Open Access
Differences in areal bone mineral density between metabolically healthy and unhealthy overweight/obese children: the role of physical activity and cardiorespiratory fitness
(Springer Nature, 2019) Ubago Guisado, Esther; Gracia-Marco, Luis; Medrano Echeverría, María; Cadenas-Sánchez, Cristina; Arenaza Etxeberría, Lide; Migueles, Jairo H.; Mora González, José; Tobalina, Ignacio; Escolano Margarit, María Victoria; Osés Recalde, Maddi; Martín Matillas, Miguel; Labayen Goñi, Idoia; Ortega, Francisco B.; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
Objectives: To examine whether areal bone mineral density (aBMD) differs between metabolically healthy (MHO) and unhealthy (MUO) overweight/obese children and to examine the role of moderate-to-vigorous physical activity (MVPA) and cardiorespiratory fitness (CRF) in this association. Methods: A cross-sectional study was developed in 188 overweight/obese children (10.4 ± 1.2 years) from the ActiveBrains and EFIGRO studies. Participants were classified as MHO or MUO based on Jolliffe and Janssen’s metabolic syndrome cut-off points for triglycerides, glucose, high-density cholesterol and blood pressure. MVPA and CRF were assessed by accelerometry and the 20-m shuttle run test, respectively. Body composition was measured by dual-energy X-ray absorptiometry. Results: In model 1 (adjusted for sex, years from peak high velocity, stature and lean mass), MHO children had significantly higher aBMD in total body less head (Cohen’s d effect size, ES = 0.34), trunk (ES = 0.43) and pelvis (ES = 0.33) than MUO children. These differences were attenuated once MVPA was added to model 1 (model 2), and most of them disappeared once CRF was added to the model 1 (model 3). Conclusions: This novel research shows that MHO children have greater aBMD than their MUO peers. Furthermore, both MVPA and more importantly CRF seem to partially explain these findings.
Open Access
Understanding the association of intrapancreatic fat deposition with adiposity and components of metabolic syndrome in children and adolescents: a systematic review and meta-analysis
(Elsevier, 2025-05-06) Izquierdo Rodríguez, Claudia; Cadenas-Sánchez, Cristina; Santos Martín, José Luis; Ruiz, Jonatan R.; Medrano Echeverría, María; Martínez Vizcaíno, Vicente; Goran, Michael I.; Labayen Goñi, Idoia; Ciencias de la Salud; Osasun Zientziak; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Background: Intrapancreatic fat deposition is associated with increased cardiovascular risk in adults, but the association is less clear in children. Our goal in this work was therefore to conduct a systematic review and meta-analysis of the associations between intrapancreatic fat deposition with adiposity and components of metabolic syndrome in children and adolescents. Methods: Systematic searches were conducted in MEDLINE, Web of Science, and Scopus from database inception to January 11, 2025 (registration number: CRD42022374159). Random-effects meta-analysis was performed to obtain pooled correlations estimates of the association of intrapancreatic fat deposition with various adiposity related outcomes (i.e., overall/central adiposity and specific fat depots; primary outcome) and cardiometabolic risk factors (i.e., glycaemic traits, insulin resistance/sensitivity, insulin secretion surrogates, plasma lipids, and blood pressure; secondary outcomes). Risk of bias and the quality of evidence were evaluated. Findings: We identified a total of 252 studies, of which 15 unique studies (N = 1261 participants, mean age ranged 10.6–17.7 years, 44.4% females) were eligible for meta-analysis. Magnetic resonance imaging-measured intrapancreatic fat deposition showed a small to medium positive significant association with adiposity (n = 53 studies, r = 0.24 [95% CI:0.19; 0.29], I2 = 61.5%), impaired glycaemic traits and insulin sensitivity (n = 11 studies, r = 0.15 [95% CI:0.03; 0.26], I2 = 58.9%), and HDL levels (n = 7 studies, pooled r = 0.11 [95% CI: 0.01; 0.20], I2 = 0%), and increased blood pressure (n = 6 studies, pooled r = 0.15 [95% CI: 0.05; 0.25], I2 = 0%). Interpretation: Intrapancreatic fat deposition may increase the risk of cardiometabolic disturbances in children. Therefore, it requires more attention in clinical research as an early indicator of ectopic fat deposition, insulin resistance and metabolic syndrome. Longitudinal studies are necessary to understand the temporal dynamics of these associations and to determine the long-term impact of intrapancreatic fat deposition on the risk of developing type 2 diabetes and cardiovascular diseases.
