Comparability of the Netherlands Physical Activity Questionnaire with accelerometer-measured physical activity in Samoan children: a retrospective analysis of Ola Tuputupua’e data

Accurate measurement of physical activity is critical to understand its role in cardiometabolic health and obesity development in children and to monitor trends in behavior and evaluate interventions. An ongoing mixed-longitudinal study of child growth and development in Samoa is collecting physical activity data with both accelerometers and the Netherlands Physical Activity Questionnaire (NPAQ). The aims of our analyses were to (1) describe the response frequency and correlations of individual questions in the NPAQ, (2) develop modified NPAQ scores with selected questions and (3) examine the concordance of modified NPAQ scores with accelerometer outcomes among children aged 2–4 years. We developed two modified NPAQ scores with combinations of questions and assessed concordance of the modified scores with accelerometer data using estimated marginal means adjusted for monitor wear time. Although the evenly distributed tertiles of the modified 15-point NPAQ score showed promising trends of increasing minutes of accelerometer-assessed high-intensity physical activity with increasing tertile, the estimated marginal means were imprecise with high variance, demonstrating that NPAQ score could not accurately assess physical activity levels of preschool-aged children in Samoa. Considering that questionnaires are often considered more cost-effective tools for physical activity measurement than accelerometry, further research is necessary to develop a culturally and age-appropriate physical activity questionnaire in this population

Prediction of fat mass from anthropometry at ages 7 to 9 years in Samoans: a cross-sectional study in the Ola Tuputupua’e cohort

Background/Objective: With increasing obesity prevalence in children globally, accurate and practical methods for quantifying body fat are critical for effective monitoring and prevention, particularly in high risk settings. No population is at higher risk of obesity than Pacific Islanders, including children living in the independent nation of Samoa. We developed and validated sex-specific prediction models for fat mass in Samoan children. Subjects/Methods: Dual x-ray absorptiometry (DXA) assessments of fat mass and weight, height, circumferences, and skinfolds were obtained from 356 children aged 7-9 years old in the Ola Tuputupua’e “Growing Up” study. Sex-specific models were developed from a randomly selected model development sample (n=118 females, n=120 males) using generalized linear regressions. In a validation sample (n=59 females; n=59 males), Lin’s concordance and Bland-Altman limits-of-agreement (LoA) of DXA-derived and predicted fat mass from this study and other published models were examined to assess precision and accuracy. Results:  Models to predict fat mass in kilograms were: e^[(-0.0034355*Age8-0.0059041*Age9+1.660441*l n⁡(Weight(kg))-0.0087281 *Height(cm)+0.1393258 *ln⁡[Suprailiac(mm)]-2.661793)]  for females and e^[-0.0409724 *Age8-0.0549923*Age9+336.8575*[Weight(kg)]^(-2)-22.34261 *l n⁡(Weight(kg)) [Weight(kg)]^(-1)+0.0108696*Abdomen(cm)+ 6.811015 *〖Subscapular (mm)〗^(-2)-8.642559 *l n⁡(Subscapular(mm)) 〖Subscapular(mm)〗^(-2)-1.663095 *Tricep(mm)^(-1)  +3.849035]  for males, where Age8=Age9=0 for children at age 7 years, Age8 =1 and Age9=0 at 8 years, Age8 =0  and Age9 = 1 at 9 years. Models showed high predictive ability, with substantial concordance (ρ_C>0.96), and agreement between DXA-derived and model-predicted fat mass (LoA female= -0.235, 95% CI:-2.924-2.453; male= -0.202, 95% CI:-1.977-1.572). Only one of four existing models, developed in a non-Samoan sample, accurately predicted fat mass among Samoan children. Conclusions: We developed models that predicted fat mass in Samoans aged 7-9 years old with greater precision and accuracy than the majority of existing models that were tested. Monitoring adiposity in children with these models may inform future obesity prevention and interventions.</p

Associations of childhood BMI traits with blood pressure and glycated haemoglobin in 6–9-year-old Samoan children

Introduction: Prevalence and risk factors for elevated glycated haemoglobin (HbA1c) and blood pressure (BP) are poorly understood among Pacific children. We examined associations of HbA1c and BP in 6–9 year-olds with body mass index (BMI) at ages 2, 5, and BMI velocity between 2–9 years in Samoa.Methods: HbA1c (capillary blood) and BP were measured in n = 410 Samoan children who were part of an ongoing cohort study. Multilevel models predicted BMI trajectory characteristics. Generalized linear regressions assessed associations of childhood characteristics and BMI trajectories with HbA1c and BP treated as both continuous and categorical outcomes. Primary caregiver-reported childhood characteristics were used as covariates.Results: Overall, 12.90% (n = 53) of children had high HbA1c (≥5.7%) and 33.17% (n = 136) had elevated BP. BMI at 5-years and BMI velocity were positively associated with high HbA1c prevalence in males. A 1 kg/m2 per year higher velocity was associated with a 1.71 (95% CI: 1.07, 2.75) times higher prevalence of high HbA1c. In females, higher BMI at 5-years and greater BMI velocity were associated with higher BP at 6–9 years (95% CI: 1.12, 1.40, and 1.42, 2.74, respectively).Conclusion: Monitoring childhood BMI trajectories may inform cardiometabolic disease screening and prevention efforts in this at-risk population.</p

Associations of childhood BMI traits with blood pressure and glycated haemoglobin in 6–9-year-old Samoan children

Introduction: Prevalence and risk factors for elevated glycated haemoglobin (HbA1c) and blood pressure (BP) are poorly understood among Pacific children. We examined associations of HbA1c and BP in 6–9 year-olds with body mass index (BMI) at ages 2, 5, and BMI velocity between 2–9 years in Samoa.Methods: HbA1c (capillary blood) and BP were measured in n = 410 Samoan children who were part of an ongoing cohort study. Multilevel models predicted BMI trajectory characteristics. Generalized linear regressions assessed associations of childhood characteristics and BMI trajectories with HbA1c and BP treated as both continuous and categorical outcomes. Primary caregiver-reported childhood characteristics were used as covariates.Results: Overall, 12.90% (n = 53) of children had high HbA1c (≥5.7%) and 33.17% (n = 136) had elevated BP. BMI at 5-years and BMI velocity were positively associated with high HbA1c prevalence in males. A 1 kg/m2 per year higher velocity was associated with a 1.71 (95% CI: 1.07, 2.75) times higher prevalence of high HbA1c. In females, higher BMI at 5-years and greater BMI velocity were associated with higher BP at 6–9 years (95% CI: 1.12, 1.40, and 1.42, 2.74, respectively).Conclusion: Monitoring childhood BMI trajectories may inform cardiometabolic disease screening and prevention efforts in this at-risk population.</p