Associations of physical activity and fitness with hepatic steatosis, liver enzymes, and insulin resistance in children with overweight/obesity

Metabolic and Anthropometric Effects of a Randomized Freely Chosen Exercise Prescription Program vs a Video-Based Training Program in Patients With Childhood Obesity: A Randomized Clinical Trial

Objectives When dealing with children and adolescents living with obesity, it is vital to be aware that exercise provides benefits in the prevention and control of non-communicable diseases and general well-being. The growing prevalence of childhood obesity makes it necessary to develop strategies aimed at controlling the barriers that limit the performance of exercise, which is why we designed a plan of exercise prescription through videos that could be accessible, free, and designed for exercise at home, as a complement to a multidisciplinary intervention program for lifestyle change. This study aimed to compare the effects of a video-based exercise prescription program (EPV) versus free-choice exercise (FCE) on anthropometric and metabolic indicators. Methods We conducted an open-label, randomized, controlled clinical trial. Patients aged eight to 16 years with obesity from the Child Unit of the General Hospital of Mexico were included. Forty-two participants finished the follow-up; 20 were boys, and 22 were girls. All patients were included in a multi-component program of healthy lifestyle changes and randomized to receive EPV (n=22) or FCE (n=20) for six months. Results The primary outcomes in both groups were a decrease in body mass index (BMI) (p < 0.001), a reduction in body fat mass (p < 0.001), and an increase in lean body mass (p = 0.003). Other outcomes observed were: in EPV, there was a decrease in low density lipid (LDL) (p=0.04); alanine aminotransferase (ALT) (p=0.002), aspartate aminotransferase (AST) (p=0.001) and uric acid (p=0.003) and an increase in high density lipid (HDL) (p=0. 002), while in FCE there was a decrease in Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) (p=0.006), insulin (p=0.006), LDL (p=0.02), ALT (p=0.002), AST (p=0.004) and gamma-glutamyl transferase (GGT) (p=0.025). Conclusion Both EPV and FCE exercise prescription programs, as part of a multidisciplinary intervention for childhood obesity, had favorable effects on body composition and metabolic parameters.

[Biochemical and cardiovascular indicators associated with handgrip strength in children and adolescents: A scoping review]

Handgrip strength is an indicator of the biological health of children and adolescents. The review's objective is to identify the biochemical and cardiovascular indicators related to handgrip strength. A scoping review was developed, in which the search was conducted in Medline, Web of Science, Science Direct, Scielo, and Sportdiscus from EBSCO. Original research was included if it involved handgrip strength and biochemical or cardiovascular indicators. In the initial search, 15,198 records were identified in databases. 31 studies were selected for this review. These reports identified 36 indicators (29 biochemical and 7 cardiovascular) that had been analyzed for their association with hand grip strength. Blood pressure (n=10; 32.3%) and homeostatic model assessment for insulin resistance (n=7; 22.5%) were the most frequently studied characteristics. In the biochemical indicators, a pattern was found in which handgrip strength had a proportional relationship with HDL levels and an inversely proportional relationship with various cardiometabolic scores. No relationship patterns were found in the cardiovascular indicators.

The associations of physical activity patterns and the triglyceride-glucose index in US adults: a secondary data analysis of NHANES (2007-2018)

The triglyceride-glucose (TyG) index, a readily accessible surrogate biomarker for insulin resistance and metabolic health, has been extensively investigated across various ethnic populations. The critical role of physical activity (PA) in enhancing insulin sensitivity has been corroborated by numerous studies. Nonetheless, the relationship between different patterns of PA and the TyG index remains ambiguous. This study seeks to elucidate the association between different PA patterns and the TyG index. Participants with complete data on TyG index, PA patterns, and other covariates from the National Health and Nutrition Examination Survey database (2007-2018) were included in this study. Participant characteristics across PA groups were compared using Rao-Scott chi-squared test or Kruskal-Wallis test. Multivariate linear regression models were used to assess the relationship between PA patterns and the TyG index, with subgroup analyses, interaction tests and restricted cubic spline (RCS) regression analyses conducted to explore the stability and potential nonlinearity of PA-TyG index association, respectively. A total of 16,440 participants were included, with 12,909, 164, 118, and 3249 individuals being inactive, insufficiently active, weekend warriors (WWs), and regularly active (RA), respectively. Multivariate adjusted linear regression models showed that insufficiently active adults (β = - 0.05, P = 0.3524), WWs (β = -0.01, P = 0.9129), and RA adults (β = - 0.110, P < 0.0001) all had significantly lower TyG indices compared to inactive adults. Significant difference was observed between WWs and RA adults (P for trend < 0.0001). Stratified analyses and interact tests revealed that the PA-TyG index association in RA group was more pronounced in individuals being male, with higher education levels, and without diabetes. Additionally, a significant, non-linear, and negative relationship between weekly total PA and TyG index in non-inactive individuals was determined by RCS analysis (P for overall < 0.001, P for nonlinearity = 0.054). Being regularly active is linked to a substantial reduction in the TyG index, whereas weekend warriors and those with insufficient activity do not experience comparable benefits. Nevertheless, the weekend warrior approach can provide a practical alternative for individuals who are unable to engage in consistent exercise.