Open Access
Effects of an exercise program on brain health outcomes for children with overweight or obesity: the ActiveBrains Randomized Clinical Trial
(JAMA, 2022) Ortega, Francisco B.; Mora González, José; Cadenas-Sánchez, Cristina; Esteban Cornejo, Irene; Migueles, Jairo H.; Solís Urra, Patricio; Verdejo Román, Juan; Rodríguez Ayllon, María; Molina García, Pablo; Ruiz, Jonatan R.; Martínez Vizcaíno, Vicente; Hillman, Charles H.; Erickson, Kirk I.; Kramer, Arthur F.; Labayen Goñi, Idoia; Catena, Andrés; Ciencias de la Salud; Osasun Zientziak; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
IMPORTANCE Pediatric overweight and obesity are highly prevalent across the world, with implications for poorer cognitive and brain health. Exercise might potentially attenuate these adverse consequences. OBJECTIVES To investigate the effects of an exercise program on brain health indicators, including intelligence, executive function, academic performance, and brain outcomes, among children with overweight or obesity and to explore potential mediators and moderators of the main effects of exercise. DESIGN, SETTING, AND PARTICIPANTS All preexercise and postexercise data for this 20-week randomized clinical trial of 109 children aged 8 to 11 years with overweight or obesity were collected from November 21, 2014, to June 30, 2016, with neuroimaging data processing and analyses conducted between June 1, 2017, and December 20, 2021. All 109 children were included in the intention-to-treat analyses; 90 children (82.6%) completed the postexercise evaluation and attended 70% or more of the recommended exercise sessions and were included in per-protocol analyses. INTERVENTIONS All participants received lifestyle recommendations. The control group continued their usual routines, whereas the exercise group attended a minimum of 3 supervised 90-minute sessions per week in an out-of-school setting. MAIN OUTCOMES AND MEASURES Intelligence, executive function (cognitive flexibility, inhibition, and working memory), and academic performance were assessed with standardized tests, and hippocampal volume was measured with magnetic resonance imaging. RESULTS The 109 participants included 45 girls (41.3%); participants had a mean (SD) body mass index of 26.8 (3.6) and a mean (SD) age of 10.0 (1.1) years at baseline. In per-protocol analyses, the exercise intervention improved crystallized intelligence, with the exercise group improving from before exercise to after exercise (mean z score, 0.62 [95% CI, 0.44-0.80]) compared with the control group (mean z score, –0.10 [95% CI, –0.28 to 0.09]; difference between groups, 0.72 SDs [95% CI, 0.46-0.97]; P < .001). Total intelligence also improved significantly more in the exercise group (mean z score, 0.69 [95% CI, 0.48-0.89]) than in the control group (mean z score, 0.07 [95% CI, –0.14 to 0.28]; difference between groups, 0.62 SDs [95% CI, 0.31-0.91]; P < .001). Exercise also positively affected a composite score of cognitive flexibility (mean z score: exercise group, 0.25 [95% CI, 0.05-0.44]; control group, –0.17 [95% CI, –0.39 to 0.04]; difference between groups, 0.42 SDs [95% CI, 0.13-0.71]; P = .005). These main effects were consistent in intention-to-treat analyses and after multiple-testing correction. There was a positive, small-magnitude effect of exercise on total academic performance (mean z score: exercise group, 0.31 [95% CI, 0.18-0.44]; control group, 0.10 [95% CI, –0.04 to 0.24]; difference between groups, 0.21 SDs [95% CI, 0.01-0.40]; P = .03), which was partially mediated by cognitive flexibility. Inhibition, working memory, hippocampal volume, and other brain magnetic resonance imaging outcomes studied were not affected by the exercise program. The intervention increased cardiorespiratory fitness performance as indicated by longer treadmill time to exhaustion (mean z score: exercise group, 0.54 [95% CI, 0.27-0.82]; control group, 0.13 [95% CI, –0.16 to 0.41]; difference between groups, 0.42 SDs [95% CI, 0.01-0.82]; P = .04), and these changes in fitness mediated some of the effects (small percentage of mediation [approximately 10%-20%]). The effects of exercise were overall consistent across the moderators tested, except for larger improvements in intelligence among boys compared with girls. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, exercise positively affected intelligence and cognitive flexibility during development among children with overweight or obesity. However, the structural and functional brain changes responsible for these improvements were not identified. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02295072

Labayen Goñi, Idoia

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