Open Access
Associations between the adherence to the Mediterranean diet and cardiorespiratory fitness with total and central obesity in preschool children: the PREFIT project
(Springer, 2018) Labayen Goñi, Idoia; Arenaza Etxeberría, Lide; Medrano Echeverría, María; García, Natalia; Cadenas-Sánchez, Cristina; Ortega, Francisco B.; Ciencias de la Salud; Osasun Zientziak
Purpose: Early recognition of risk factors associated with overweight/obesity is animportant step towards preventing long-term health consequences. The aim of the current study was to examine the associations of the adherence to the Mediterranean dietary pattern (MDP) and cardiorespiratory fitness (CRF) with adiposity in preschool children from thenorth of Spain. Methods: The adherence to the MDP (KIDMED), CRF (20-m shuttle run test), total (BMI) and central (waist circumference) adiposity and socio-demographic factors were assessed in 619 children (48.6% girls) who were on average 4.7 years old. Results: Higher MDP index (P < 0.05) and CRF levels (P < 0.01) were significantly related to lower waist circumference. CRF was inversely associated with BMI (P <= 0.001), yet no significant association was observed between MDP and BMI. Children not having high CRF levels and high MDP (i.e., non-upper sex-specific tertile of CRF or MDP, respectively) had the highest waist circumference. Conclusions: Our findings support that higher adherence to the MDP and higher CRF are associated with lower waist circumference in preschool children, pointing them as relevant modifiable factors to be targeted by educational strategies aiming to prevent central obesity and later obesity-related comorbidities.
Open Access
Patterns of active commuting to school in Spanish preschool children and its associations with socio-economic factors: the PREFIT project
(MDPI, 2021) Herrador-Colmenero, Manuel; Cadenas-Sánchez, Cristina; Labayen Goñi, Idoia; Muntaner Mas, Adrià; Moliner-Urdiales, Diego; Lozano Berges, Gabriel; Benito, Pedro J.; Rodríguez Pérez, M. A.; Delgado Alfonso, Álvaro; Sanchís Moysi, Joaquín; Martínez Vizcaíno, Vicente; Chillón, Palma; PREFIT Project Group; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
The aims of this study were to describe patterns of active commuting to school (ACS) of preschool children, and to analyse the relationship between ACS and family socio-economic factors. A total of 2636 families of preschoolers (3-to-5 years old) were asked to complete a questionnaire at home about the mode of commuting to school of their children and marital status, educational level, and profession of both father and mother. Chi-square analyses were applied to compare ACS between school grades and gender of the children. To analyse the association of ACS with socio-economic factors, logistic regression analyses were performed. Almost 50% of participants reported ACS of their offspring, with a higher rate in 3rd preprimary grade (5 years old) than in 1st and 2nd preprimary grades (3-and 4-years old. All, p <0.05). Those preschool children who had parents with lower educational level and no managerial work had higher odds to ACS than those who had parents with higher educational level and managerial work (all, p ≤ 0.001). Around half of the Spanish preschool children included in this study commuted actively to school and families with lower educational levels or worse employment situation were related to active commuting to school.
Open Access
Differences in brain volume between metabolically healthy and unhealthy overweight and obese children: the role of fitness
(MDPI, 2020) Cadenas-Sánchez, Cristina; Esteban Cornejo, Irene; Migueles, Jairo H.; Labayen Goñi, Idoia; Verdejo Román, Juan; Mora González, José; Henriksson, Pontus; Maldonado, José; Gómez Vida, José; Hillman, Charles H.; Erickson, Kirk I.; Kramer, Arthur F.; Catena, Andrés; Ortega, Francisco B.; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
The aim of this study was to examine whether metabolically healthy overweight/obese children have greater global and regional gray matter volumes than their metabolically unhealthy peers. We further examined the association between gray matter volume and academic achievement, along with the role of cardiorespiratory fitness in these associations. A total of 97 overweight/obese children (10.0 +/- 1.2 years) participated. We classified children as metabolically healthy/unhealthy based on metabolic syndrome cut-offs. Global and regional brain volumes were assessed by magnetic resonance imaging. Academic achievement was assessed using the Woodcock-Munoz standardized test. Cardiorespiratory fitness was assessed by the 20 m shuttle run test. Metabolically healthy overweight/obese (MHO) children had greater regional gray matter volume compared to those who were metabolically unhealthy (MUO) (all p <= 0.001). A similar trend was observed for global gray matter volume (p = 0.06). Global gray matter volume was positively related to academic achievement (beta = 0.237, p = 0.036). However, all the associations were attenuated or disappeared after adjusting for cardiorespiratory fitness (p > 0.05). The findings of the present study support that metabolically healthy overweight/obese children have greater gray matter volume compared to those that are metabolically unhealthy, which is in turn related to better academic achievement. However, cardiorespiratory fitness seems to explain, at least partially, these findings.
