Anna Viitasalo

Physical activity and sedentary behaviour in relation to cardiometabolic risk in children: cross-sectional findings from the Physical Activity and Nutrition in Children (PANIC) Study

BackgroundLower levels of physical activity (PA) and sedentary behaviour (SB) have been associated with increased cardiometabolic risk among children. However, little is known about the independent and combined associations of PA and SB as well as different types of these behaviours with cardiometabolic risk in children. We therefore investigated these relationships among children.MethodsThe subjects were a population sample of 468 children 6–8 years of age. PA and SB were assessed by a questionnaire administered by parents and validated by a monitor combining heart rate and accelerometry measurements. We assessed body fat percentage, waist circumference, blood glucose, serum insulin, plasma lipids and lipoproteins and blood pressure and calculated a cardiometabolic risk score using population-specific Z-scores and a formula waist circumference + insulin + glucose + triglycerides - HDL cholesterol + mean of systolic and diastolic blood pressure. We analysed data using multivariate linear regression models.ResultsTotal PA was inversely associated with the cardiometabolic risk score (β = -0.135, p = 0.004), body fat percentage (β = -0.155, p < 0.001), insulin (β = -0.099, p = 0.034), triglycerides (β = -0.166, p < 0.001), VLDL triglycerides (β = -0.230, p < 0.001), VLDL cholesterol (β = -0.168, p = 0.001), LDL cholesterol (β = -0.094, p = 0.046) and HDL triglycerides (β = -0.149, p = 0.004) and directly related to HDL cholesterol (β = 0.144, p = 0.002) adjusted for age and gender. Unstructured PA was inversely associated with the cardiometabolic risk score (β = -0.123, p = 0.010), body fat percentage (β = -0.099, p = 0.027), insulin (β = -0.108, p = 0.021), triglycerides (β = -0.144, p = 0.002), VLDL triglycerides (β = -0.233, p < 0.001) and VLDL cholesterol (β = -0.199, p < 0.001) and directly related to HDL cholesterol (β = 0.126, p = 0.008). Watching TV and videos was directly related to the cardiometabolic risk score (β = 0.135, p = 0.003), body fat percentage (β = 0.090, p = 0.039), waist circumference (β = 0.097, p = 0.033) and systolic blood pressure (β = 0.096, p = 0.039). Resting was directly associated with the cardiometabolic risk score (β = 0.092, p = 0.049), triglycerides (β = 0.131, p = 0.005), VLDL triglycerides (β = 0.134, p = 0.009), VLDL cholesterol (β = 0.147, p = 0.004) and LDL cholesterol (β = 0.105, p = 0.023). Other types of PA and SB had less consistent associations with cardiometabolic risk factors.ConclusionsThe results of our study emphasise increasing total and unstructured PA and decreasing watching TV and videos and other sedentary behaviours to reduce cardiometabolic risk among children.Trial registrationClinicalTrials.gov Identifier: NCT01803776.

Cardiovascular fitness and haemodynamic responses to maximal cycle ergometer exercise test in children 6–8 years of age

Abstract We investigated cardiovascular fitness and haemodynamic responses to maximal cycle ergometer exercise test in children. The participants were a population sample of 425 children (204 girls, 221 boys) aged 6–8 years. Heart rate (HR) and systolic blood pressure (SBP) were measured from the beginning of pre-exercise rest to the end of recovery period. We provided reference values for peak workload and changes in HR and SBP during and after maximal exercise test in girls and boys. Girls had a lower cardiovascular fitness, indicated by peak workload per body weight [mean (2 s) 2.7 (0.9) vs. 3.1 (1.0) W · kg–1, P < 0.001] and lean mass [mean (2 s) 3.5 (0.9) vs. 3.8 (1.0) W· kg–1, P < 0.001] than boys. Plateau or decline in SBP close to the end of the test was found in about third of children and was considered a normal SBP response. Girls had a slower HR decrease within 2 min after the test than boys [mean (2 s) 53 (18) vs. 59 (22) beats · min–1, P < 0.001]. The results are useful for physicians and exercise physiologists to evaluate cardiovascular fitness and haemodynamic responses to exercise in children and to detect children with low exercise tolerance or abnormal haemodynamic responses to exercise.

Associations of I148M variant in PNPLA3 gene with plasma ALT levels during 2-year follow-up in normal weight and overweight children: the PANIC Study.

PNPLA3 I148M polymorphism (rs738409) has been strongly associated with liver fat content and plasma alanine aminotransferase (ALT) levels in obese adults and children, but little is known about these relationships in normal weight individuals. We studied the associations and interactions of overweight and the PNPLA3 I148M polymorphism with plasma ALT levels during 2‐year follow‐up in children.

