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A 2 year physical activity and dietary intervention attenuates the increase in insulin resistance in a general population of children: the PANIC study.
Lakka, TA, Lintu, N, Väistö, J, Viitasalo, A, Sallinen, T, Haapala, EA, Tompuri, TT, Soininen, S, Karjalainen, P, Schnurr, TM, et al
Diabetologia. 2020;63(11):2270-2281
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The number of children and adolescents with type 2 diabetes and prediabetes has increased over the past decades which is likely due to decreased physical activity, increased sedentary time, unhealthy diet and consequently increased body fat content. Insulin resistance plays an important role in the development of type 2 diabetes. The aim of this 2 year non-randomised, controlled trial was to investigate the long-term effects of a combined physical activity and dietary intervention programme on insulin resistance in a general population of children, most of whom had a normal body weight. Children in the intervention group had six intervention visits which included 30–45 min of physical activity counselling and 30–45 min of dietary counselling for the children and their parents/carers. Fasting insulin and HOMA-IR (a measure for insulin resistance) increased significantly less in the intervention group than in the control group, whilst there were no significant differences in fasting glucose, body fat or lean body mass after 2 years. The effects on insulin resistance were mediated by changes in physical activity, sedentary time and diet. The authors conclude that the prevention of type 2 diabetes should begin in childhood by increasing physical activity, decreasing sedentary time and improving diet in the general paediatric population and not just among overweight and obese children.
Abstract
AIMS/HYPOTHESIS We studied for the first time the long-term effects of a combined physical activity and dietary intervention on insulin resistance and fasting plasma glucose in a general population of predominantly normal-weight children. METHODS We carried out a 2 year non-randomised controlled trial in a population sample of 504 children aged 6-9 years at baseline. The children were allocated to a combined physical activity and dietary intervention group (306 children at baseline, 261 children at 2-year follow-up) or a control group (198 children, 177 children) without blinding. We measured fasting insulin and fasting glucose, calculated HOMA-IR, assessed physical activity and sedentary time by combined heart rate and body movement monitoring, assessed dietary factors by a 4 day food record, used the Finnish Children Healthy Eating Index (FCHEI) as a measure of overall diet quality, and measured body fat percentage (BF%) and lean body mass by dual-energy x-ray absorptiometry. The intervention effects on insulin, glucose and HOMA-IR were analysed using the intention-to-treat principle and linear mixed-effects models after adjustment for sex, age at baseline, and pubertal status at baseline and 2 year follow-up. The measures of physical activity, sedentary time, diet and body composition at baseline and 2 year follow-up were entered one-by-one as covariates into the models to study whether changes in these variables might partly explain the observed intervention effects. RESULTS Compared with the control group, fasting insulin increased 4.65 pmol/l less (absolute change +8.96 vs +13.61 pmol/l) and HOMA-IR increased 0.18 units less (+0.31 vs +0.49 units) over 2 years in the combined physical activity and dietary intervention group. The intervention effects on fasting insulin (regression coefficient β for intervention effect -0.33 [95% CI -0.62, -0.04], p = 0.026) and HOMA-IR (β for intervention effect -0.084 [95% CI -0.156, -0.012], p = 0.023) were statistically significant after adjustment for sex, age at baseline, and pubertal status at baseline and 2 year follow-up. The intervention had no effect on fasting glucose, BF% or lean body mass. Changes in total physical activity energy expenditure, light physical activity, moderate-to-vigorous physical activity, total sedentary time, the reported consumption of high-fat (≥60%) vegetable oil-based spreads, and FCHEI, but not a change in BF% or lean body mass, partly explained the intervention effects on fasting insulin and HOMA-IR. CONCLUSIONS/INTERPRETATION The combined physical activity and dietary intervention attenuated the increase in insulin resistance over 2 years in a general population of predominantly normal-weight children. This beneficial effect was partly mediated by changes in physical activity, sedentary time and diet but not changes in body composition. TRIAL REGISTRATION ClinicalTrials.gov NCT01803776 Graphical abstract.
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New Insights about How to Make an Intervention in Children and Adolescents with Metabolic Syndrome: Diet, Exercise vs. Changes in Body Composition. A Systematic Review of RCT.