Open Access
Fitness, physical activity and academic achievement in overweight/obese children
(Taylor & Francis, 2020) Cadenas-Sánchez, Cristina; Migueles, Jairo H.; Esteban Cornejo, Irene; Mora González, José; Henriksson, Pontus; Rodríguez Ayllon, María; Molina García, Pablo; Löf, Marie; Labayen Goñi, Idoia; Hillman, Charles H.; Catena, Andrés; Ortega, Francisco B.; Ciencias de la Salud; Osasun Zientziak
The aim of this study was to examine the associations of fitness and physical activity with academic achievement in children with overweight/obesity. A total of 106 (10.0 ± 1.1y, 61 boys) children participated. The fitness components were assessed by field and laboratory-based tests. Physical activity was measured via accelerometry. The academic achievement was assessed by a standardised test and school-grades. Field-based cardiorespiratory fitness was associated with language skills (ß-standardised- ranging from 0.281 to 0.365, p < 0.01). The field-based muscular strength was associated with grade point average, natural and social sciences, and foreign language (ß = 0.280–0.326, all p ≤ 0.01). Speed-agility was associated with some language-related skills (ß = 0.325–0.393, all p ≤ 0.01). The laboratory-based muscular strength also showed an association with mathematics skills (ß = 0.251–0.306, all p ≤ 0.01). Physical activity did not show significant association with academic achievement (p > 0.01). Overall, the significant associations observed for muscular strength and speed/agility were attenuated and disappeared in many cases after additional adjustments for body mass index and cardiorespiratory fitness, indicating that these associations are inter-dependent. Our study contributes by indicating that other fitness components apart from cardiorespiratory fitness, such as muscular strength and speed-agility, are positively associated with academic achievement. However, these associations appear to be dependent on body mass index and cardiorespiratory fitness.
Open Access
Association of breakfast quality and energy density with cardiometabolic risk factors in overweight/obese children: role of physical activity
(MDPI, 2018) Arenaza Etxeberría, Lide; Muñoz-Hernández, Victoria; Medrano Echeverría, María; Osés Recalde, Maddi; Amasene, María; Merchán Ramírez, Elisa; Cadenas-Sánchez, Cristina; Ortega, Francisco B.; Ruiz, Jonatan R.; Labayen Goñi, Idoia; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
There is a general belief that having breakfast is an important healthy lifestyle factor; however, there is scarce evidence on the influence of breakfast quality and energy density on cardiometabolic risk in children, as well as on the role of physical activity in this association. The aims of this paper were (i) to examine the associations of breakfast quality and energy density from both solids and beverages with cardiometabolic risk factors, and (ii) to explore whether physical activity levels may attenuate these relationships in children with overweight/obesity from two projects carried out in the north and south of Spain. Breakfast consumption, breakfast quality index (BQI) score, BEDs/BEDb (24 h-recalls and the KIDMED questionnaire), and physical activity (PA; accelerometry) were assessed, in 203 children aged 8-12 years who were overweight or obese. We measured body composition (Dual X-ray Absorptiometry), uric acid, blood pressure, lipid profile, gamma-glutamyl-transferase (GGT), glucose, and insulin, and calculated the HOMA and metabolic syndrome z-score. The BQI score was inversely associated with serum uric acid independently of a set of relevant confounders (= -0.172, p = 0.028), but the relationship was attenuated after further controlling for total PA (p < 0.07). BEDs was positively associated with total and HDL cholesterol, and systolic blood pressure regardless of confounders (all p < 0.05), while BEDb was positively associated with HOMA in either active/inactive children (all p < 0.03). In conclusion, higher breakfast quality and lower breakfast energy density should be promoted in overweight/obesity children to improve their cardiometabolic health.