The Effects of a 2-year Individualized and Family-based Lifestyle Intervention on Physical Activity, Sedentary Behavior and Diet in Children

OBJECTIVE To investigate the effects of a long-term, individualized and family-based lifestyle intervention on physical activity, sedentary behavior and diet quality in children. METHODS We carried out a 2-year intervention study in a population sample of 506 children aged 6-8years in Finland in 2007-2012. We allocated the participants at baseline in the intervention and control group. We assessed physical activity and sedentary behavior by questionnaires and diet by food records. RESULTS Total physical activity (+9min/d in intervention group vs. -5min/d in control group, p=0.001 for time*group interaction), unsupervised physical activity (+7min/d vs. -9min/d, p<0.001) and organized sports (+8min/d vs. +3min/d, p=0.001) increased in the intervention group but not in the control group. Using computer and playing video games increased less in the intervention group than in the control group (+9min/d vs. +19min/d, p=0.003). Consumption of vegetables (+12g/d vs. -12g/d, p=0.001), high-fat vegetable-oil based margarine (+10g/d vs. +3g/d, p<0.001) and low-fat milk (+69g/d vs. +11g/d, p=0.042) and intake of dietary fiber (+1.3g/d vs. +0.2g/d, p=0.023), vitamin C (+4.5mg/d vs. -7.2mg/d, p=0.042) and vitamin E (+1.4mg/d vs. +0.5mg/d, p=0.002) increased in the intervention group but not in the control group. Consumption of butter-based spreads increased in the control group but not in the intervention group (+2g/d vs. -1g/d, p=0.002). CONCLUSIONS Individualized and family-based lifestyle intervention increased physical activity, attenuated increase in sedentary behavior and enhanced diet quality in children. TRIAL REGISTRATION ClinicalTrials.gov: NCT01803776.

The Presentation of Adrenarche Is Sexually Dimorphic and Modified by Body Adiposity

CONTEXT Adrenarche refers to the onset of increased production of adrenal androgens in childhood leading variably to clinical signs of androgen action. The prevalence and presentation of adrenarche in prepubertal girls and boys is not well known. OBJECTIVE Our objective was to examine the prevalence and clinical presentation of adrenarche in a population sample of prepubertal children aged less than 9 years. DESIGN AND PARTICIPANTS This cross-sectional study included prepubertal children (209 girls and 228 boys; median age 7.6 [range 6.8-8.9] years) taking part in The Physical Activity and Nutrition in Children (PANIC) Study. MAIN OUTCOME MEASURE The prevalence of adrenarche was assessed. RESULTS The prevalence of any clinical sign of androgen action was higher in girls than in boys (26.1% vs 10.0%; P < .001) and biochemical adrenarche without any clinical sign was less common in girls than in boys (8.1% vs 16.7%; P = .007). When premature adrenarche was defined by serum dehydroepiandrosterone sulfate concentration ≥1 μmol/L (≥37 μg/dL) and any clinical sign before the age of 8 years in girls and 9 years in boys, its total prevalence was 8.6% in girls and 1.8% in boys. The risk of having any clinical sign increased with higher body fat percentage in boys and with higher serum dehydroepiandrosterone sulfate concentration in girls. CONCLUSIONS Clinical signs of androgen action are more common, but biochemical adrenarche without any clinical sign is less common in prepubertal girls than boys. This sexual dimorphism of adrenarche might be explained by sex-dependent differences in peripheral androgen metabolism or action that are modified by body fat.

Associations of cardiorespiratory fitness, physical activity, and adiposity with arterial stiffness in children

Associations of cardiorespiratory fitness (CRF), physical activity (PA), sedentary behavior, and body fat percentage (BF%) with arterial stiffness and dilation capacity were investigated in 160 prepubertal children (83 girls) 6–8 years of age. We assessed CRF (watts/lean mass) by maximal cycle ergometer exercise test, total PA, structured exercise, unstructured PA, commuting to and from school, recess PA and total and screen‐based sedentary behavior by questionnaire, BF% using dual‐energy X‐ray absorptiometry, and arterial stiffness and dilation capacity using pulse contour analysis. Data were adjusted for sex and age. Poorer CRF (standardized regression coefficient β = −0.297, P < 0.001), lower unstructured PA (β = −0.162, P = 0.042), and higher BF% (β = 0.176, P = 0.044) were related to higher arterial stiffness. When CRF, unstructured PA, and BF% were in the same model, only CRF was associated with arterial stiffness (β = −0.246, P = 0.006). Poorer CRF was also related to lower arterial dilation capacity (β = 0.316, P < 0.001). Children with low CRF (< median) and high BF% (≥ median; P = 0.002), low CRF and low unstructured PA (< median; P = 0.006) or children with low unstructured PA and high BF% (P = 0.005) had higher arterial stiffness than children in the opposite halves of these variables. Poor CRF was independently associated with increased arterial stiffness and impaired arterial dilation capacity among children.

