Higher socioeconomic status is related to healthier levels of fatness and fitness already at 3 to 5 years of age: The PREFIT project

Sex Differences in Grip Strength From Birth to Age 16: A Meta-Analysis

In 1985, Thomas and French published results of a meta-analysis that examined sex differences in grip strength in children 5 years of age and older. Their analysis included results from only four studies, and no update has been published. The purpose of the current study was to use meta-analysis to examine sex differences in grip strength from birth to age 16. The analysis included 808 effects from 169 studies conducted in 45 countries between 1961 and 2023. The total sample was 353,676 (178,588 boys, 175,088 girls). From birth to 16 years of age, grip strength was consistently greater in boys than girls. Between 3 and 10 years old, the effect size was small-to-moderate, with female grip strength equaling 90% of male grip strength (Hedges g = 0.33-0.46). At age 11, the effect size decreased slightly, likely due to girls reaching puberty before boys (g = 0.29, 95% confidence intervals (CI) [0.22, 0.35]). At age 13, the effect size increased markedly likely due to male puberty (g = 0.63, 95% CIs [0.55, 0.70]). By age 16, the sex difference in grip strength was substantial, with female grip strength equaling 65% of male grip strength (g = 2.07, 95% CIs [1.86, 2.27]). Secondary analyses revealed that the sex difference in grip strength is broadly similar between countries and has been mostly stable since the 1960s, except for a narrowing of the difference among 5-10-year-olds after 2010. Various biological factors explain why, on average, boys are stronger than girls from birth onward.

Dietary Patterns by Level of Maternal Education and Their Contribution to BMI, Fat Mass Index, and Fat-Free Mass Index at Age 5 and the Longitudinal Association with BMI at Age 10

BACKGROUND

Our aim was to identify dietary patterns by the level of maternal education that contribute to BMI, fat mass index (FMI), and fat-free mass index (FFMI) in children at age 5 and to assess if these dietary patterns are related to BMI at age 10.

METHODS

Per group (low/middle/high level), Reduced Rank Regression (RRR) was used to derive dietary patterns for the response variables BMI z-score, FMI, and FFMI in 1728 children at age 5 in the Amsterdam Born Children and their Development (ABCD) cohort. Regression analyses were then used to determine the association with BMI at age 10.

RESULTS

In each group, pattern 1 was characterized by its own cluster of food groups. Low: water/tea, savory snacks, sugar, low-fat meat, and fruits; middle: water/tea, low-fat cheese, fish, low-fat dairy, fruit drink, low-fat meat, and eggs; and high: low-fat cheese, fruits, whole-grain breakfast products, and low-fat and processed meat. Additionally, in each group, pattern 1 was positively associated with BMI z-scores at age 10 (low: β ≤ 0.43 [95% CI ≤ 0.21; 0.66], p < 0.001, middle: β ≤ 0.23 [0.09; 0.36], p ≤ 0.001, and high: β ≤ 0.24 [0.18; 0.30], p < 0.001).

CONCLUSIONS

The dietary patterns stratified by the level of maternal education are characterized by different food groups. But in all the groups, pattern 1 is positively associated with BMI at age 10.

Association between glucose levels of children with type 1 diabetes and parental economic status in mobile health application

BACKGROUND

The glycemic control of children with type 1 diabetes (T1D) may be influenced by the economic status of their parents.

AIM

To investigate the association between parental economic status and blood glucose levels of children with T1D using a mobile health application.

METHODS

Data from children with T1D in China's largest T1D online community, Tang-TangQuan®. Blood glucose levels were uploaded every three months and parental economic status was evaluated based on annual household income. Children were divided into three groups: Low-income (< 30000 Yuan), middle-income (30000-100000 Yuan), and high-income (> 100000 yuan) (1 Yuan = 0.145 United States Dollar approximately). Blood glucose levels were compared among the groups and associations were explored using Spearman's correlation analysis and multivariable logistic regression.