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
Step-based metrics and overall physical activity in children with overweight or obesity: cross-sectional study
(JMIR Publications, 2020) Migueles, Jairo H.; Cadenas-Sánchez, Cristina; Aguiar, Elroy J.; Molina García, Pablo; Solís Urra, Patricio; Mora González, José; García Mármol, Eduardo; Shiroma, Eric J.; Labayen Goñi, Idoia; Chillón, Palma; Löf, Marie; Tudor Locke, Catrine; Ortega, Francisco B.; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
Background: Best-practice early interventions to increase physical activity (PA) in children with overweight and obesity should be both feasible and evidence based. Walking is a basic human movement pattern that is practical, cost-effective, and does not require complex movement skills. However, there is still a need to investigate how much walking—as a proportion of total PA level—is performed by children who are overweight and obese in order to determine its utility as a public health strategy. Objective: This study aimed to (1) investigate the proportion of overall PA indicators that are explained by step-based metrics and (2) study step accumulation patterns relative to achievement of public health recommendations in children who are overweight and obese. Methods: A total of 105 overweight and obese children (mean 10.1 years of age [SD 1.1]; 43 girls) wore hip-worn accelerometers for 7 days. PA volumes were derived using the daily average of counts per 15 seconds, categorized using standard cut points for light-moderate-vigorous PA (LMVPA) and moderate-to-vigorous PA (MVPA). Derived step-based metrics included volume (steps/day), time in cadence bands, and peak 1-minute, 30-minute, and 60-minute cadences. Results: Steps per day explained 66%, 40%, and 74% of variance for counts per 15 seconds, LMVPA, and MVPA, respectively. The variance explained was increased up to 80%, 92%, and 77% by including specific cadence bands and peak cadences. Children meeting the World Health Organization recommendation of 60 minutes per day of MVPA spent less time at zero cadence and more time in cadence bands representing sporadic movement to brisk walking (ie, 20-119 steps/min) than their less-active peers. Conclusions: Step-based metrics, including steps per day and various cadence-based metrics, seem to capture a large proportion of PA for children who are overweight and obese. Given the availability of pedometers, step-based metrics could be useful in discriminating between those children who do or do not achieve MVPA recommendations.
Open Access
Effects of a family-based lifestyle intervention plus supervised exercise training on abdominal fat depots in children with overweight or obesity: a secondary analysis of a nonrandomized clinical trial
(American Medical Association, 2022) Cadenas-Sánchez, Cristina; Cabeza Laguna, Rafael; Idoate, Fernando; Osés Recalde, Maddi; Medrano Echeverría, María; Villanueva Larre, Arantxa; Arenaza Etxeberría, Lide; Sanz Muñoz, Aritz; Ortega, Francisco B.; Ruiz, Jonatan R.; Labayen Goñi, Idoia; Ciencias de la Salud; Ingeniería Eléctrica, Electrónica y de Comunicación; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD; Institute of Smart Cities - ISC; Osasun Zientziak; Ingeniaritza Elektrikoa, Elektronikoaren eta Telekomunikazio Ingeniaritzaren
Importance Excess abdominal fat is a major determinant in the development of insulin resistance and other metabolic disorders. Increased visceral adipose tissue (VAT) seems to precede the development of insulin resistance and is therefore a prime target of childhood lifestyle interventions aimed at preventing diabetes. OBJECTIVES To examine the effect of added exercise to a family-based lifestyle intervention program designed to reduce VAT plus subcutaneous (ASAT), intermuscular (IMAAT), and pancreatic (PAT) adipose tissue in children with overweight or obesity and to explore the effect of changes in VAT on insulin resistance. DESIGN, SETTING, AND PARTICIPANTS This 2-group, parallel-design clinical trial was conducted in Vitoria-Gasteiz, Spain. A total of 116 children with overweight or obesity participated and were assigned to a 22-week family-based lifestyle program (control group [n = 57]) or the same program plus an exercise intervention (exercise group [n = 59]). Data were collected between September 1, 2014, and June 30, 2017, and imaging processing for fat depot assessments and data analysis were performed between May 1, 2019, and February 12, 2021. INTERVENTIONS The compared interventions consisted of a family-based lifestyle and psychoeducation program (two 90-minute sessions per month) and the same program plus supervised exercise (three 90-minute sessions per week). MAIN OUTCOMES AND MEASURES The primary outcome of this study was the change in VAT between baseline and 22 weeks as estimated by magnetic resonance imaging. The secondary outcomes were changes in ASAT, IMAAT, and PAT. The effect of changes in VAT area on insulin resistance was also recorded. RESULTS The 116 participants included in the analysis (62 girls [53.4%]) had a mean (SD) age of 10.6 (1.1) years, and 67 (57.8%) presented with obesity. Significantly greater reductions were recorded for the exercise group in terms of reduction in VAT (−18.1% vs −8.5% for the control group; P = .004), ASAT (−9.9% vs −3.0%; P = .001), and IMAAT (−6.0% vs −2.6%; P = .02) fat fractions compared with the control group. Changes in VAT explained 87.6% of the improvement seen in insulin resistance (β = −0.102 [95% CI, −0.230 to −0.002]). CONCLUSIONS AND RELEVANCE These findings suggest that the addition of exercise to a lifestyle intervention program substantially enhanced the positive effects on abdominal fat depots in children with overweight or obesity. In addition, the reduction in VAT seemed to largely mediate the improvement of insulin sensitivity. These results highlight the importance of including exercise as part of lifestyle therapies aimed at treating childhood obesity and preventing the development of type 2 diabetes.
