Associations of body composition and physical fitness with gestational diabetes and cardiovascular health in pregnancy: Results from the HealthyMoms trial

Open access funding provided by Linkoping UniversityWe gratefully thank the participating women in the HealthyMoms trial. The authors also acknowledge Eva Flinke and Ellinor Nilsson for invaluable help with the data collection and the midwifes in Region Östergötland for help with the recruitment. The HealthyMoms trial is funded by the Swedish Research Council (2016-01147 to M.L.) and additionally supported by the Swedish Research Council for Health, Working Life and Welfare (Forte, 2017-00088 to P.H.; 2018-01410 to M.L.); Bo and Vera Ax:son Johnsons’ Foundation (to M.L.); the Strategic Research Area Health Care Science, Karolinska Institutet/Umeå University (to P.H.); the Swedish Society of Medicine (to P.H.); Karolinska Institutet (to P.H. and M.L.); and Lions Forskningsfond (to P.H.). M.H.L. was supported by a grant from Yrjö Jahnsson Foundation.The aim of this study was to examine associations of body composition (fat mass index, % fat mass, fat-free mass index, body mass index) and physical fitness (cardiorespiratory fitness and handgrip strength) with gestational diabetes and cardiovascular health in early pregnancy. This cross-sectional study utilized baseline data (n = 303) collected in early pregnancy from the HealthyMoms trial. Body composition was measured using air-displacement plethysmography, cardiorespiratory fitness was assessed by means of the 6-min walk test and handgrip strength using a dynamometer. Logistic regression was used to estimate odds ratios (ORs) for gestational diabetes as well as high (defined as 1 SD above the mean) blood pressure, homeostatic model assessment for insulin resistance (HOMA-IR), and metabolic syndrome score (MetS score) per 1 SD increase in body composition and fitness variables. Fat mass index, % fat mass and body mass index were all strongly associated with gestational diabetes (ORs: 1.72-2.14, P = 0.61). In conclusion, accurately measured fat mass index or % fat mass were strongly associated with gestational diabetes risk and markers of cardiovascular health although associations were not stronger than the corresponding ones for body mass index. Fat-free mass index had only weak associations with gestational diabetes and cardiovascular health which support that the focus during clinical care would be on excess fat mass and not fat-free mass.Linkoping Universit

Handgrip strength and all-cause dementia incidence and mortality: findings from the UK Biobank prospective cohort study

We thank UK Biobank participants. This research has been conducted using the UK Biobank Resource (application No 7155). The authors of this manuscript certify that they comply with the ethical guidelines for authorship and publishing in the Journal of Cachexia, Sarcopenia and Muscle.40Background This study aimed to investigate the associations of grip strength with incidence and mortality from dementia and whether these associations differ by sociodemographic and lifestyle factors. Methods A total of 466 788 participants of the UK Biobank (median age 56.5 years, 54.5% women). The outcome was all-cause dementia incidence and mortality and the exposure was grip strength. Grip strength was assessed using a Jamar J00105 hydraulic hand dynamometer. Results Excluding the first 2 years of follow-up (landmark analysis), mean follow-up was 9.1 years (inter-quartile range: 8.3; 9.7) for incidence and 9.3 (inter-quartile range: 8.7; 10.0) for mortality. During this time, 4087 participants developed dementia, and 1309 died from it. Lower grip strength was associated with a higher risk of dementia incidence and mortality independent of major confounding factors (P < 0.001). Individuals in the lowest quintile of grip strength had 72% [95% confidence interval (CI): 1.55; 1.92] higher incident dementia risk and 87% [95% CI: 1.55; 2.26] higher risk of dementia mortality compared with those in the highest quintile. Our PAF analyses indicate that 30.1% of dementia cases and 32.3% of dementia deaths are attributable to having low grip strength. The association between grip strength and dementia outcomes did not differ by lifestyle or sociodemographic factors. Conclusions Lower grip strength was associated with a higher risk of all-cause dementia incidence and mortality, independently of important confounding factors.715

Validity of Estimating the Maximal Oxygen Consumption by Consumer Wearables: A Systematic Review with Meta‑analysis and Expert Statement of the INTERLIVE Network