Role of waist circumference, body mass index and high-sensitivity C-reactive protein in pediatric steatotic liver disease: A cross-sectional study

INTRODUCTION AND OBJECTIVES

Relationships and interactions among waist circumference (WC), body mass index (BMI) and high-sensitivity C-reactive protein (hs-CRP) with steatotic liver disease (SLD) in children have rarely been studied as a whole. We aimed to investigate the association among WC, BMI and hs-CRP with SLD and its related metabolic indictors.

MATERIALS AND METHODS

A total of 10,776 children aged 10-15 years were screened in our study. Anthropometric data, biochemical parameters and ultrasound assessments were collected. Metabolic indictors between children with and without SLD were compared. The correlation of waist circumference Z score (ZWC), body mass index Z score (ZBMI) and hs-CRP with SLD and its related metabolic indictors, and the interactive effect between ZWC with hs-CRP and ZBMI with hs-CRP upon SLD, respectively, was tested.

RESULTS

A total of 543 children with normal BMI (n = 287) and high BMI (n = 256) were examined. Hs-CRP, ZWC and ZBMI were all found to significantly correlate with SLD and its related metabolic indexes. The interaction effect analysis showed that ZWC and male was independent risk factor of SLD with OR (95 %CI) of 23.431 (7.253, 75.697) and 7.927 (2.766,22.713), respectively, whereas the same effect wasn't found in ZBMI. The cut-off value of ZWC for the prediction of SLD was 1.494 and 1.541 in boys and girls, respectively.

CONCLUSIONS

Increased WC, BMI and hs-CRP exerts adverse effect in pediatric SLD and its related metabolic indictors. WC and male gender could be independent risk factors for SLD, and WC was a powerful index for the prediction of SLD in children aged 10-15 years.

Temporal trends in weight-based disparities in physical fitness of children: 30-years of continuous surveillance through Slovenian national system

BACKGROUND

Obesity in childhood has deleterious consequences for health while improving physical fitness can significantly reduce health risks related to high body mass index. We aimed to examine the evolution of disparities in physical fitness based on weight status among 7-15-year-olds in Slovenia between 1989 and 2019 and compare these trends across sex, age and socioeconomic status.

METHODS

We used annual data collected within the SLOfit monitoring system in the period between 1989 and 2019, totalling 4,256,930 participants (about 137 000 per year). We examined cardiorespiratory fitness (600-m run test), muscular fitness (60-s sit-ups, bent arm hang, and standing broad jump test) and skill-related fitness (backwards obstacle course, 60-m dash, arm plate tapping). We grouped children according to the IOTF cut-offs for BMI to those living with normal weight or excess weight and estimated changes in physical fitness over time by fitting quantile regression models separately by sex and age group, and then using segmented regression to identify the patterns of trends over time.

RESULTS

Weight-based disparities in physical fitness were large in 1989 and have further increased by 2019. The increase in disparities was generally around 5 percentiles larger in boys, and 10-15-year-olds compared to younger children. It was particularly pronounced for body core strength and speed in boys (up to 15 and 19 percentiles, respectively) and upper body strength and speed among girls (up to 13 percentiles). Most of the increase in disparities in health-related fitness accumulated during the 2010s, when the fitness of children generally improved, but much less so in children living with excess weight.

CONCLUSIONS

Despite recent improvements in population fitness levels, children with excess weight seem to be left behind, which adds to existing health inequalities. Our results should encourage policymakers to redesign policies aimed at promoting physical activity and enhancing physical fitness to make them more equitable and ultimately lead to reducing inequalities in fitness.

Practice Recommendations for Metabolic Dysfunction-Associated Steatotic Liver Disease by the Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition (ISPGHAN)

JUSTIFICATION

There has been an alarming increase in metabolic dysfunction-associated steatotic liver disease (MASLD) and it is now the most common chronic liver disease worldwide, in both adult and pediatric populations. The lack of regional guidelines has hampered the formulation of national policies for prevention and management of MASLD in children. Therefore, we formulated recommendations for steatotic liver disease in children.

OBJECTIVES

To review the existing literature on the burden and epidemiology of pediatric MASLD and formulate recommendations for diagnostic evaluation, prevention, and management strategies.

PROCESS

The Indian Society of Pediatric Gastroenterology, Hepatology, and Nutrition invited national and international stakeholders to participate in a consensus meeting held on April 20, 2024, in Mumbai, Maharashtra, India. Various aspects of pediatric steatotic liver disease were deliberated upon and a consensus document and recommendations were formulated after several rounds of discussion.