Open Access
Physical fitness reference standards for preschool children: the PREFIT project
(Elsevier, 2018) Cadenas-Sánchez, Cristina; Intemann, T.; Labayen Goñi, Idoia; Peinado, A. B.; Vidal-Conti, J.; Sanchís Moysi, Joaquín; Moliner-Urdiales, Diego; Rodríguez Pérez, M. A.; Cañete García-Prieto, J.; Fernández-Santos, J. D. R; Martínez Téllez, Borja; Vicente Rodríguez, Germán; Löf, Marie; Ruiz, Jonatan R.; Ortega, Francisco B.; Osasun Zientziak; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD; Ciencias de la Salud
Objectives: Reference values are necessary for classifying children, for health screening, and for early prevention as many non-communicable diseases aggravate during growth and development. While physical fitness reference standards are available in children aged 6 and older, such information is lacking in preschool children. Therefore, the purposes of this study were (1) to provide sex-and age-specific physical fitness reference standards for Spanish preschool children; and (2) to study sex differences across this age period and to characterise fitness performance throughout the preschool period. Design: Cross-sectional. Methods: A total of 3179 preschool children (1678 boys) aged 2.8–6.4 years old from Spain were included in the present study. Physical fitness was measured using the PREFIT battery. Results: Age- and sex-specific percentiles for the physical fitness components are provided. Boys performed better than girls in the cardiorespiratory fitness, muscular strength, and speed-agility tests over the whole preschool period studied and for the different percentiles. In contrast, girls performed slightly better than boys in the balance test. Older children had better performance in all fitness tests than their younger counterparts. Conclusions: Our study provides age- and sex-specific physical fitness reference standards in preschool children allowing interpretation of fitness assessment. Sexual dimorphism in fitness tests exists already at preschool age, and these differences become larger with age. These findings will help health, sport, and school professionals to identify preschool children with a high/very low fitness level, to examine changes in fitness over time, and to analyse those changes obtained due to intervention effects.
Open Access
Development of a prediction protocol for the screening of metabolic associated fatty liver disease in children with overweight or obesity
(Wiley, 2022) Osés Recalde, Maddi; Cadenas-Sánchez, Cristina; Medrano Echeverría, María; Galbete Jiménez, Arkaitz; Miranda Ferrúa, Emiliano; Ruiz, Jonatan R.; Sánchez-Valverde, Félix; Ortega, Francisco B.; Cabeza Laguna, Rafael; Villanueva Larre, Arantxa; Idoate, Fernando; Labayen Goñi, Idoia; Osasun Zientziak; Institute of Smart Cities - ISC; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD; Ciencias de la Salud; Gobierno de Navarra / Nafarroako Gobernua
Background: the early detection and management of children with metabolic associ-ated fatty liver disease (MAFLD) is challenging. Objective: to develop a non-invasive and accurate prediction protocol for the identi-fication of MAFLD among children with overweight/obesity candidates to confirma-tory diagnosis. Methods: a total of 115 children aged 8–12 years with overweight/obesity, rec-ruited at a primary care, were enrolled in this cross-sectional study. The external vali-dation was performed using a cohort of children with overweight/obesity (N=46)aged 8.5–14.0 years. MAFLD (≥5.5% hepatic fat) was diagnosed by magnetic reso-nance imaging (MRI). Fasting blood biochemical parameters were measured, and25 candidates’ single nucleotide polymorphisms (SNPs) were determined. Variablespotentially associated with the presence of MAFLD were included in a multivariatelogistic regression. Results: children with MAFLD (36%) showed higher plasma triglycerides (TG),insulin, homeostasis model assessment ofinsulin resistance (HOMA-IR), alanineaminotransferase (ALT), aspartate transaminase (AST), glutamyl-transferase (GGT)and ferritin (p< 0.05). The distribution of the risk-alleles of PPARGrs13081389, PPARGrs1801282, HFErs1800562 and PNLPLA3rs4823173 was significantly different between children with and without MAFLD (p<0.05). Threebiochemical- and/or SNPs-based predictive models were developed, showingstrong discriminatory capacity (AUC-ROC: 0.708–0.888) but limited diagnosticperformance (sensitivity 67%–82% and specificity 63%–69%). A prediction proto-col with elevated sensitivity (72%) and specificity (84%) based on two consecutive steps was developed. The external validation showed similar results: sensitivity of 70% and specificity of 85%. Conclusions: the HEPAKID prediction protocol is an accurate, easy to implant, minimally invasive and low economic cost tool useful for the early identification and management of paediatric MAFLD in primary care.