Albert Pérez, E, Mateu Olivares, V, Martínez-Espinosa, RM, Molina Vila, MD, Reig García-Galbis, M
Nutrients. 2018;10(7)
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Metabolic Syndrome is the term used to group a cluster of health concerns including overweight, obesity, hypertension, elevated cholesterol, blood glucose intolerance and insulin resistance which together can contribute to the development of Type II Diabetes and Cardiovascular Disease. Diagnosis is usually given if a patient has three or more of these conditions however the diagnosis in children and adolescents is often inconsistent, and so guidelines for therapeutic strategies for metabolic syndrome also vary greatly. This review looked at 9 studies of children aged up to 19 years old, all diagnosed with metabolic syndrome, and given dietary, physical, psychological, and pharmacological interventions, to try and understand what the best clinical approach might be. It was found that a balanced diet combined with aerobic and resistance exercise helped to significantly reduce body mass, more so than the trials which included treatment with Metformin. A balance diet included calorie restriction and carbohydrate reduction, carefully planned around the daily exercise program of 2-3 resistance sessions each week and frequent cardio sessions of differing intensity and duration. They concluded that a minimum of 6 months was needed to reach optimal weight loss and body fat loss. Overall, the findings of this study support diet and physical exercise as beneficial clinical interventions, whilst the use of medication is still unclear.
Abstract
OBJECTIVE To record which interventions produce the greatest variations in body composition in patients ≤19 years old with metabolic syndrome (MS). METHOD search dates between 2005 and 2017 in peer reviewed journals, following the PRISMA method (Preferred Reporting Items for Systematic reviews and Meta-Analyses). The selection criteria were: diagnostic for MS or at least a criterion for diagnosis; randomized clinical trials, ≤19 years of age; intervention programs that use diet and/or exercise as a tool (interventions showing an interest in body composition). RESULTS 1781 clinical trials were identified under these criteria but only 0.51% were included. The most frequent characteristics of the selected clinical trials were that they used multidisciplinary interventions and were carried out in America. The most utilized parameters were BMI (body mass index) in kg/m² and BW (body weight) in kg. CONCLUSIONS Most of the clinical trials included had been diagnosed through at least 2 diagnostic criteria for MS. Multidisciplinary interventions obtained greater changes in body composition in patients with MS. This change was especially prevalent in the combinations of dietary interventions and physical exercise. It is proposed to follow the guidelines proposed for patients who are overweight, obese, or have diabetes type 2, and extrapolate these strategies as recommendations for future clinical trials designed for patients with MS.
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Swimming pool exposure is associated with autonomic changes and increased airway reactivity to a beta-2 agonist in school aged children: A cross-sectional survey.
Cavaleiro Rufo, J, Paciência, I, Silva, D, Martins, C, Madureira, J, Oliveira Fernandes, E, Padrão, P, Moreira, P, Delgado, L, Moreira, A
PloS one. 2018;13(3):e0193848
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Studies have shown an association between swimming in chemically-treated pools and a higher risk of asthma in children, although the mechanism is not fully understood. This study aimed to investigate how swimming pool attendance influences lung and nervous system function in school-aged children. Around 800 children were classified as current swimmers (CS), past swimmers (PS) or non-swimmers (NS). The children underwent several tests to determine their lung function and allergic response to common allergens. Parasympathetic nervous system function was tested by measuring the speed at which their pupils constricted in response to light. The current swimmers group had significantly lower pupil constriction speeds compared to PS and NS, suggesting a poorer functioning of the autonomic nervous system, possibly due to inflammation resulting from swimming pool chemical exposure. CS experienced greater constriction of the airways compared to NS. A non-significant trend for a higher risk of asthma, atopic eczema and rhinitis, was observed in swimmers. The authors concluded that swimming pool attendance appears to be associated with autonomic nervous system changes and increased baseline airway smooth muscle constriction even in children without asthma.
Abstract
BACKGROUND Endurance swimming exercises coupled to disinfection by-products exposure has been associated with increased airways dysfunction and neurogenic inflammation in elite swimmers. However, the impact of swimming pool exposure at a recreational level on autonomic activity has never been explored. Therefore, this study aimed to investigate how swimming pool attendance is influencing lung and autonomic function in school-aged children. METHODS A total of 858 children enrolled a cross sectional survey. Spirometry and airway reversibility to beta-2 agonist, skin-prick-tests and exhaled nitric oxide measurements were performed. Pupillometry was used to evaluate autonomic nervous function. Children were classified as current swimmers (CS), past swimmers (PS) and non-swimmers (NS), according to the amount of swimming practice. RESULTS Current swimmers group had significantly lower maximum and average pupil constriction velocities when compared to both PS and NS groups (3.8 and 5.1 vs 3.9 and 5.3 vs 4.0 and 5.4 mm/s, p = 0.03 and p = 0.01, respectively). Moreover, affinity to the beta-2 agonist and levels of exhaled nitric oxide were significantly higher in CS when compared to NS (70 vs 60 mL and 12 vs 10 ppb, p<0.01 and p = 0.03, respectively). A non-significant trend for a higher risk of asthma, atopic eczema and allergic rhinitis was found with more years of swimming practice, particularly in atopic individuals (β = 1.12, 1.40 and 1.31, respectively). After case-case analysis, it was possible to observe that results were not influenced by the inclusion of individuals with asthma. CONCLUSIONS Concluding, swimming pool attendance appears to be associated with autonomic changes and increased baseline airway smooth muscle constriction even in children without asthma.