RESULTS

From September 2015 to August 2022, 1406 eligible children with T1D were included (779 female, 55.4%). Median age was 8.1 years (Q1-Q3: 4.6-11.6) and duration of T1D was 0.06 years (0.02-0.44). Participants were divided into three groups: Low-income (n = 320), middle-income (n = 724), and high-income (n = 362). Baseline hemoglobin A1c (HbA1c) levels were comparable among the three groups (P = 0.072). However, at month 36, the low-income group had the highest HbA1c levels (P = 0.036). Within three years after registration, glucose levels increased significantly in the low-income group but not in the middle-income and high-income groups. Parental economic status was negatively correlated with pre-dinner glucose (r = -0.272, P = 0.012). After adjustment for confounders, parental economic status remained a significant factor related to pre-dinner glucose levels (odds ratio = 13.02, 95%CI: 1.99 to 126.05, P = 0.002).

CONCLUSION

The blood glucose levels of children with T1D were negatively associated with parental economic status. It is suggested that parental economic status should be taken into consideration in the management of T1D for children.

Association Between Children's and Parents' Physical Activity During the COVID-19 Pandemic: A Cross-Lagged Analysis

BACKGROUND

COVID-19 caused closures of movement supporting environments such as gyms and schools in Canada. This study evaluated the association between Ontario parents' and children's physical activity levels across time during COVID-19, controlling for variables that were identified as significant predictors of children's and parents' physical activity (e.g., children's age, parents' employment status).

METHODS

Parents (n = 243; mean age = 38.8 y) of children aged 12 and under (n = 408; mean age = 6.3 y) living in Ontario, Canada completed 2 online surveys, the first between August and December 2020 and the second between August and December 2021. At baseline, parents were asked to recall prepandemic physical activity levels. To determine the association between parent and child physical activity during COVID-19, a cross-lagged model was estimated to determine the cross-sectional and longitudinal associations between parents' and children's physical activity across time.

RESULTS

Bivariate associations revealed that parents' and children's physical activity levels were significantly related during lockdown and postlockdown but not prelockdown. The autoregressive paths from prelockdown to during lockdown were significant for children (β = 0.53, P < .001) and parents (β = 1.058, P < .001) as were the autoregressive paths from during lockdown to postlockdown for children (β = 0.61, P < .001) and parents (β = 0.48, P < .001). In fully adjusted models, the cross-lagged association between parents' physical activity prelockdowns was significantly positively associated with their children's physical activity during lockdowns (β = 0.19, P = .013).

CONCLUSIONS

Resources are needed to ensure that children and parents are obtaining sufficient levels of physical activity, particularly during a pandemic.

Physical activity in infancy and early childhood: a narrative review of interventions for prevention of obesity and associated health outcomes

In the context of the childhood obesity epidemic, this narrative review aims to explore opportunities to promote physical activity (PA) between birth and age 5 years as well as the health outcomes associated with PA in early childhood. Although early childhood is an ideal time to promote healthy habits, guidelines for PA have often ignored early childhood given the limited evidence for children <5 years old. Herein we discuss and highlight infant, toddler and preschool age interventions to promote PA and prevent obesity both in the short and long-term. We describe novel and modified interventions to promote improved early childhood health outcomes, encompassing cardiorespiratory, muscle, and bone strengthening components necessary for short-term motor development and long-term health. We call for new research aimed at developing and testing innovative early childhood interventions that may be performed in home or childcare settings, monitored by parents or caregivers.

Spatial Heterogeneity and Regional Clustering of Factors Influencing Chinese Adolescents' Physical Fitness

There is often significant spatial heterogeneity in the factors influencing physical fitness in adolescents, yet less attention has been paid to this in established studies. Based on the 2018 Chinese National Student Physical Fitness Standard Test data, this study uses a multi-scale, geographically weighted regression (MGWR) model combined with a K-means clustering algorithm to construct a spatial regression model of the factors influencing adolescent physical fitness, and to investigate the degree of spatial variation in the physical fitness of Chinese adolescents from a socio-ecological perspective of health promotion. The following conclusions were drawn: the performance of the youth physical fitness regression model was significantly improved after taking spatial scale and heterogeneity into account. At the provincial scale, the non-farm output, average altitude, and precipitation of each region were strongly related to youth physical fitness, and each influencing factor generally showed a banded spatial heterogeneity pattern, which can be summarized into four types: N-S, E-W, NE-SW, and SE-NW. From the perspective of youth physical fitness, China can be divided into three regions of influence: the socio-economic-influenced region, mainly including the eastern region and some of the central provinces of China; the natural-environment-influenced region, which mainly includes the northwestern part of China and some provinces in the highland region; and the multi-factor joint-influenced region, which mainly includes the provinces in the central and northeastern regions of China. Finally, this study provides syndemic suggestions for physical fitness and health promotion for youths in each region.