This research was partly funded by Huawei Technologies Oy (Finland) Co. Ltd. A limited liability company headquartered in Helsinki, Finland.Background Technological advances have recently made possible the estimation of maximal oxygen consumption (VO2max) by consumer wearables. However, the validity of such estimations has not been systematically summarized using metaanalytic methods and there are no standards guiding the validation protocols. Objective The aim was to (1) quantitatively summarize previous studies investigating the validity of the VO2max estimated by consumer wearables and (2) provide best-practice recommendations for future validation studies. Methods First, we conducted a systematic review and meta-analysis of studies validating the estimation of VO2max by wearables. Second, based on the state of knowledge (derived from the systematic review) combined with the expert discussion between the members of the Towards Intelligent Health and Well-Being Network of Physical Activity Assessment (INTERLIVE) consortium, we provided a set of best-practice recommendations for validation protocols. Results Fourteen validation studies were included in the systematic review and meta-analysis. Meta-analysis results revealed that wearables using resting condition information in their algorithms significantly overestimated VO2max (bias 2.17 ml·kg−1·min−1; limits of agreement − 13.07 to 17.41 ml·kg−1·min−1), while devices using exercise-based information in their algorithms showed a lower systematic and random error (bias − 0.09 ml·kg−1·min−1; limits of agreement − 9.92 to 9.74 ml·kg−1·min−1). The INTERLIVE consortium proposed six key domains to be considered for validating wearable devices estimating VO2max, concerning the following: the target population, reference standard, index measure, testing conditions, data processing, and statistical analysis. Conclusions Our meta-analysis suggests that the estimations of VO2max by wearables that use exercise-based algorithms provide higher accuracy than those based on resting conditions. The exercise-based estimation seems to be optimal for measuring VO2max at the population level, yet the estimation error at the individual level is large, and, therefore, for sport/ clinical purposes these methods still need improvement. The INTERLIVE network hereby provides best-practice recommendations to be used in future protocols to move towards a more accurate, transparent and comparable validation of VO2max derived from wearables.Huawei Technologie

Differences in specific abdominal fat depots between metabolically healthy and unhealthy children with overweight/obesity: The role of cardiorespiratory fitness

Objectives: Fat depots localization has a critical role in the metabolic health status of adults. Nevertheless, whether that is also the case in children remains under-studied. Therefore, the aims of this study were: (i) to examine the differences between metabolically healthy (MHO) and unhealthy (MUO) overweight/ obesity phenotypes on specific abdominal fat depots, and (ii) to further explore whether cardiorespiratory fitness plays a major role in the differences between metabolic phenotypes among children with overweight/obesity. Methods: A total of 114 children with overweight/obesity (10.6 ± 1.1 years, 62 girls) were included. Children were classified as MHO (n = 68) or MUO. visceral (VAT), abdominal subcutaneous (ASAT), intermuscular abdominal (IMAAT), psoas, hepatic, pancreatic, and lumbar bone marrow adipose tissues were measured by magnetic resonance imaging. Cardiorespiratory fitness was assessed using the 20 m shuttle run test. Results: MHO children had lower VAT and ASAT contents and psoas fat fraction compared to MUO children (difference = 12.4%–25.8%, all p < 0.035). MUO-unfit had more VAT and ASAT content than those MUO-fit and MHO-fit (difference = 34.8%–45.3%, all p < 0.044). MUO-unfit shows also greater IMAAT fat fraction than those MUO-fit and MHO-fit peers (difference = 16.4%–13.9% respectively, all p ≤ 0.001). In addition, MHO-unfit presented higher IMAAT fat fraction than MHO-fit (difference = 13.4%, p < 0.001). MUO-unfit presented higher psoas fat fraction than MHO-fit (difference = 29.1%, p = 0.008). Conclusions: VAT together with ASAT and psoas fat fraction, were lower in MHO than in MUO children. Further, we also observed that being fit, regardless of metabolic phenotype, has a protective role over the specific abdominal fat depots among children with overweight/obesity.Spanish Ministry of Health “Fondos de Investigación Sanitaria del Instituto de Salud Carlos III” (PI13/01335)EU Fondos Estructurales de la Unión Europea (FEDER) funds (“Una manera de hacer Europa”)Department of Economic Development of the Government of Navarra (0011-1365- 2019- 000085)Spanish Ministry of Science and Innovation (FJC2018-037925- I)European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska Curie grant agreement No. 101028929European Union NextGeneration EU and the Spanish Ministry of Universities (postdoctoral fellowship Margarita Salas, 572827-MS15

