Organized sport participation is associated with higher levels of overall health-related physical activity in children (CHAMPS Study-DK)

Introduction Many children fail to meet international guideline recommendations for health-related activity (≥60 minutes/day of moderate-to-vigorous physical activity [MVPA]), and intervention studies to date have reported negligible effects. Objective Explore the associations of organized leisure-time sport participation with overall physical activity levels and health-related physical activity guideline concordance. Methods This prospective cohort study was nested in the Childhood Health, Activity, and Motor Performance School Study Denmark. Study participants were a representative sample of 1124 primary school students. Organized leisure-time sport participation was reported via text messaging and physical activity was objectively measured over seven days with accelerometry. Associations between sport participation and physical activity level were explored with multilevel mixed-effects regression models and reported with beta coefficients (b) and adjusted odds ratios (aOR). Results Participants were 53% female, with mean(SD) age = 8.4(1.4) years. Boys were more active than girls (p<0.001), and physical activity levels and guideline concordance decreased with age (p<0.001). Soccer participation at any frequency was associated with greater overall MVPA (b[95% CI] = 0.66[0.20,1.13] to 2.44[1.44,3.44]). Depending on participation frequency, this equates to 5–20 minutes more MVPA on the average day and 3 to 15 fold increased odds of achieving recommended levels of health-related physical activity (aOR[95%CI] = 3.04[1.49,6.19] to 14.49[1.97,106.56]). Similar associations were identified among children playing handball at least twice per week. Relationships with other sports (gymnastics, basketball, volleyball) were inconsistent. Conclusions Many children, particularly girls and those in higher grade levels do not adhere to health-related physical activity recommendations. Organized leisure-time sport participation may be a viable strategy to increase overall health-related physical activity levels and international guideline concordance in children

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29–39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol—which is a marker of cardiovascular risk—changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million–4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.</p

Vigorous physical activity is important in maintaining a favourable health trajectory in active children: The CHAMPS Study-DK

Physical activity (PA) is critical to improving health factors such as weight, adiposity, and aerobic fitness. However, children who meet PA guideline recommendations demonstrate developmental differences in health-related outcomes. To investigate prospective associations between PA behaviour (overall PA and PA intensity) and trajectories of health-related factors among physically active children. This prospective study (2.5 years) included 391 children (baseline age: 8.1 ± 1.4 years; girls 36.3%) from ten public schools. All children performed 60-min or more of moderate-to-vigorous physical activity (MVPA) per day objectively measured. Trajectories of BMI, waist circumference, and aerobic fitness were constructed with a group-based multi-trajectory model. Three trajectory subgroups were identified: ‘high fitness/normal weight’ (48.4% of children), ‘moderate fitness /normal weight’ (42.5% of children), and ‘low fitness/overweight-obese’ (9.1% of children). Children performing higher overall PA, were less likely of being classified as members of the ‘Low Fitness/Overweight-Obese’ [Relative Risk Ratio (RRR and 95% CI) = 0.56 (0.37 to 0.85) compared to ‘high fitness/normal weight’ subgroup. Each additional 5% in light PA time was associated with approximately twofold [RRR 2.12 (1.24–3.61)] increased risk of being in the ‘low fitness/overweight-obese’ trajectory relative to the ‘high fitness/normal weight’ trajectory. Each additional 2% in vigorous-PA time was associated with a 42% and 85% reduced risk (relative to ‘high fitness/normal weight’) of being in the ‘moderate fitness/normal weight’ [RRR 0.58 (0.38–0.96)] and ‘low fitness/overweight-obesity’ [RRR 0.15 (0.06–0.37)] trajectory, respectively. Overall PA and additional time in vigorous-PA was associated with improved health-related outcomes, while light PA was negatively associated with health-related outcomes among children who adhere to PA guideline recommendations. Vigorous PA was the strongest predictor of the health trajectories. All PA guidelines for children should place greater emphasis on the importance of vigorous PA

Developmental trajectories of Body Mass Index, waist circumference, and aerobic fitness in Youth: Implications for physical activity guideline recommendations (CHAMPS Study-DK)

Objectives Describe the trajectories of body mass index (BMI), waist circumference, and aerobic fitness in children and identify different outcomes of guideline-recommended physical activity (PA) in a subset of active children. Methods We recruited students from 10 public primary schools and obtained repeated measures of BMI, waist circumference, and aerobic fitness over 30 months. Aerobic fitness was measured with the Andersen test. We objectively measured physical activity behaviour with accelerometers and classified children as ‘physically active’ when they achieved ≥ 60 min of moderate-to-vigorous PA per day (guideline concordance). Univariate trajectories of BMI, waist circumference, and aerobic fitness were calculated for all children, and we constructed a multi-trajectory model comprising all outcomes in the subgroup of physically active children. The construct validity of all models was investigated by examining for between-group differences in cardiovascular disease risk factors obtained from fasting blood samples. Results Data from 1208 children (53% female) with a mean (SD) age of 8.4 (1.4) years were included. The univariate trajectory models identified three distinct trajectories for BMI, waist circumference, and aerobic fitness. The multi-trajectory model classified 9.1% of physically active children as following an ‘overweight/obese/low fitness’ trajectory. There were moderate-to-large differences in cardiovascular risk factors between all trajectory groups (p < 0.001; d = 0.4–1.20). Conclusion We identified distinct developmental trajectories of BMI, waist circumference, and aerobic fitness in children. Nearly one in 10 children who met PA guideline recommendations followed an unfavourable health trajectory. Health-related PA recommendations may be insufficient for some children