Effectiveness of Brainball program on physical fitness of primary school pupils in Vietnam. A longitudinal study

Objective

The present study aimed to evaluate the effectiveness of the Brainballs on the physical fitness of 2nd-grade students at a primary school in Vietnam during and eight months after the experiment.

Methods

The study included 55 pupils (23 boys and 32 girls) aged seven years. The study design was a pedagogical experiment with a parallel-group technique, including experimental and control groups. The examination was carried out in 2019/2020 in three terms pre- (September 2019), post- (January 2020), and follow-up (September 2020). Physical fitness was tested with the use of the International Physical Fitness Test. The Brainball program, conducted twice a week for 35 minutes, combined physical education (PE) with subject-related content, utilizing 100 balls with painted letters, numbers, and signs.

Results

Results show that the fitness level was not increased significantly after 20 weeks of the intervention program, neither in experimental nor control groups. However, it significantly improved eight months later at the follow-up examination. The analysis of covariance indicated that pupils from the experimental group improved significantly on most physical fitness as compared to the control group, specifically on the following tests: 50-meter running (p = 0.0044), toe touch (p = 0.0137), standing long jump (p = 0.0076), 4 × 10 m sprint (p = 0.0333), hand strength (p = 0.0233).

Conclusions

These results have shown long-term positive effects of the use of "Brainball" educational balls in physical education classes on the physical fitness development of students, especially in the qualities of speed, strength, and flexibility.

Relationship between Learning and Psychomotor Skills in Early Childhood Education

Psychomotor skills are, among others, an aspect particularly valuable for structuring the teaching-learning process of infant schoolchildren. For this reason, a study was carried out with the aim of describing and comparing the socio-demographic, psychomotor, and learning levels of schoolchildren in the second stage of infant education. Ninety-five pupils from the second cycle of infant education in the capital of Granada took part in this study. A sociodemographic questionnaire, the movement assessment battery for children-2 (MABC-2), and the preschool learning behaviour scale (PLBS) were used to collect data. The main results show that manual dexterity appears as the main motor factor and similar figures in the three dimensions of learning behaviours. On the other hand, balance and learning behaviours were higher in 6-year-old schoolchildren. In terms of gender, girls obtained higher values for the level of the learning behaviour variables. A positive correlation was found between the dimensions of learning and motor activity.

Multiscale Impact of Environmental and Socio-Economic Factors on Low Physical Fitness among Chinese Adolescents and Regionalized Coping Strategies

As low physical fitness in adolescents increases their risk of all-cause mortality in future adulthood as well as regional public health budgets, many scholars have studied the factors influencing physical fitness in adolescents. However, the spatial non-stationarity and scale between physical fitness and influencing factors in adolescents are often neglected. To rectify this situation, this study constructed a multi-scale geographically weighted regression model based on data from the China National Student Fitness Survey and the China Statistical Yearbook in 2018 to investigate the spatial patterns of factors influencing low physical fitness among adolescents. The results showed that the influencing factors for measuring the physical fitness of Chinese adolescents had significant spatial heterogeneity and multi-scale effects. The local R² values were relatively low in the western region of China. Consideration should be given to increasing the lifestyle and ethnic and cultural characteristics of local residents when selecting influencing factors in the future. The physical fitness of men was mainly influenced by socio-economic factors, while that of women was influenced by natural environmental factors. According to the different spatial distribution patterns of MGWR, this study suggests that each region should develop regionalized strategies to cope with the low physical fitness of adolescents, including taking advantage of the natural environment to develop physical fitness promotion projects, accelerating the upgrading of industrial structures in the north-eastern and western regions, and the need to remain cautious of rapid urbanization in the east.

Effects of an Exercise Program on Brain Health Outcomes for Children With Overweight or Obesity: The ActiveBrains Randomized Clinical Trial

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.