Life’s Essential 8 and carotid artery plaques: the Swedish cardiopulmonary bioimage study

To quantify cardiovascular health (CVH), the American Heart Association (AHA) recently launched an updated construct of the "Life's Simple 7" (LS7) score, the "Life's Essential 8" (LE8) score. This study aims to analyse the association between both CVH scores and carotid artery plaques and to compare the predictive capacity of such scores for carotid plaques.MethodsRandomly recruited participants aged 50-64 years from the Swedish CArdioPulmonary bioImage Study (SCAPIS) were analysed. According to the AHA definitions, two CVH scores were calculated: i) the LE8 score (0, worst CVH; 100, best CVH) and two different versions of the LS7 score [(0-7) and (0-14), 0 indicating the worst CVH]. Ultrasound-diagnosed carotid plaques were classified as no plaque, unilateral, and bilateral plaques. Associations were studied by adjusted multinomial logistic regression models and adjusted (marginal) prevalences, while comparison between LE8 and LS7 scores was performed through receiver operating characteristic (ROC) curves.ResultsAfter exclusions, 28,870 participants remained for analysis (50.3% women). The odds for bilateral carotid plaques were almost five times higher in the lowest LE8 (<50 points) group [OR: 4.93, (95% CI: 4.19-5.79); adjusted prevalence 40.5%, (95% CI: 37.9-43.2)] compared to the highest LE8 (& GE;80 points) group [adjusted prevalence 17.2%, (95% CI: 16.2-18.1)]. Also, the odds for unilateral carotid plaques were more than two times higher in the lowest LE8 group [OR: 2.14, (95% CI: 1.82-2.51); adjusted prevalence 31.5%, (95% CI: 28.9-34.2)] compared to the highest LE8 group [adjusted prevalence 29.4%, (95% CI: 28.3-30.5)]. The areas under ROC curves were similar between LE8 and LS7 (0-14) scores: for bilateral carotid plaques, 0.622 (95% CI: 0.614-0.630) vs. 0.621 (95% CI: 0.613-0.628), P = 0.578, respectively; and for any carotid plaque, 0.602 (95% CI: 0.596-0.609) vs. 0.600 (95% CI: 0.593-0.607), P = 0.194, respectively.ConclusionThe new LE8 score showed inverse and dose-response associations with carotid plaques, particularly bilateral plaques. The LE8 did not outperform the conventional LS7 score, which showed similar ability to predict carotid plaques, especially when scored as 0-14 points. We conclude that both the LE8 and LS7 may be useful in clinical practice for monitoring CVH status in the adult population.The Swedish CArdioPulmonary bioImage Study (SCAPIS) is the Swedish Heart-Lung FoundationKnut and Alice Wallenberg Foundation,VINNOVA (Sweden`s Innovation Agency),The University of Gothenburg and Sahlgrenska University HospitalStockholm County councilLinköping UniversityUniversity Hospital,Lund University and Skåne University HospitalUmeå UniversityUniversity Hospital, Uppsala UniversityMargarita Salas grantAutonomous University of Madrid.Grant PID2020-120249RB-I00 funded by MCIN/ AEI/10.13039/501100011033 and by the Andalusian GovernmentAndalusian Government (Junta de Andalucía, Plan Andaluz de Investigación, ref. P20_00124)

The association of adolescent fitness with cardiometabolic diseases in late adulthood: A 45-year longitudinal study