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Positive effects on bone mineralisation and muscular fitness after 10 months of intense school-based physical training for children aged 8-10 years: the FIT FIRST randomised controlled trial.
Larsen, MN, Nielsen, CM, Helge, EW, Madsen, M, Manniche, V, Hansen, L, Hansen, PR, Bangsbo, J, Krustrup, P
British journal of sports medicine. 2018;52(4):254-260
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Fractures in older people are a huge public health challenge. Low bone strength in childhood is associated with a higher fracture risk in later life. Weight-bearing activities during childhood can improve muscle and bone strength, potentially reducing the risk of falls and fractures in later life. This study looked at the impact of frequent exercise sessions on bone strength in children aged 8-10 years. 295 Danish school children were divided into three groups: a small-sided ball game group (SSG), a circuit strength training group (CST) or a control group. Exercise sessions lasted for 40 minutes, three times a week for 10 months. Scans were used to determine bone mineral density (BMD), bone mineral content (BMC) and lean body mass (LBM). A variety of tests to determine muscular fitness were carried out at the beginning and end of the study. Both exercise groups saw significant improvements in BMD. Both training types resulted in significant improvements in postural balance and jump length. No differences between the groups were observed for sprint performance or LBM. The authors concluded that 40 min sessions 3 times a week with SSG or CST over a full school year improves bone mineralisation and several aspects of muscular fitness of children aged 8-10 years, suggesting that well-organised physical education classes can contribute positively to musculoskeletal health in young children.
Abstract
OBJECTIVES We investigated whether musculoskeletal fitness of school children aged 8-10 years was affected by frequent intense PE sessions. DESIGN AND PARTICIPANTS 295 Danish school children aged 8-10 years were cluster randomised to a small-sided ball game group (SSG) (n=96, four schools, five classes), a circuit strength training group (CST) (n=83, four schools, four classes) or a control group (CON, n=116, two schools, five classes). INTERVENTION SSG or CST was performed 3×40 min/week over 10 months. Whole-body dual-energy X-ray absorptiometry (DXA) scans were used to determine areal bone mineral density (aBMD), bone mineral content (BMC) and lean body mass (LBM). Flamingo balance, standing long jump and 20-m sprint tests were used to determine muscular fitness. RESULTS Analysis of baseline-to-10 months change scores showed between-group differences in favour of the interventions in whole-body aBMD (SSG vs CON: 8 mg/cm2, 95% CI 3 to 13; CST vs CON: 7 mg/cm2, 95% CI 2 to 13, p<0.05) and leg BMC (SSG vs CON: 11 g, 95% CI 4 to 18; CST vs CON: 11 g, 95% CI 3 to 18, p<0.05). SSG had higher change scores in leg aBMD compared with CON and CST (SSG vs CON: 19 mg/cm2, 95% CI 11 to 39, p<0.05; SSG vs CST: 12 mg/cm2, 95% CI 3 to 21, p<0.05), and CST had higher change scores in whole-body BMC compared with CON (CST vs CON: 25 g, 95% CI 10 to 39, p<0.05). Both training types resulted in higher change scores in postural balance (SSG vs CON: 2.4 fewer falls/min, 95% CI 0.3 to 4.5, CST vs CON: 3.6 fewer falls/min, 95% CI 1.3 to 5.9, p<0.05) and jump length (SSG vs CON: 10%, 95% CI 5 to 16%; CST vs CON: 9%, 95% CI 3 to 15%, p<0.05). No between-group differences were observed for sprint performance or LBM (p>0.05). CONCLUSIONS In conclusion, 3×40 min/week with SSG or CST over a full school year improves bone mineralisation and several aspects of muscular fitness of children aged 8-10 years, suggesting that well-organised intense physical education classes can contribute positively to develop musculoskeletal health in young children. TRIAL REGISTRATION NUMBER NCT02000492, post results.