RECOMMENDATIONS

Metabolic dysfunction-associated steatotic liver disease (MASLD) should be used as the preferred term in place of non-alcoholic fatty liver disease (NAFLD). There is a high prevalence of steatotic liver disease (SLD) among Indian children and adolescents, especially those who are overweight or obese. This condition may be progressive in childhood and associated with increased morbidity and mortality in adulthood. Various lifestyle, dietary, and genetic factors may predispose individuals to MASLD, including an increased intake of calorie-dense processed foods, sweetened sugar beverages, excessive screen time, higher sedentary time and lack of moderate to vigorous physical activity. MASLD is usually asymptomatic or presents with mild, non-specific symptoms and therefore, a high degree of suspicion is required for early diagnosis. MASLD is usually associated with cardiometabolic factors (hypertension, insulin resistance/diabetes mellitus, and/or dyslipidemia) and secondary causes should be excluded in all cases, particularly in the presence of red flag signs. Screening for MASLD should be considered in all obese children (body mass index or BMI ≥95th percentile) and in all overweight children (BMI ≥ 85th and <95thpercentile) with additional risk factors, such as prediabetes/diabetes, dyslipidemia, positive family history of metabolic syndrome, obstructive sleep apnea, and hypopituitarism. Abdominal ultrasound in combination with alanine aminotransferase (ALT) levels should be used as a screening test for MASLD in Indian children as per the proposed algorithm. Diet (any hypocaloric diet) and exercise (aerobic, resistance, or a combination of both; moderate to high intensity; regular in frequency) remain the cornerstones of pediatric MASLD management. Pharmacotherapy and/or endoscopic/surgical techniques for obesity should be considered as adjuncts and should be considered only after a failed adequate trial of lifestyle modifications.

Essential Improvements in Fat Percentage and Cardiometabolic Fitness After a Residential Stay for Socially Vulnerable Children-With and Without the "11 for Health" Concept

The Danish Christmas Seal Homes offer a 10-week residential stay for socially vulnerable children. We aimed to examine the effects on body composition and cardiometabolic fitness variables of the standard program (SG) and whether substituting physical activity sessions with sessions from a football-based health education program is beneficial for the participants ("11 for Health"; SG+). Three hundred and nine children participated in SG (12.4 [1.6] y) and 305 in SG+ (12.4 [1.4] y). Fat percentage was lowered by 6% for females (from 37% to 31%) and 8% for males (from 36% to 28%), with no between-group differences. We observed improvements in systolic and diastolic blood pressure (3 and 5 mm Hg, respectively), resting heart rate (10 beats/min), aerobic fitness, jump performance, and relative muscle mass with no between-group differences. Furthermore, there were between-group differences in insulin levels for females (1.7 pmol/L; 95% CI, 0.3 to 3.0) and postural balance for males (1.0 s; 95% CI, 0.0 to 2.0), both in favor of SG+, and covered distance in the Andersen test for females (26 m; 95% CI, 3 to 49) in favor of SG. In conclusion, a 10-week stay at the Danish Christmas Seal Home resulted in clinically relevant improvement in fat percentage and cardiometabolic fitness in socially vulnerable children, regardless of the program type.

Sex Differences in the Association Between AST/ALT and Incidence of Type 2 Diabetes in Japanese Patients with Nonalcoholic Fatty Liver Disease: A Retrospective Cohort Study

OBJECTIVES/INTRODUCTION

The purpose of the current study was to investigate the association between Aspartate Transaminase (AST)/Alanine transaminase(ALT) and type 2 diabetes (T2DM) in nonalcoholic fatty liver disease (NAFLD) patients and to determine whether there were sex differences.

METHODS

In the retrospective study, we collected data on NAFLD patients (1, 896 men and 465 women) at Murakami Memorial Hospital from 2004 to 2015. Data were stratified by sex to investigate the association between AST/ALT and T2DM incidence by sex. Multiple regression analysis, smooth curve fitting model and subgroup analysis were used to determine the correlation, non-linear relationship and threshold effect between AST/ALT and T2DM.

RESULTS

In our study, 157 men and 40 women developed T2DM at follow-up. After adjusting for risk factors, AST/ALT was significantly associated with T2DM in men with NAFLD but not in women with NAFLD. The risk of T2DM increased as the AST/ALT ratio decreased. Besides, in male NAFLD patients, AST/ALT showed a non-linear relationship with T2DM, with an inflection point value of 0.964. When the AST to ALT ratio was below the threshold (AST/ALT <0.964), AST/ALT was significantly negatively associated with T2DM (HR = 0.177, 95% CI 0.055-0.568; P = 0.0036). In contrast, when AST/ALT >0.964, no significant association was found (HR = 3.174, 95% CI 0.345-29.167; P = 0.3074). Moreover, subgroup analysis showed that GGT could alter the relationship between AST/ALT and T2DM. In the group with GGT ≤ 40, AST/ALT was strongly associated with T2DM (HR = 0.24, 95% CI 0.09-0.66; P = 0.0059).

CONCLUSIONS

These results suggested that there were sex differences in the association between AST/ALT and T2DM in NAFLD participants. A non-linear association between AST/ALT and T2DM was observed in males. AST/ALT in the normal GGT group (GGT ≤40) might better facilitate the early screening of T2DM.

Effects of short-term supervised exercise training on liver fat in adolescents with obesity: a randomized controlled trial

OBJECTIVE

The objective of this study was to quantify the effects of a 4-week, supervised, high-intensity interval training (HIIT) on intrahepatic triglyceride content (IHTG, percentage), cardiorespiratory fitness (CRF), and cardiometabolic markers in adolescents with obesity.