This work was supported by Emil Aaltonen Foundation under Grant 210097 O, Ellen ja Artturi Nyyssönen Foundation, and Juho Vainio Foundation under Grant 202300290.Objectives: The aim of this study was to examine the associations of adolescent cardiorespiratory fitness (CRF), muscular fitness (MF), and speed-agility fitness (SA) with middle-aged cardiometabolic disease risk and explore sex differences. Methods: This 45-year prospective cohort study examined the associations be- tween objectively measured fitness at adolescence (12–19 years) and physician- ascertained diabetes mellitus, elevated blood pressure (BP), and coronary heart disease reported either in early (37–44 years) or late (57–64 years) middle age, and self-measurement of waist circumference (WC) in late middle age. Fitness meas- urements for healthy adolescents in baseline included CRF (1.5 km [girls] and 2 km [boys] run), MF (standing broad jump, sit-ups, pull-ups [boys], and flexed- arm hang [girls]), and SA (50 m dash and 4 × 10 m shuttle run). Logistic regression and general linear models were adjusted for baseline age, sex, and body mass index (BMI), involving data from baseline and at least one follow-up measure- ment (N up to 1358, 47% males). Results: Adolescent CRF was inversely, and regardless of adiposity, associ- ated with middle age accumulated burden of cardiometabolic conditions in the whole sample (N = 562, ß = −0.10, 95% confidence intervals [CI] [−0.18, −0.03], p = 0.006), and elevated BP in females (N = 256, OR = 0.71, 95% CI [0.51, 0.91]). Overall, we observed stronger associations in females than in males. An inverse association of adolescent MF and SA with middle-aged WC was observed, but it did not show as consistent associations as with CRF. Conclusions: In this study, adolescent fitness, particularly CRF, was inversely as- sociated with the burden of cardiometabolic conditions up to 45 years. Promotion of fitness in youth may be beneficial in preventing adulthood cardiometabolic diseases.Emil Aaltonen Foundation 210097 OEllen ja Artturi Nyyssönen FoundationJuho Vainio Foundation 20230029

Recommendations for Determining the Validity of Consumer Wearables and Smartphones for the Estimation of Energy Expenditure: Expert Statement and Checklist of the INTERLIVE Network

Open Access funding provided by the IReL Consortium. This research was partly funded by Huawei Technologies, Finland. RA and BC are partly funded by Science Foundation Ireland (12/RC/2289_P2). PMG and FBO are supported by grants from the MINECO/FEDER (DEP2016-79512-R) and from the University of Granada, Plan Propio de Investigacion 2016, Excellence actions: Units of Excellence; Scientific Excellence Unit on Exercise and Health (UCEES); Junta de Andalucia, Consejeria de Conocimiento, Investigacion y Universidades and European Regional Development Funds (ref. SOMM17/6107/UGR). JT and JS are partly funded by the Research Council of Norway (249932/F20). AG is supported by a European Research Council Grant (grant number 716657).Background Consumer wearables and smartphone devices commonly offer an estimate of energy expenditure (EE) to assist in the objective monitoring of physical activity to the general population. Alongside consumers, healthcare professionals and researchers are seeking to utilise these devices for the monitoring of training and improving human health. However, the methods of validation and reporting of EE estimation in these devices lacks rigour, negatively impacting on the ability to make comparisons between devices and provide transparent accuracy. Objectives The Towards Intelligent Health and Well-Being Network of Physical Activity Assessment (INTERLIVE) is a joint European initiative of six universities and one industrial partner. The network was founded in 2019 and strives towards developing best-practice recommendations for evaluating the validity of consumer wearables and smartphones. This expert statement presents a best-practice validation protocol for consumer wearables and smartphones in the estimation of EE. Methods The recommendations were developed through (1) a systematic literature review; (2) an unstructured review of the wider literature discussing the potential factors that may introduce bias during validation studies; and (3) evidence-informed expert opinions from members of the INTERLIVE network. Results The systematic literature review process identified 1645 potential articles, of which 62 were deemed eligible for the final dataset. Based on these studies and the wider literature search, a validation framework is proposed encompassing six key domains for validation: the target population, criterion measure, index measure, testing conditions, data processing and the statistical analysis. Conclusions The INTERLIVE network recommends that the proposed protocol, and checklists provided, are used to standardise the testing and reporting of the validation of any consumer wearable or smartphone device to estimate EE. This in turn will maximise the potential utility of these technologies for clinicians, researchers, consumers, and manufacturers/ developers, while ensuring transparency, comparability, and replicability in validation.IReL ConsortiumHuawei TechnologiesScience Foundation IrelandEuropean Commission 12/RC/2289_P2Spanish Government DEP2016-79512-RUniversity of Granada, Plan Propio de Investigacion 2016, Excellence actions: Units of Excellence; Scientific Excellence Unit on Exercise and Health (UCEES)Junta de AndaluciaEuropean Commission SOMM17/6107/UGRResearch Council of Norway 249932/F20European Research Council (ERC) 71665