The Influence of Cultural Experiences on the Associations between Socio-Economic Status and Motor Performance as Well as Body Fat Percentage of Grade One Learners in Cape Town, South Africa

Fundamental movement skills (FMS), physical fitness (PF) and body fat percentage (BF%) are significantly related to socio-economic status (SES). However, it remains unclear why previous studies have had different findings regarding the direction of the association between SES and FMS, PF and BF%. A suggested explanation is that the direction of the link can be influenced by cultural experiences and traditions. Therefore, the aim of the current study was to investigate links between SES and FMS, PF, BF% of Grade One learners from two different ethno-geographic areas in Cape Town, South Africa. Grade One children (n = 191) (n = 106 boys and n = 85 girls; age (6.7 ± 0.33)) from different socio-economic areas in Cape Town, South Africa, were selected to participate in the study. South African schools are classified into five different quintiles (1 = poorest and 5 = least poor public schools). For this study, two schools were selected, one from quintile 2 and the other from quintile 5. BF% was assessed according to Slaughter's equation. FMS were measured using the Gross Motor Development Test-2 (TGMD-2) and PF via five tests: 1. dynamic strength of lower limb (broad jump); 2. dynamic strength of upper limb and trunk (throwing a tennis ball); 3. speed agility (4 × 10 m shuttle running); 4. cardiorespiratory fitness (20 m shuttle run endurance test (Leger test)) and 5. flexibility (sit and reach test). An analysis of covariance (ANCOVA) found that BF% and WHtR were significantly greater in children with higher SES (Z = 6.04 p < 0.001; Hedg = 0.54), (Z = 3.89 p < 0.001; Hedg = 0.32). Children with lower SES achieved significantly better TGMD-2 standard scores in the locomotor subtest, compared to their peers with higher SES. In the object control subtest, no significant SES-related difference was found. However, ANCOVA showed that girls performed better in FMS than boys. In PF, the main effect of SES was observed in dynamic strength of trunk and upper limb (throwing) and flexibility, where children with lower SES performed significantly better. No significant difference was found in cardiorespiratory performance (CRP) (Beep test), even though children with lower SES achieved better results. Results from the current study suggest that links between SES, PF, FMS and body fat percentage in children seem to be dependent on cultural and traditional experiences. These experiences should therefore be included as an important factor for the development of programmes and interventions to enhance children's lifelong motor behaviour and health strategies.

Impact of Parental Education and Physical Activity on the Long-Term Development of the Physical Fitness of Primary School Children: An Observational Study

Low physical fitness (PF) has been associated with higher risk of suffering from different diseases. The importance of PF is evident already in early ages, as children’s PF appears to be a key factor of their future PF and physical activity level. Among the variables that may have an influence on children’s PF, the importance of parent’s socioeconomic status and active/inactive behaviors has been stressed in several previous studies. However, previous literature has mostly reported this association through cross-sectional studies. The purpose of this study was to examine the impact of parental education and self-reported parental physical activity (PA) on their children’s development of PF during the 4-year duration of primary education. Using German Motor Test 6-18, the major components of PF (sprint velocity, coordination, flexibility, strength endurance, power, and endurance) were measured on a total of 371 children (46.9% girls, 30.6% migration background, 19.6% overweight/obese at the fourth test time point, compliance 70.1%) from 20 primary schools in Tyrol, Austria. Results showed that children with at least one parent with upper secondary education or above obtained significantly higher PF scores at all time points compared to children with both parents with lower secondary education and below. However, PF in both groups developed over time in a comparable manner irrespective of parental education. From the age of 9 years old, children with regularly physically active parents showed a stronger development of PF over the time compared to their peers with parents reporting irregular/no PA. Our results suggest that low-educated parents’ children might be considered a special target group for interventions aiming at increasing PF. More research is needed in order to delve into the potential underdevelopment of PF in 9-year-old children whose parents have low PA levels.