METHODS

A total of 40 adolescents (age 13-18 y, BMI 36.7 ± 5.8 kg/m2 ) at risk for metabolic dysfunction-associated steatotic liver disease (MASLD) based on obesity and elevated Fibroscan measured controlled attenuation parameter (CAP) scores were randomized to HIIT three times a week for 4 weeks (n = 34) or observation (control; n = 6). Liver magnetic resonance imaging proton-density fat-fraction (MRI-PDFF), CAP, oral glucose tolerance test, serum alanine aminotransferase, dual-energy x-ray absorptiometry, and CRF tests were performed before and after intervention. Within- and between-group differences were compared.

RESULTS

A total of 13 (38%) and 4 (66%) children had MASLD by MRI-PDFF (IHTG ≥ 5%) in the HIIT and control groups, respectively. The implemented HIIT protocol had no impact on CRF or IHTG (baseline 5.26%, Δ = -0.31 percentage points, 95% CI: -0.77 to 0.15; p = 0.179), but it decreased the 2-h glucose concentration (baseline 116 mg/dL, Δ = -11 mg/dL; 95% CI: -17.6 to -5.5; p < 0.001). When limiting the analysis to participants with MASLD (n = 17), HIIT decreased IHTG (baseline 8.81%, Δ = -1.05 percentage points, 95% CI: -2.08 to -0.01; p = 0.048). Between-group comparisons were not different.

CONCLUSIONS

The implemented exercise protocol did not reduce IHTG, but it led to modest improvement in markers of cardiometabolic health.

Association between cardiorespiratory fitness level and insulin resistance in adolescents with various obesity categories

BACKGROUND

An association between cardiorespiratory fitness (CRF) and insulin resistance in obese adolescents, especially in those with various obesity categories, has not been systematically studied. There is a lack of knowledge about the effects of CRF on insulin resistance in severely obese adolescents, despite their continuous rise.

AIM

To investigate the association between CRF and insulin resistance in obese adolescents, with special emphasis on severely obese adolescents.

METHODS

We performed a prospective, cross-sectional study that included 200 pubertal adolescents, 10 years to 18 years of age, who were referred to a tertiary care center due to obesity. According to body mass index (BMI), adolescents were classified as mildly obese (BMI 100% to 120% of the 95th percentile for age and sex) or severely obese (BMI ≥ 120% of the 95th percentile for age and sex or ≥ 35 kg/m2, whichever was lower). Participant body composition was assessed by bioelectrical impedance analysis. A homeostatic model assessment of insulin resistance (HOMA-IR) was calculated. Maximal oxygen uptake (VO2max) was determined from submaximal treadmill exercise test. CRF was expressed as VO2max scaled by total body weight (TBW) (mL/min/kg TBW) or by fat free mass (FFM) (mL/min/kg FFM), and then categorized as poor, intermediate, or good, according to VO2max terciles. Data were analyzed by statistical software package SPSS (IBM SPSS Statistics for Windows, Version 24.0). P < 0.05 was considered statistically significant.

RESULTS

A weak negative correlation between CRF and HOMA-IR was found [Spearman's rank correlation coefficient (rs) = -0.28, P < 0.01 for CRFTBW; (rs) = -0.21, P < 0.01 for CRFFFM]. One-way analysis of variance (ANOVA) revealed a significant main effect of CRF on HOMA-IR [F(2200) = 6.840, P = 0.001 for CRFTBW; F(2200) = 3.883, P = 0.022 for CRFFFM]. Subsequent analyses showed that obese adolescents with poor CRF had higher HOMA-IR than obese adolescents with good CRF (P = 0.001 for CRFTBW; P = 0.018 for CRFFFM). Two-way ANOVA with Bonferroni correction confirmed significant effect of interaction of CRF level and obesity category on HOMA-IR [F(2200) = 3.292, P = 0.039 for CRFTBW]. Severely obese adolescents had higher HOMA-IR than those who were mildly obese, with either good or poor CRF. However, HOMA-IR did not differ between severely obese adolescents with good and mildly obese adolescents with poor CRF.

CONCLUSION

CRF is an important determinant of insulin resistance in obese adolescents, regardless of obesity category. Therefore, CRF assessment should be a part of diagnostic procedure, and its improvement should be a therapeutic goal.

What's New in the Treatment of Non-Alcoholic Fatty Liver Disease (NAFLD)

Non-alcoholic fatty liver disease (NAFLD) is a serious health problem due to its high incidence and consequences. In view of the existing controversies, new therapeutic options for NAFLD are still being sought. Therefore, the aim of our review was to evaluate the recently published studies on the treatment of NAFLD patients. We searched for articles in the PubMed database using appropriate terms, including "non-alcoholic fatty liver disease", "nonalcoholic fatty liver disease", "NAFLD", "diet", "treatment", "physical activity", "supplementation", "surgery", "overture" and "guidelines". One hundred forty-eight randomized clinical trials published from January 2020 to November 2022 were used for the final analysis. The results show significant benefits of NAFLD therapy associated with the use of not only the Mediterranean but also other types of diet (including low-calorie ketogenic, high-protein, anti-inflammatory and whole-grain diets), as well as enrichment with selected food products or supplements. Significant benefits in this group of patients are also associated with moderate aerobic physical training. The available therapeutic options indicate, above all, the usefulness of drugs related to weight reduction, as well as the reduction in insulin resistance or lipids level and drugs with anti-inflammatory or antioxidant properties. The usefulness of therapy with dulaglutide and the combination of tofogliflozin with pioglitazone should be emphasized. Based on the results of the latest research, the authors of this article suggest a revision of the therapeutic recommendations for NAFLD patients.

