.

Methods: In a cross-sectional setting, we measured plasma concentrations of mid-regional proatrial natriuretic peptide (MR-proANP) in 343 adolescents (age 14-16 years) and 616 young adults (age 20-28 years) from the Danish site of the European Youth Heart Study, which is a population-based study of cardiovascular disease risk factors in children, adolescents and young adults. We used linear regression analysis to examine the associations, expressed as standardized regression coefficients, of various variables of interest with MR-proANP stratified according to age group, adjusting for age and gender.

Results: Among the young adults, MR-proANP was negatively associated with body mass index (BMI) (β = -0.10, P = 0.02), waist circumference (WC) (β = -0.14, P < 0.001), systolic blood pressure (BP) (β = -0.08, P = 0.03), diastolic BP (β = -0.23, P < 0.001), insulin (β = -0.15, P < 0.001), and triglycerides (β = -0.14, P < 0.001). Among the adolescents a somehow different pattern was observed since MR-proANP was not significantly associated with BMI (β = -0.00, P = 0.98), WC (β = -0.01, P = 0.90) and insulin (β = -0.02, P = 0.69). Nevertheless, among the adolescents, MR-proANP was negatively associated with triglycerides (β = -0.13, P = 0.01), diastolic BP (β = -0.12, P = 0.01) and systolic BP (β = -0.10, P = 0.10), although the latter association was of borderline significance.

Conclusions: The young adults displayed significant negative associations between MR-proANP and several components of the metabolic syndrome, whereas such associations were not found among the adolescents besides triglycerides and diastolic BP.
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http://dx.doi.org/10.1093/ajh/hpx026DOI Listing
June 2017

Associations of Vigorous-Intensity Physical Activity with Biomarkers in Youth.

Med Sci Sports Exerc 2017 07;49(7):1366-1374

1Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC; 2Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC; 3Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC; 4Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, DENMARK; 5Department of Sport Medicine, Norwegian School of Sport Science, Oslo, NORWAY; 6Federal University of Pelotas, Pelotas, BRAZIL; 7School of Social and Community Medicine, University of Bristol, Bristol, UNITED KINGDOM; 8Epidemiology, Biostatistics and Public Health Institute, University of Zürich, Zürich, SWITZERLAND; 9Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UNITED KINGDOM; and 10Exercise and Health Laboratory, CIPER, Faculty of Human Kinetics, University of Lisbon, Cruz-Quebrada, PORTUGAL.

Introduction: Physical activity (PA) conveys known cardiometabolic benefits to youth, but the contribution of vigorous-intensity PA (VPA) to these benefits is unknown. Therefore, we sought to determine (a) the associations between VPA and cardiometabolic biomarkers independent of moderate-intensity PA (MPA) and time sedentary and (b) the accelerometer cut point that best represents the threshold for health-promoting VPA in youth.

Methods: Data from the International Children's Accelerometry Database (ICAD) were analyzed in 2015. The relationship between cardiometabolic biomarkers and four categories of VPA estimated via three sets of cut points were examined using isotemporal substitution quantile regression modeling at the 10th, 25th, 50th, 75th, and 90th percentile of the distribution of each biomarker, separately. Age, sex, accelerometer wear time, sedentary time, and MPA were controlled for while allowing substitution for light-intensity PA. Data from 11,588 youth (4-18 yr) from 11 ICAD studies (collected 1998-2009) were analyzed.

Results: Only 32 of 360 significant associations were observed. Significant, negative relationships were observed for VPA with waist circumference and insulin. Replacing light-intensity PA with VPA (corresponding to at the 25th to 90th percentiles of VPA) was associated with 0.67 (-1.33 to -0.01; P = 0.048) to 7.30 cm (-11.01 to -3.58; P < 0.001) lower waist circumference using Evenson and ICAD cut points (i.e., higher counts per minute). VPA levels were associated with 12.60 (-21.28 to -3.92; P = 0.004) to 27.03 pmol·L (-45.03 to -9.03; P = 0.003) lower insulin levels at the 75th to 90th percentiles using Evenson and ICAD cut points when substituted for light PA.