Association between the Sociodemographic Characteristics of Parents with Health-Related and Lifestyle Markers of Children in Three Different Spanish-Speaking Countries: An Inter-Continental Study at OECD Country Level

The purpose of this cross-cultural study was to determine the association between the sociodemographic background of a child’s parents (i.e., their socioeconomic level, marital status, and educational level) with the child’s lifestyle (i.e., Mediterranean diet (MD), physical activity (PA) and screen time (ST)), and health markers. Material: This cross-sectional study included 1273 children, from Chile (n = 496), Colombia (n = 340), and Spain (n = 437). The sociodemographic information together with the lifestyle and health markers of the children were measured. There was an inverse association between a low or medium-low socioeconomic level for the parents of Chilean children and handgrip strength (β −0.61, p < 0.001); meanwhile, for Spanish children, an inverse association between a low or medium-low socioeconomic level and PA after school (β −0.58, p = 0.016), lifestyle (β −0.74, p = 0.015), and with MD adherence (β −0.86, p = 0.004) was found. The risk (i.e., by odd ratios (OR)) of being divorced/separated parents marital status showed an inverse association with abdominal obesity (OR 0.21, p = 0.045) in Spanish children; however, the parent’s marital status and a low educational level were risk factors for the suffering of a low nutritional level in Colombian children (OR 2.02, p = 0.048; OR 2.49, p < 0.001, respectively). On the other hand, a low educational level for parents reported for Chilean children had a positive association with ST of ≥4 h per day (OR 1.82, p = 0.020). In conclusion, in Spanish-speaking children, the lifestyle and health markers of the children are affected by the sociodemographic background of their parents; however, these effects could be moderated by the socio-cultural and economic status of their countries as members of the OCDE; therefore, it is essential to develop policies that decrease these gaps, so that children who are under-resourced can reach their full potential.

Socioeconomic inequalities in the prevalence of overweight and obesity among Portuguese preschool-aged children: Changes from 2009 to 2016

OBJECTIVES

We evaluated, for the first time in Portugal, the prevalence of overweight and obesity according to parental education in a population of preschool-aged Portuguese children in 2009/2010 and 2016/2017.

METHODS

Anthropometric data were collected in public and private preschools (n = 1996 in 2009/2010; n = 2077 in 2016/2017). Body mass index was calculated and weight status categories were based on the International Obesity Task Force cutoff points. Parental education level was self-reported.

RESULTS

Prevalence of overweight (17.1%-14.1%; p < 0.001) and obesity (6.6%-3.9%, p < 0.001) was lower in 2016/2017 than in 2009/2010, with higher rates being found in the north of the country. Parental education was significantly associated with childhood overweight and obesity and inequalities between low- and high-education increased between the two periods.

CONCLUSIONS

While a decrease in childhood overweight and obesity were positive findings, the prevalence is still high and shows pronounced socioeconomic differences. Policies for obesity prevention need to be inclusive and tackle inequalities, with interventions tailored to suit local contexts.

Socioeconomic and gender-based disparities in the motor competence of school-age children

This study examined socioeconomic and gender-based disparities in motor competence (MC) amongst 6-12-year-old children (N = 2654). Validated product-oriented tests assessing agility, balance and coordination were used to measure MC. School-level socioeconomic status (low, middle, high) was used to assess socioeconomic disparities. Analysis of covariance (ANCOVA) were conducted and odds ratios were calculated for the likelihood of having low MC by gender and socioeconomic status (SES). Girls displayed lower MC than boys for agility and coordination involving object-control (P < 0.001) while boys scored lower than girls for balance and hand-foot coordination (P < 0.001). Children in high SES schools displayed the highest level of MC for agility, balance and coordination (P < 0.001). Compared to the children in high SES schools, odds of having low competence in balance was higher for the children in low SES schools and odds of having low competence in agility and coordination were higher for the children in both low and middle SES schools. Newell's model of constraints (1986) and Bourdieu's concept of habitus (1984) were used to consider potential explanations of the observed disparities. To level up inequalities in children's MC, resources invested in school-based interventions should be proportionate to the school SES.

Lean mass index is positively associated with white matter volumes in several brain regions in children with overweight/obesity

BACKGROUND

The relationship of obesity with grey and white matter volumes has been examined in several studies, and the results are decidedly mixed.

OBJECTIVE

To investigate the associations of body mass index (BMI), fat mass index (FMI) and lean mass index (LMI) with total and regional grey and white matter volumes.