Physical Activity Levels and Sleep in Schoolchildren (6-17) with and without School Sport

There is strong evidence to support the association between daily physical activity and sleep parameters in children and adolescents. Physical activity and outdoor play are favourably associated with most sleep outcomes in school children. The aim is to find out the levels of physical activity and the quality of sleep in Basque schoolchildren aged between six and seventeen and to analyse the possible differences between those who carry out some kind of physical sports activity and those who do not. The sample consisted of 1082 schoolchildren (50.1% male and 49.9% female). Differences between groups were compared using the Mann-Whitney U test (2 samples) and Kruskal-Wallis one-factor ANOVA (k samples). A total of 723 (66.94%) of the participants said they practiced some physical sports activity. The accelerometers obtained significant differences in all levels of physical activity, as well as in sleep efficiency, with higher levels of physical activity (sedentary p = 0.001; light p = 0.017; moderate p = 0.009; vigorous p = 0.001 and moderate-to-vigorous physical activity p = 0.002) and better sleep efficiency (p = 0.002) in those schoolchildren who perform some type of physical sports activity. A significant difference in time spent in sedentary activities was also observed between primary and secondary school pupils of both sexes and regardless of the degree of physical sports activity completion.

Resting and exercise metabolic characteristics in obese children with insulin resistance

Purpose: This study aimed to explore the characteristics of resting energy expenditure (REE) and lipid metabolism during incremental load exercise in obese children and adolescents with insulin resistance (IR) to provide evidence for exercise intervention in obese children and adolescents with IR.

Method: From July 2019 to August 2021, 195 obese children and adolescents aged 13–17 were recruited through a summer camp. The participants were divided into IR (n = 67) and no-IR (without insulin resistance, n = 128) groups and underwent morphology, blood indicators, body composition, and resting energy consumption gas metabolism tests. Thirty participants each were randomly selected from the IR and no-IR groups to carry out the incremental treadmill test.

Results: Significant metabolic differences in resting and exercise duration were found between the IR and no-IR groups. In the resting state, the resting metabolic equivalents (4.33 ± 0.94 ml/min/kg vs. 3.91 ± 0.73 ml/min/kg, p = 0.001) and REE (2464.03 ± 462.29 kcal/d vs. 2143.88 ± 380.07 kcal/d, p &lt; 0.001) in the IR group were significantly higher than in the no-IR group. During exercise, the absolute maximal fat oxidation (0.33 ± 0.07 g/min vs. 0.36 ± 0.09 g/min, p = 0.002) in the IR group was significantly lower than in the no-IR group; maximal fat oxidation intensity (130.9 ± 8.9 bpm vs. 139.9 ± 7.4 bpm, p = 0.040) was significantly lower in the IR group.

Conclusion: Significant resting and exercise metabolic differences were found between obese IR and no-IR children and adolescents. Obese IR children and adolescents have higher REE and lower maximal fat oxidation intensity than obese no-IR children and adolescents.

Advances in metformin for the treatment of non-alcoholic fatty liver disease in children

INTRODUCTION

The increased economic and social burdens for NAFLD worldwide make treating such a disease a significant public health issue. Metformin, a kind of insulin sensitizer generally used to treat type 2 diabetes, has been recently found to have efficacy on children's NAFLD in various areas such as glucolipid metabolism, intestinal bacterial metabolism, oxidative stress, and anti-inflammatory response. This article aims to provide an overview of the possible mechanisms of NAFLD in children and the potential therapeutic application of metformin.

AREAS COVERED

The Cochrane Library, PubMed, Scopus, and EMBASE database was systematically searched on 12 April 2022, using the keywords metformin; non-alcoholic fatty liver disease; and children to identify similar studies. An additional search for recently published research was performed in June 2020.

EXPERT OPINION

Although metformin has been proved to have an excellent therapeutic effect on children's NAFLD; we can still explore its potential impacts and mechanisms from different angles, such as combined medication. At the same time, we should also pay attention to its side effects.