Conclusions: Substituting light PA with VPA was inversely associated with waist circumference and insulin. However, VPA was inconsistently related to the remaining biomarkers after controlling for time sedentary and MPA.
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http://dx.doi.org/10.1249/MSS.0000000000001249DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5472198PMC
July 2017

Total body fat, abdominal fat, body fat distribution and surrogate markers for health related to adipocyte fatty acid-binding protein (FABP4) in children.

J Pediatr Endocrinol Metab 2017 Apr;30(4):375-382

Department of Translational Medicine, Unit of Medical Imaging and Physiology, Skåne University Hospital, Lund University, Lund.

Background: The aim of the study was to assess possible relationships between adipocyte fatty acid-binding protein (FABP4) and total body fat (TBF), abdominal fat, body fat distribution, aerobic fitness, blood pressure, cardiac dimensions and the increase in body fat over 2 years in a community sample of children.

Methods: A cross-sectional study was used in a community sample of 170 (92 boys and 78 girls) children aged 8-11 years. TBF and abdominal fat (AFM) were measured by dual-energy X-ray absorptiometry (DXA). TBF was also expressed as percentage of total body mass (BF%), and body fat distribution was calculated as AFM/TBF. Maximal oxygen uptake (VO2PEAK) was assessed by indirect calorimetry during a maximal exercise test and scaled to body mass. Systolic and diastolic blood pressure (SBP and DBP) and pulse pressure (PP) were measured. Echocardiography was performed. Left atrial (LA) size was measured, and left ventricular mass (LVM) was calculated. A follow-up DXA scan was available in 152 children (84 boys and 68 girls). Frozen serum samples were analyzed for FABP4.

Results: Partial correlations, with adjustment for sex, between FABP4 vs. ln TBF, ln BF%, ln AFM, AFM/TBF and VO2PEAK were (r=0.69, 0.68, 0.69, 0.49 and -0.39, p<0.05 for all). Moreover, SBP, PP, LVM and LA were also weakly correlated with FABP4 (r=0.23, 0.22, 0.28 and 0.21, p<0.05 for all). Correlations between FABP4 vs. increase in TBF and AFM over 2 years were 0.29 and 0.26, p<0.05, for both. (Increase in percent body fat or change in fat distribution were not correlated.) Conclusions: Findings from this community-based cohort of young children show that increased body fat and abdominal fat, more abdominal body fat distribution, low fitness, more LVM and increased LA, increased SBP and PP were all associated with increased levels of FABP4. Increase in TBF and abdominal fat over 2 years were also associated with increased levels of FABP4.
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http://dx.doi.org/10.1515/jpem-2016-0278DOI Listing
April 2017

Cardiorespiratory fitness cut points to avoid cardiovascular disease risk in children and adolescents; what level of fitness should raise a red flag? A systematic review and meta-analysis.

Br J Sports Med 2016 Dec 26;50(23):1451-1458. Epub 2016 Sep 26.

Universidad de Castilla-La Mancha, Health and Social Research Center, Granada, Spain.

Background: Poor cardiorespiratory fitness is associated with cardiovascular disease risk factors.

Aim: To perform a systematic review and meta-analysis of the relationship between poor cardiorespiratory fitness and cardiovascular disease risk in children and adolescents.

Methods: Systematic literature search (1980 to 11 April 2015) for studies that determined a cardiorespiratory fitness cut point that predicted cardiovascular disease risk in children and adolescents.

Results: We identified 7 studies that included 9280 children and adolescents (49% girls) aged 8-19 years from 14 countries. Cardiovascular disease risk was already present in boys (6-39%) and girls (6-86%). Boys with low fitness (<41.8 mL/kg/min) had a 5.7 times greater likelihood of having cardiovascular disease risk (95% CI 4.8 to 6.7). The comparable diagnostic OR for girls with low fitness (<34.6 mL/kg/min) was 3.6 (95% CI 3.0 to 4.3). The 95% confidence region of cardiorespiratory fitness associated with low cardiovascular disease risk ranges, 41.8-47.0 mL/kg/min in boys (eg, stages 6-8 for a boy aged 15 years) and 34.6-39.5 mL/kg/min in girls (eg, stages 3-5 for a girl aged 15 years). The cardiorespiratory fitness cut point to avoid cardiovascular disease risk ranged 41.8 mL/kg/min in boys and was 34.6 mL/kg/min in girls.