Association of MBOAT7 gene variant with plasma ALT levels in children: the PANIC study.

Background:We studied for the first time among children differences in plasma alanine aminotransferase (ALT) among genotypes of the rs641738 polymorphism in the MBOAT7 gene that has been associated with increased risk of nonalcoholic fatty liver disease among adults. We also investigated the associations of a genetic risk score combining information from the MBOAT7, PNPLA3, and TM6SF2 polymorphisms with plasma ALT.Methods:We performed a 2-y follow-up study in 467 Caucasian children aged 6–9 y, genotyped the MBOAT7, PNPLA3, and TM6SF2 polymorphisms, calculated a genetic risk score from these polymorphisms (scored 0–3) and assessed plasma ALT.Results:Children carrying the T allele of the MBOAT7 polymorphism had 7% higher plasma ALT at baseline (17.8 vs. 19.1 U/l, P = 0.022) and 10% higher plasma ALT at 2-y follow-up (18.0 vs. 19.7 U/l, P = 0.022) than the noncarriers. A higher genetic risk score was associated with higher plasma ALT at baseline (17.5, 18.5, 19.2, and 22.8 U/l, P = 0.008 for linear trend) and 2-y follow-up (18.2, 18.9, 18.9, and 32.8 U/l, P = 0.017 for linear trend).Conclusion:Children carrying the T allele of the MBOAT7 polymorphism had higher plasma ALT than the noncarriers. Children with the MBOAT7, PNPLA3, and TM6SF2 variants had the highest plasma ALT.

Association of plasma fatty acid composition with plasma irisin levels in normal weight and overweight/obese children.

Irisin has been suggested to protect against overweight. There are no previous data on the association of plasma fatty acid (FA) composition with plasma irisin.

The 148 M allele of the PNPLA3 is associated with plasma irisin levels in a population sample of Caucasian children: The PANIC Study

BACKGROUND There are no previous data on the association of PNPLA3 I148M polymorphism (rs738409) with circulating adipokines and myokines in children. SUBJECTS/METHODS Subjects were a population sample of 481 Caucasian children aged 6-8 years. We assessed circulating levels of irisin together with IL-6, TNF-α, leptin, high molecular weight (HMW)-adiponectin, alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) while the subjects were stratified according to PNPLA3 I148M variants. RESULTS The PNPLA3 rs738409 polymorphism had a linear relationship with plasma levels of irisin after adjustment for age, sex and body height (p=0.007) but it was not associated with circulating levels of interleukin- 6 (IL-6), tumor-necrosis factor α (TNF-α), leptin or HMW-adiponectin. CONCLUSION PNPLA3 148M allele carriers had higher plasma levels of irisin than the non-carriers. This might be due to compensatory mechanism to limit early steatotic and inflammatory changes in the liver.

Associations of Physical Performance and Adiposity with Cognition in Children.

OBJECTIVES To investigate the independent and combined associations of cardiorespiratory performance (CP), neuromuscular performance (NP; including motor performance [MP]) and body fat percentage (BF%) with cognition in children. METHODS The participants were 202 boys and 201 girls age 6-8 yr. Cardiorespiratory performance was assessed using maximal cycle ergometer test and was expressed as maximal workload per lean body mass. Neuromuscular performance score included muscle strength, speed, agility, balance, manual dexterity, and flexibility; and MP included speed and agility, balance, and manual dexterity. Body fat percentage was assessed by dual-energy x-ray absorptiometry. Cognition was assessed using Raven Coloured Progressive Matrices (CPM). Linear regression and general linear models were used to analyze the independent and combined associations of CP, NP, MP, and BF% with Raven CPM score. RESULTS Neuromuscular performance and MP were directly associated with the Raven CPM score (β = 0.138-0.190; P < 0.01). Children in the lowest or the highest thirds of BF% and in the lowest third of MP had a lower Raven CPM score than other children (P < 0.05). Children in the lowest or highest third of BF% along with the poorest MP had a lower Raven CPM score than those in the middle third of BF% and higher MP (P < 0.05). These associations and differences were much stronger in boys than in girls. Cardiorespiratory performance was not related to the Raven CPM score. CONCLUSIONS Poorer NP and MP were associated with a worse cognition in children and particularly in boys. Cognition was poorer especially among children with the lowest or highest BF% accompanied with a poorer MP.