Green space exposure during pregnancy and umbilical cord blood levels of liver enzymes

Evidence has suggested better pregnancy outcomes due to exposure to greenspace; however, the studies on such an association with the level of liver enzymes in the cord blood are still nonexistent. Hence, this study investigated the relationship between exposure to greenspace during the entire pregnancy and gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels in cord blood samples. We selected 150 pregnant women from our pregnancy cohort in Sabzevar, Iran (2018). Greenspace exposure was characterized based on (i) residential distance to green space, (ii) time spent in public/private green spaces, (iii) residential surrounding greenspace, (iv) visual access to greenspace, and (v) number of indoor natural pot plants at home. We developed linear regression models to investigate the adjusted associations of greenspace exposure with enzyme levels. Each one interquartile range (IQR) increase in the residential surrounding greenspace (100 m buffer) was related to a reduction of -12.58 (U/L) (95% CI -22.86, -2.29), -3.35 (U/L) (95% CI -5.50, -1.20), and -0.57 (U/L) (95% CI -1.12, -0.02) in the levels of GGT, AST, and ALT, respectively. Moreover, a similar association was observed for the time the participants spent in green spaces. A decrease in the residential distance to large green spaces was related with lower cord blood levels of AST, ALT, and GGT. Having a window with greenspace view at home was significantly related to lower AST level. The results for the indoor plant pots were not conclusive. Our findings suggested an inverse relationship between greenspace exposure during pregnancy and cord blood levels of liver enzymes. Further studies in other settings and populations are needed to confirm our findings.

Association between alanine aminotransferase as surrogate of fatty liver disease and physical activity and sedentary time in adolescents with obesity

To compare patterns of sedentary (SED) time (more sedentary, SED + vs less sedentary, SED-), moderate to vigorous physical activity (MVPA) time (more active, MVPA + vs less active, MVPA-), and combinations of behaviors (SED-/MVPA + , SED-/MVPA-, SED + /MVPA + , SED + /MVPA-) regarding nonalcoholic fatty liver diseases (NAFLD) markers. This cross-sectional study included 134 subjects (13.4 ± 2.2 years, body mass index (BMI) 98.9 ± 0.7 percentile, 48.5% females) who underwent 24-h/7-day accelerometry, anthropometric, and biochemical markers (alanine aminotransferase (ALT) as first criterion, and aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), AST/ALT ratio as secondary criteria). A subgroup of 39 patients underwent magnetic resonance imaging-liver fat content (MRI-LFC). Hepatic health was better in SED- (lower ALT, GGT, and MRI-LFC (p < 0.05), higher AST/ALT (p < 0.01)) vs SED + and in MVPA + (lower ALT (p < 0.05), higher AST/ALT (p < 0.01)) vs MVPA- groups after adjustment for age, gender, and Tanner stages. SED-/MVPA + group had the best hepatic health. SED-/MVPA- group had lower ALT and GGT and higher AST/ALT (p < 0.05) in comparison with SED + /MVPA + group independently of BMI. SED time was positively associated with biochemical (high ALT, low AST/ALT ratio) and imaging (high MRI-LFC) markers independently of MVPA. MVPA time was associated with biochemical markers (low ALT, high AST/ALT) but these associations were no longer significant after adjustment for SED time.

CONCLUSION

Lower SED time is associated with better hepatic health independently of MVPA. Reducing SED time might be a first step in the management of pediatric obesity NAFLD when increasing MVPA is not possible.

WHAT IS KNOWN

• MVPA and SED times are associated with cardiometabolic risks in youths with obesity. • The relationships between NAFLD markers and concomitant MVPA and SED times have not been studied in this population.

WHAT IS NEW

• Low SED time is associated with healthier liver enzyme profiles and LFC independent of MVPA. • While low SED/high MVPA is the more desirable pattern, low SED/low MVPA pattern would have healthier liver enzyme profile compared with high MVPA/high SED, independent of BMI, suggesting that reducing SED time irrespective of MVPA is needed to optimize liver health.

Association between Physical Activity and Non-Alcoholic Fatty Liver Disease in Adults with Metabolic Syndrome: The FLIPAN Study

Background: A lifestyle with regular PA (physical activity) and Mediterranean diet has benefits on NAFLD (non-alcoholic fatty liver disease) and MetS (metabolic syndrome). Objectives: To assess the association between physical activity and NAFLD in adults with MetS. Design: Cross-sectional study in 155 participants (40−60 years old) from Balearic Islands and Navarra (Spain) with diagnosis of NAFLD and MetS, and BMI (body mass index) between 27 and 40 Kg/m2. Methods: PA level was categorized into two groups according to weekly METs (metabolic equivalents of tasks). PA was assessed using a validated Minnesota questionnaire and accelerometers. MetS parameters were assessed by blood collection analysis and NAFLD by abdominal MRI (magnetic resonance imaging). Results: Participants with high PA showed more energy expenditure and expended more calories than ingested (−143.9 Kcal/day; p < 0.001). PA was a risk factor for AST (aspartate aminotransferase) (adjusted OR: 7.26; 95% CI: 1.79−29.40) and a protective factor for ALT (alanine aminotransferase) (adjusted OR: 0.24; 95% CI: 0.12−0.48), GGT (gamma-glutamyl transferase) (adjusted OR: 0.52; 95% CI: 0.29−0.94) and IFC-NMR (intrahepatic fat content by nuclear magnetic resonance) (adjusted OR: 0.26; 95% CI: 0.12−0.56) when sociodemographic confounders were considered. Conclusions: NAFLD patients with high PA showed more positive relationship on MetS parameters and liver profile (ALT, GGT, IFC-NMR) than subjects with low PA, but not for AST. Difference between calories ingested and expended influenced this relationship.