Healthy Weight and Obesity Prevention

Overweight and obesity have reached epidemic levels in the United States and worldwide, and this has contributed to substantial cardiovascular and other health risks. However, controversy exists concerning the causes of obesity and effective modalities for its prevention and treatment. There is also controversy related to the concept of metabolically healthy obesity phenotype, the “obesity paradox,” and on the importance of fitness to protect individuals who are overweight or obese from cardiovascular diseases. In this state-of-the-art review, the authors focus on “healthy weight” with the emphasis on the pathophysiologic effects of weight gain on the cardiovascular system; mechanistic/triggering factors; and the role of preventive actions through personal, education/environment, and societal/authoritative factors, as well as factors to provide guidance for caregivers of health promotion. Additionally, the authors briefly review metabolically healthy obesity, the obesity paradox, and issues beyond lifestyle consideration for weight loss with medications and bariatric surgery.From the John Ochsner Heart and Vascular Institute, Ochsner Clinical School—The University of Queensland School of Medicine, New Orleans, Louisiana; Department of Physical Therapy, College of Applied Health Science, University of Illinois at Chicago, Chicago, Illinois; PROFITH “PROmoting FITness and Health through Physical Activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain; Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri; and the Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Dr. Ortega receives support for research activity from the Spanish Ministry of Economy and Competitiveness and FEDER (DEP2016-79512-R); additional funding from the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Unit of Excellence on Exercise and Health (UCEES); and the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 667302. Dr. Kushner has served on the advisory board for Novo Nordisk, Weight Watchers, and Retrofit. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose

Recommendations for determining the validity of consumer wearable and smartphone step count: expert statement and checklist of the INTERLIVE network

PBJ is supported by the Portuguese Foundation for Science and Technology (SFRH/BPD/115977/2016). WJ is partly funded by Science Foundation Ireland (12/RC/2289_P2). PMG and FBO are supported by grants from the MINECO/FEDER (DEP2016-79512-R) and from the University of Granada, Plan Propio de Investigacion 2016, Excellence actions: Units of Excellence; Scientific Excellence Unit on Exercise and Health (UCEES); Junta de Andalucia, Consejeria de Conocimiento, Investigacion y Universidades and European Regional Development Funds (ref. SOMM17/6107/UGR). JMM is partly funded by Private Stiftung Ewald Marquardt fur Wissenschaft und Technik, Kunst und Kultur. UE and JS are partly funded by the Research Council of Norway (249932/F20). AG is supported a European Research Council Grant (grant number 716657). ELS is supported by TrygFonden (grant number 310081). This research was partly funded by Huawei Technologies, Finland.Consumer wearable and smartphone devices provide an accessible means to objectively measure physical activity (PA) through step counts. With the increasing proliferation of this technology, consumers, practitioners and researchers are interested in leveraging these devices as a means to track and facilitate PA behavioural change. However, while the acceptance of these devices is increasing, the validity of many consumer devices have not been rigorously and transparently evaluated. The Towards Intelligent Health and Well-Being Network of Physical Activity Assessment (INTERLIVE) is a joint European initiative of six universities and one industrial partner. The consortium was founded in 2019 and strives to develop best-practice recommendations for evaluating the validity of consumer wearables and smartphones. This expert statement presents a best-practice consumer wearable and smartphone step counter validation protocol. A two-step process was used to aggregate data and form a scientific foundation for the development of an optimal and feasible validation protocol: (1) a systematic literature review and (2) additional searches of the wider literature pertaining to factors that may introduce bias during the validation of these devices. The systematic literature review process identified 2897 potential articles, with 85 articles deemed eligible for the final dataset. From the synthesised data, we identified a set of six key domains to be considered during design and reporting of validation studies: target population, criterion measure, index measure, validation conditions, data processing and statistical analysis. Based on these six domains, a set of key variables of interest were identified and a 'basic' and 'advanced' multistage protocol for the validation of consumer wearable and smartphone step counters was developed. The INTERLIVE consortium recommends that the proposed protocol is used when considering the validation of any consumer wearable or smartphone step counter. Checklists have been provided to guide validation protocol development and reporting. The network also provide guidance for future research activities, highlighting the imminent need for the development of feasible alternative 'gold-standard' criterion measures for free-living validation. Adherence to these validation and reporting standards will help ensure methodological and reporting consistency, facilitating comparison between consumer devices. Ultimately, this will ensure that as these devices are integrated into standard medical care, consumers, practitioners, industry and researchers can use this technology safely and to its full potential.Portuguese Foundation for Science and Technology SFRH/BPD/115977/2016Science Foundation IrelandEuropean Commission 12/RC/2289_P2MINECO/FEDER DEP2016-79512-RUniversity of Granada, Plan Propio de Investigacion 2016, Excellence actions: Units of ExcellenceScientific Excellence Unit on Exercise and Health (UCEES)European Commission SOMM17/6107/UGRPrivate Stiftung Ewald Marquardt fur Wissenschaft und Technik, Kunst und KulturResearch Council of Norway 249932/F20European Research Council (ERC) European Commission 716657TrygFonden 310081Huawei TechnologiesJunta de Andaluci