Summary: Fitness levels below 42 and 35 mL/kg/min for boys and girls, respectively, should raise a red flag. These translate to 6 and 3 stages on the shuttle run test for a boy and a girl, both aged 15 years, respectively. These cut points identify children and adolescents who may benefit from primary and secondary cardiovascular prevention programming.
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http://dx.doi.org/10.1136/bjsports-2015-095903DOI Listing
December 2016

Effects of physical activity on schoolchildren's academic performance: The Active Smarter Kids (ASK) cluster-randomized controlled trial.

Prev Med 2016 10 7;91:322-328. Epub 2016 Sep 7.

Sogn og Fjordane University College, Faculty of Teacher Education and Sports, Sogndal, Norway; Norwegian School of Sport Sciences, Department of Sports Medicine, Oslo, Norway. Electronic address:

Objective: To investigate the effect of a seven-month, school-based cluster-randomized controlled trial on academic performance in 10-year-old children.

Methods: In total, 1129 fifth-grade children from 57 elementary schools in Sogn og Fjordane County, Norway, were cluster-randomized by school either to the intervention group or to the control group. The children in the 28 intervention schools participated in a physical activity intervention between November 2014 and June 2015 consisting of three components: 1) 90min/week of physically active educational lessons mainly carried out in the school playground; 2) 5min/day of physical activity breaks during classroom lessons; 3) 10min/day physical activity homework. Academic performance in numeracy, reading and English was measured using standardized Norwegian national tests. Physical activity was measured objectively by accelerometry.

Results: We found no effect of the intervention on academic performance in primary analyses (standardized difference 0.01-0.06, p>0.358). Subgroup analyses, however, revealed a favorable intervention effect for those who performed the poorest at baseline (lowest tertile) for numeracy (p=0.005 for the subgroup∗group interaction), compared to controls (standardized difference 0.62, 95% CI 0.19-1.07).

Conclusions: This large, rigorously conducted cluster RCT in 10-year-old children supports the notion that there is still inadequate evidence to conclude that increased physical activity in school enhances academic achievement in all children. Still, combining physical activity and learning seems a viable model to stimulate learning in those academically weakest schoolchildren.
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http://dx.doi.org/10.1016/j.ypmed.2016.09.005DOI Listing
October 2016

Age-related patterns of vigorous-intensity physical activity in youth: The International Children's Accelerometry Database.

Prev Med Rep 2016 Dec 16;4:17-22. Epub 2016 May 16.

MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom.

Physical activity declines during youth but most evidence reports on combined moderate and vigorous-intensity physical activity. We investigated how vigorous-intensity activity varies with age. Cross-sectional data from 24,025 participants (5.0-18.0 y; from 20 studies in 10 countries obtained 2008-2010) providing ≥ 1 day accelerometer data (International Children's Accelerometry Database (ICAD)). Linear regression was used to investigate age-related patterns in vigorous-intensity activity; models included age (exposure), adjustments for monitor wear-time and study. Moderate-intensity activity was examined for comparison. Interactions were used to investigate whether the age/vigorous-activity association differed by sex, weight status, ethnicity, maternal education and region. A 6.9% (95% CI 6.2, 7.5) relative reduction in mean vigorous-intensity activity with every year of age was observed; for moderate activity the relative reduction was 6.0% (5.6%, 6.4%). The age-related decrease in vigorous-intensity activity remained after adjustment for moderate activity. A larger age-related decrease in vigorous activity was observed for girls (- 10.7%) versus boys (- 2.9%), non-white (- 12.9% to - 9.4%) versus white individuals (- 6.1%), lowest maternal education (high school (- 2.0%)) versus college/university (ns) and for overweight/obese (- 6.1%) versus healthy-weight participants (- 8.1%). In addition to larger annual decreases in vigorous-intensity activity, overweight/obese individuals, girls and North Americans had comparatively lower average vigorous-intensity activity at 5.0-5.9 y. Age-related declines in vigorous-intensity activity during youth appear relatively greater than those of moderate activity. However, due to a higher baseline, absolute moderate-intensity activity decreases more than vigorous. Overweight/obese individuals, girls, and North Americans appear especially in need of vigorous-intensity activity promotion due to low levels at 5.0-5.9 y and larger negative annual differences.
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http://dx.doi.org/10.1016/j.pmedr.2016.05.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4929125PMC
December 2016