The prospective association of organized sports participation with cardiovascular disease risk in children (the CHAMPS Study-DK)

Objective To investigate the prospective association of organized leisure-time sports participation with cardiovascular risk in children. Methods Students were recruited from 10 public primary schools. From July 2009 to October 2010, parents reported children's weekly organized leisure-time sports participation via text messaging. Clustered cardiovascular risk was estimated with a composite score comprising fasting serum triglyceride levels, homeostasis assessment model-estimated insulin resistance, total to high-density lipoprotein cholesterol ratio, and systolic blood pressure. Additional outcomes were body mass index categories and fasting serum insulin and glucose concentrations. Associations were explored with generalized estimating equations and reported with beta coefficients (β) and percent difference per weekly sports session or incidence rate ratios. All models were adjusted for baseline values and other potential confounders. Results In total, 1197 children (53% female) with a mean age of 8.4±1.4 years were included. Participating in sports for 53 weeks was associated with lower clustered cardiovascular risk (β, −0.25; 95% CI, −0.41 to −0.10; percent difference, 3.2%; 95% CI, 5.2%-1.3%). Similar outcomes were observed for log homeostasis assessment model-estimated insulin resistance (β, −0.08; 95% CI, −0.12 to −0.04; percent difference, 3.4%; 5.1%-1.7%) and log insulin (β, −0.07; 95% CI, −0.11 to −0.04; percent difference, 2.6%; 95% CI, 4.0%-1.5%). Sports participation was associated with a 20% decreased risk of overweight/obesity (incidence rate ratio, 0.78; 95% CI, 0.64-0.96). Conclusion Participating in organized leisure-time sports for approximately 1 year is associated with decreased clustered cardiovascular risk in children. These findings show that participating in youth sports may be an effective strategy to reduce cardiovascular risk in children

Physical education and leisure-time sport reduce overweight and obesity: A number needed to treat analysis

Background School-based physical education (PE) and organised leisure-time sports participation (LTSP) represent important physical activity opportunities for children. We examined the preventive effect of increased PE as well as LTSP on overweight and obesity (OW/OB) in school children. Methods Longitudinal data from children attending 10 primary schools in the Danish municipality of Svendborg, comprising 6 intensive PE (270 min/week) and 4 control (90 min/week) schools were assessed. Age- and sex-specific cut-offs for body mass index (BMI) determined OW/OB status. Associations between OW/OB status and school type (intensive PE or control) or LTSP were investigated using mixed, multilevel logistic regression models. Significant parameter estimates were converted into number needed to treat statistics (NNT). Results In total, 1009 children (53.3% female; mean age 8.4 ± 1.4 years) were included in the analysis, with 892 children (52% female) being normal weight (NW) at baseline. Eighteen (NNT = 17.1; 95% CI [11.0, 226.1]) children attending an intensive PE school for 2 years, resulted in one fewer case of OW/OB compared with attendance at a normal PE school. For NW children, prevention of one case of OW/OB requires 36 (NNT = 35.8; 95% CI [25.1, 596.3]) children to participate in intensive PE for 2 years in comparison with normal PE. LTSP over 2 years may prevent OW/OB if 15 children participate in one LTSP session/week, 9 in two LTSP sessions/week and 8 in three LTSP sessions/week; for normal weight children, 25 children had to participate in one LTSP session/week, 16 in two LTSP sessions/week and 14 in three LTSP sessions/week. Conclusion We provide the first NNT estimates of school-based PE and LTSP to prevent the onset of OW/OB. PE, and separately, LTSP seem to have both a protective and a treatment effect against OW/OB in children

Early maternal effects and antibacterial immune factors in the eggs, nestlings and adults of the barn swallow

Transfer of immune factors via the egg may represent a maternal adaptation enhancing offspring survival. Lysozyme is a major component of maternal antibacterial immunity which is transferred to the eggs in birds. In a population of barn swallows (Hirundo rustica), lysozyme activity declined during the prelaying and laying periods in females but not in males. Egg hatching failure decreased with maternal lysozyme activity. The first eggs in a clutch contained more lysozyme and produced nestlings with larger lysozyme activity when 5 days old than last-laid ones. In a cross-fostering experiment where brood size was manipulated, nestling origin but not post-manipulation brood size affected lysozyme activity. Hence, maternal lysozyme varies during the breeding season and may differentially enhance antibacterial immune defence of the eggs and nestlings in relation to laying order. These findings suggest that offspring innate immunity is influenced by early maternal effects