Low handgrip strength is associated with higher liver enzyme concentrations in US adolescents

BACKGROUND

Increasing evidence highlights the role of muscular strength as a protective factor for cardiometabolic health in adolescents. However, it is not known the relationship between liver enzyme concentrations, liver disease risk factors, and muscular strength among young populations. The aim of this study was to determine the association between muscle strength and liver enzymes and chronic liver disease risk among US adolescents.

METHODS

Data from the NHANES cross-sectional study (2011-2014) was used. A total of 1270 adolescents were included in the final analysis (12-17 years old). Absolute handgrip strength (kg) was normalized according to body composition parameters by body weight [NHSw], whole-body fat [NHSf], and trunk fat [NHSt]).

RESULTS

In boys, handgrip strength was inversely associated with higher values of aspartate aminotransferase (AST) and gamma glutamyl transpeptidase (GGT) for all estimations of muscle strength (NHSw, NHSf, and NHSt) (p < 0.050). Likewise, boys with high and intermediate NHSw, NHSf, and NHSt presented lower AST and GGT than their counterparts with low handgrip strength (p < 0.050).

CONCLUSIONS

Our findings highlight the importance of muscular strength during adolescence since they could help in developing better liver enzyme profiles among adolescent population.

IMPACT

Our research suggests that US adolescents with low handgrip strength have higher values of liver enzymes as well as a higher prevalence of chronic liver disease. These findings are clinically meaningful and highlight the importance of muscular strength during adolescence since they could help in developing better liver enzyme profiles among young populations.

HOMA Index, Vitamin D Levels, Body Composition and Cardiorespiratory Fitness in Juvenile Obesity: Data from the CHILT III Programme, Cologne

Juvenile obesity is associated with insulin resistance, among other comorbidities. In the pathogenesis of insulin-resistance-related diseases, including obesity and diabetes, Vitamin D deficiency is very common. Therefore, the relationship between insulin resistance, body composition, vitamin D level, and cardiorespiratory fitness in obese children and youth were analyzed based on the Children's Health InterventionaL Trial III project, Germany. Data on vitamin D levels and homeostatic model assessment (HOMA) indices were available from 147 participants (52.4% female; 90.5% obese; 12.3 ± 2.3 years, BMI: 30.5 ± 5.2 kg/m², BMI standard deviation score (BMI-SDS): 2.52 ± 0.46). Vitamin D levels correlated negatively with the HOMA index, BMI, BMI-SDS, abdominal circumference, and body fat percentage but positively with relative cardiorespiratory fitness (p < 0.05 in each case). In the backward stepwise linear regression analysis, body fat (in kg; β = 0.403) and vitamin D levels (β = -0.154) explained 21.0% of the variance in the HOMA index. In summary, increased body fat and lower vitamin D levels are associated with increased HOMA indices in overweight and obese children and adolescents. In order to prevent potential negative consequences, including the development of manifest Type 2 diabetes, a healthy lifestyle with a vitamin-D-enriched diet and more time spent outdoors should be promoted.

Simple Method to Predict Insulin Resistance in Children Aged 6-12 Years by Using Machine Learning

BACKGROUND

Due to the increasing insulin resistance (IR) in childhood, rates of diabetes and cardiovascular disease may rise in the future and seriously threaten the healthy development of children. Finding an easy way to predict IR in children can help pediatricians to identify these children in time and intervene appropriately, which is particularly important for practitioners in primary health care.

PATIENTS AND METHODS

Seventeen features from 503 children 6-12 years old were collected. We defined IR by HOMA-IR greater than 3.0, thus classifying children with IR and those without IR. Data were preprocessed by multivariate imputation and oversampling to resolve missing values and data imbalances; then, recursive feature elimination was applied to further select features of interest, and 5 machine learning methods-namely, logistic regression (LR), support vector machine (SVM), random forest (RF), extreme gradient boosting (XGBoost), and gradient boosting with categorical features support (CatBoost)-were used for model training. We tested the trained models on an external test set containing information from 133 children, from which performance metrics were extracted and the optimal model was selected.

RESULTS

After feature selection, the numbers of chosen features for the LR, SVM, RF, XGBoost, and CatBoost models were 6, 9, 10, 14, and 6, respectively. Among them, glucose, waist circumference, and age were chosen as predictors by most of the models. Finally, all 5 models achieved good performance on the external test set. Both XGBoost and CatBoost had the same AUC (0.85), which was highest among those of all models. Their accuracy, sensitivity, precision, and F1 scores were also close, but the specificity of XGBoost reached 0.79, which was significantly higher than that of CatBoost, so XGBoost was chosen as the optimal model.

CONCLUSION

The model developed herein has a good predictive ability for IR in children 6-12 years old and can be clinically applied to help pediatricians identify children with IR in a simple and inexpensive way.