Effects of exercise in addition to a family-based lifestyle intervention program on hepatic fat in children with overweight

ClinicalTrials.gov ID: NCT02258126Background: Paediatric hepatic steatosis is highly prevalent and closely related to type 2 diabetes. Aims: To determine whether the addition of supervised exercise to a family-based lifestyle- and psycho-educational intervention results in greater reduction of percentage hepatic fat (HF), adiposity, and cardiometabolic risk factors in children with overweight/obesity. Methods: The study subjects of this non-randomized, two-arm, parallel design, clinical trial were 116 overweight/obese children (10.6±1.1 years, 53.4% girls) living in Vitoria-Gasteiz (Spain). For 22 weeks they followed either a lifestyle- and psycho-education program (control intervention [CI], N=57), consisting of two family-based education sessions/month, or the same plus supervised exercise (intensive intervention [II], N=59) focused mainly on high-intensity aerobic workouts (3 sessions/week, 90 min/session). The primary outcome was the change in percentage HF (as measured by MRI) between baseline and the end of the intervention period. Secondary outcomes included changes in body mass index (BMI), fat mass index (FMI), abdominal fat (measured by dual-X-ray-absorptiometry), blood pressure, triglycerides, high density lipoprotein, low density lipoprotein, gamma-glutammyl-transferase, glucose and insulin concentrations. Results: A total of 102 children completed the trial (N=53 and N=49 in the CI and II groups, respectively). Percentage HF decreased only in the II group (-1.20±0.31% vs. 0.04±0.30%, II and CI, respectively), regardless of baseline value and any change in adiposity (P<0.01). BMI, FMI, abdominal fat (P≤0.001) and insulin (P<0.05) were reduced in both groups. Conclusions: Multicomponent intervention programs that include exercise training may help reduce, adiposity, insulin resistance and hepatic steatosis in overweight/obese children.Spanish Ministry of Health "Fondos de Investigation Sanitaria del Institute de Salud Carlos III" PI13/01335Spanish Ministry of Industry and Competitiveness DEP2016-78377-REU Fondos Estructurales de la Union Europea (FEDER) funds ("Una manera de hacer Europa")Spanish Ministry of Education, Culture and Sports FPU14/03329Education Department of the Government of the Basque Country PRE_2016_1_0057 PRE_2017_2_0224 PRE_2018_2_0057University of Granada Plan Propio de Investigacion 2016-Excellence actions: Unit of Excellence on Exercise and Health (UCEES)Junta de Andalucia, Consejeria de Conocimiento, Investigacion y Universidades (FEDER) SOMM17/6107/UG