METHODS

This is a cross-sectional study involving 100 children (60% boys) with overweight/obesity. T1-weighted images were acquired using magnetic resonance imaging. Dual energy X-ray absorptiometry was used to measure body composition. Separate hierarchical regression analyses were performed between predictor variables (BMI, FMI and LMI) and the total brain volumes including sex, years from peak height velocity and parental education as covariates. In addition, FMI was added as a covariate when LMI was the predictor and vice versa. Statistical analyses of imaging data were performed using three whole-brain voxel-wise multiple regression models and adjusted by the same covariates.

RESULTS

LMI was positively associated with white matter in numerous regions and to a lower extent, with grey matter regions. Further, the relationship between LMI, and grey and white matter regions was independent of FMI levels.

CONCLUSIONS

LMI seems to be a positive predictor of regional white matter volumes in children with overweight/obesity.

Socioeconomic Inequality in Metabolic Control Among Children With Type 1 Diabetes: A Nationwide Longitudinal Study of 4,079 Danish Children

OBJECTIVE

To examine inequality in glycemic control by maternal educational level among children with type 1 diabetes in a setting with universal access to health care.

RESEARCH DESIGN AND METHODS

This was a longitudinal nationwide study of 4,079 Danish children with type 1 diabetes between the years 2000 and 2013. Children were divided into four groups based on mothers' education prebirth (≤high school [n = 1,643], vocational or 2-year college [n = 1,548], bachelor's degree [n = 695], ≥master's degree [n = 193]). Means of socioeconomic and treatment characteristics were compared between groups. HbA_1c and the number of daily glucose tests were compared repeatedly from onset until 5 years after onset across groups. HbA_1c was compared across daily blood glucose testing frequency and groups. Linear regression was used to compare HbA_1c across groups with and without adjustment for socioeconomic and treatment characteristics.

RESULTS

Large differences in HbA_1c across maternal education were found. The mean level of HbA_1c during follow-up was 59.7 mmol/mol (7.6%) for children of mothers with ≥master's degrees and 68.7 mmol/mol (8.4%) for children of mothers with ≤high school (difference: 9.0 mmol/mol [95% CI 7.5, 10.6]; 0.8% [95% CI 0.7, 1.0]). The associations were attenuated but remained significant after adjustment. Observable characteristics explained 41.2% of the difference in HbA_1c between children of mothers with ≤high school and mothers with ≥master's degree; 22.5% of the difference was explained by more frequent blood glucose monitoring among the children with the highly educated mothers.

CONCLUSIONS

Family background is significantly related to outcomes for children with type 1 diabetes, even with universal access to health care.

A Single Question of Parent-Reported Physical Activity Levels Estimates Objectively Measured Physical Fitness and Body Composition in Preschool Children: The PREFIT Project

Physical inactivity is recognized as a determinant of low physical fitness and body composition in preschool children, which in turn, are important markers of health through the lifespan. Objective methods to assess physical activity, physical fitness and body composition in preschool children are preferable; however, they have some practical limitations in the school context. Therefore, the aim of this study was to test whether a single question regarding physical activity level of preschool children, reported by their parents, could be used as an alternative screening tool of physical fitness and body composition. The information was obtained from 10 different cities throughout Spain, gathering a total of 3179 healthy preschool children (52.8% boys and 47.2% girls) aged 3-5 years. Physical activity levels of preschool children were reported by parents using a single question with five response options (very low, low, average, high, or very high). Physical fitness and body composition were assessed with the PREFIT fitness battery. The results showed that parents' perception of their children's physical activity was positively associated with all objectively measured physical fitness components (βrange = -0.094 to 0.113; all p < 0.020); and negatively with body composition indicators as measured (βrange = -0.113 to -0.058; all p < 0.001). The results showed significant differences in all physical fitness and body composition z-scores across the parent-reported physical activity levels (all p < 0.017 and all p < 0.001, respectively), as well as, for the fitness index (p < 0.001). Our study suggests that in school settings with insufficient resources to objectively assess fitness and body composition, parents-reported physical activity level by means of a single question might provide useful information about these important health markers in preschool children.