Non-Alcoholic Fatty Liver Disease in Children

Background and Objectives: The prevalence of pediatric non-alcoholic fatty liver disease is increasing. A lot of new data are published regularly. Materials and Methods: Original clinical studies, review articles, and guidelines in children were searched for and the most relevant included in this review. Results: A total of 138 retrieved papers were classified into pathogenesis, epidemiology, diagnosis, and treatment. Pathogenesis is currently explained with the "multi hit hypothesis", with complex interactions of genetic and environmental factors which trigger inflammation in steatotic liver. The prevalence is rising. A diagnosis can be made with laboratory tests, imaging, and liver biopsy after the exclusion of other causes of liver steatosis. The mainstay of treatment is lifestyle modification consisting of dietary intervention and increased physical activity. The progression to liver cirrhosis can occur even in children. Conclusions: Non-alcoholic fatty liver disease in children is a part of a metabolic syndrome in the majority of patients. Due to its complex etiology and high prevalence, multidisciplinary teams, together with public health professionals, should be involved in its treatment.

Body Adiposity, But Not Elements of Objectively Measured Sedentary Behavior or Physical Activity, Is Associated With Circulating Liver Enzymes in Adults With Overweight and Obesity

OBJECTIVE

We studied the associations between accelerometer-measured sedentary behavior (SB) and habitual physical activity (PA) as well as markers of body adiposity and other cardiometabolic risk factors with liver enzymes alanine aminotransferase (ALT), aspartate aminotransferase (AST) and γ-glutamyltransferase (GGT).

METHODS

A total of 144 middle-aged adults (mean age 57 (SD 6.5) years) with overweight or obesity (mean body mass index [BMI] 31.8 [SD 3.9] kg/m²) participated. Different components of SB (sitting, lying) and PA (standing, breaks in SB, daily steps, light PA, moderate-to-vigorous PA and total PA) were measured with validated hip-worn accelerometers for four consecutive weeks (mean 25 days, [SD 4]). Fasting venous blood samples were analysed using standard assays. The associations were examined with Pearson's partial correlation coefficient test and linear mixed model.

RESULTS

Among 102 women and 42 men accelerometer measured SB or the elements of PA were not associated with circulating liver enzymes. When adjusted for age and sex, liver enzymes correlated positively with BMI and waist circumference (WC) (ALT r=0.34, p<0.0001, r=0.41, < 0.0001, AST r=0.17, p=0.049, r=0.26, p=0.002, GGT r=0.29, p=0.0005, r=0.32, p < 0.0001, respectively). SB proportion associated positively with BMI (r=0.21, p=0.008) and WC (r=0.27, p=0.001). Components of PA associated negatively with BMI (MVPA r=-0.23, p=0.005, daily steps r=-0.30, p<0.0001 and breaks in sedentary time r=-0.32, p<0.0001), as well as with WC (breaks in SB r=-0.35, p<0.0001, MVPA r=-0.26, p=0.002, daily steps r=-0.31, p<0.0001, standing time r=-0.27, p=0.001). Liver enzymes associated positively with common cardiometabolic markers such as resting heart rate (ALT; β=0.17, p=0.03, AST; β=0.25, p=0.002, GGT; β=0.23, p=0.004) and systolic/diastolic blood pressure (ALT β=0.20, p=0.01, β=0.22, p=0.005, AST (only diastolic) β=0.23, p=0.006, GGT β=0.19, p=0.02, = 0.23, p=0.004, respectively), fasting insulin (ALT β=0.41, p<0.0001, AST β=0.36, p=0.0003, GGT β=0.20, p=0.04) and insulin resistance index (ALT β=0.42, p<0.0001, AST β=0.36, p=0.0003, GGT β=0.21, p=0.03), even after adjustment with BMI.

CONCLUSIONS

Liver enzymes correlate with body adiposity and appear to cluster with other common cardiometabolic risk factors, even independently of body adiposity. SB and PA appear not to be essential in modulating the levels of circulating liver enzymes.

Associations between Health-Related Physical Fitness and Cardiovascular Disease Risk Factors in Overweight and Obese University Staff

PURPOSE

This cross-sectional study examined the associations between health-related physical fitness (HPF) and cardiovascular disease (CVD) risk factors in overweight and obese university staff.

METHODS

A total of 340 university staff (109 women, mean age 43.1 ± 9.7 years) with overweight (n = 284) and obesity (n = 56) were included. The HPF indicators included skeletal muscle mass index (SMI), body fat percentage (BFP), grip strength (GS), sit-and-reach test (SRT), and vital capacity index (VCI). CVD risk factors were measured, including uric acid (UA), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and glucose (GLU).

RESULTS

BFP, SMI, and GS were positively associated with UA level (β = 0.239, β = 0.159, β = 0.139, p < 0.05). BFP was positively associated with TG and TG/HDL-C levels (β = 0.421, β = 0.259, p < 0.05). GS was positively associated with HDL-C level (β = 0.244, p < 0.05). SRT was negatively associated with GLU level (β = -0.130, p < 0.05).

CONCLUSIONS

In overweight and obese university staff, body composition, muscle strength, and flexibility were associated with CVD risk factors. An HPF test may be a practical nonmedical method to assess CVD risk.