Normal weight obesity and physical fitness in Chinese university students: an overlooked association

Cardiorespiratory fitness and submaximal exercise dynamics in normal-weight obesity and metabolically healthy obesity

PURPOSE

Cardiorespiratory fitness (CRF) is critical for cardiovascular health. Normal-weight obesity (NWO) and metabolically healthy obesity (MHO) may be at increased risk for cardiovascular disease, but a comparison of CRF and submaximal exercise dynamics against rigorously defined low- and high-risk groups is lacking.

METHODS

Four groups (N = 40; 10/group) based on body mass index (BMI), body fat %, and metabolic syndrome (MetS) risk factors were recruited: healthy controls (CON; BMI 18.5-24.9 kg/m2, body fat < 25% [M] or < 35% [F], 0-1 risk factors), NWO (BMI 18.5-24.9 kg/m2, body fat ≥ 25% [M] or ≥ 35% [F]), MHO (BMI > 30 kg/m2, body fat ≥ 25% [M] or ≥ 35% [F], 0-1 risk factors), or metabolically unhealthy obesity (MUO; BMI > 30 kg/m2, body fat ≥ 25% [M] or ≥ 35% [F], 2 + risk factors). All participants completed a V ˙ O2peak test on a cycle ergometer.

RESULTS

V ˙ O2peak was similarly low in NWO (27.0 ± 4.8 mL/kg/min), MHO (25.4 ± 6.7 mL/kg/min) and MUO (24.6 ± 10.0 mL/kg/min) relative to CON (44.2 ± 11.0 mL/kg/min) when normalized to total body mass (p's < 0.01), and adjusting for fat mass or lean mass did not alter these results. This same differential V ˙ O2 pattern was apparent beginning at 25% of the exercise test (PGroup*Time < 0.01).

CONCLUSIONS

NWO and MHO had similar peak and submaximal CRF to MUO, despite some favorable health traits. Our work adds clarity to the notion that excess adiposity hinders CRF across BMI categories.

CLINICALTRIALS

gov registration: NCT05008952.

Exploring the Factors Behind Regional Differences in Physical Fitness of Geological University Students

The intention of this study is to investigate the distribution of physical fitness of the geographical students. The indicators among freshmen at a Chinese geological university and compare their fitness levels with students from other types of institutions. The research revealed that students at higher latitudes exhibited greater physical strength but were less athletic than those at lower latitudes. Spatial dependence on physical fitness was more pronounced in males than in females, particularly for indicators characterizing athletic capacity. Influencing factors such as PM10, air temperature, rainfall, eggs consumption, grain consumption, and GDP which were identified as the major climate, dietary structure, and economic level were examined. Revised：PM10, air temperature and eggs consumption, factors influencing the spatial distribution of male physical fitness across the country. Rainfall, grains consumption and GDP, factors influencing the spatial distribution of female physical fitness across the country. respectively. These factors were found to affect males (42.43%) more than females (25.33%). These findings highlight the significance of regional differences in students' physical fitness levels, with students in geological universities demonstrating better overall physical fitness compared to their counterparts at other schools. Consequently, it is essential to develop tailored physical education strategies for students in various regions, taking into account local economic, climatic, and dietary factors. This study offers a greater explanation of physical fitness disparities between the Chinese university students as well as provides insights for designing effective physical education programs.

Body mass index combined with (waist + hip)/height accurately screened for normal-weight obesity in Chinese young adults

OBJECTIVES

Only a few studies have explored the prevalence of normal-weight obesity in young adults or the development of a simple evaluation index for body fat percentage. Therefore, this study aimed to examine the prevalence of normal-weight obesity in young Chinese adults and use anthropometric measurements to develop an evaluation index.

METHODS

In total, 1322 college students participated in the study and were divided into the normal-weight lean, normal-weight obese, and overweight and obese groups based on their body mass index and body fat percentage. The differences in body composition, circumference, and circumference ratio among these three groups were examined.

RESULTS

When exploring the correlation between the circumference ratio and body fat percentage, the circumference ratio was suitable for early screening of abnormal body fat percentage, and the cutoff value was calculated. Body composition and circumference were significantly different among the three groups: (waist + hip)-to-height, hip-to-height, and waist-to-height ratios were strongly correlated with body fat percentage.

CONCLUSIONS

(Waist + hip)-to-height ratio can be used as a simple evaluation index for indicating abnormal body fat percentage when higher than 1.032 in male and 1.047 in female individuals. Downregulating the normal upper limit for body mass index to 24.4 and 23.8 kg/m² in male and female individuals, respectively, is recommended. Body mass index combined with (waist + hip)-to-height ratio allowed for more accurate screening of normal-weight obesity as an easy and cost-free evaluation measure for abnormal body fat percentage.

Characterization and prevalence of obesity among normal weight college students

Normal weight obesity (NWO) describes individuals who have a normal weight body mass index (BMI), but have an unhealthy amount of body fat. Based on the life-long habits that develop during college, exploring NWO among a college-aged population may be essential in identifying and preventing obesity that develops in early adulthood. This study aimed to characterize NWO among young adults with normal weight BMI. 94 college students (Mean ± SD: Age: 19.6 ± 1.5 yrs; BMI: 21.9 ± 1.8 kg/m²) enrolled during the Fall semester (Aug-Oct) were assessed for body composition by dual energy X-ray absorptiometry to determine body fat percentage, fat mass, lean mass and trunk fat; lifestyle habits were characterized from validated questionnaires. Mean arterial pressure and metabolic biomarkers [total cholesterol, high density lipoproteins, non-high density lipoproteins, and glucose] were evaluated for cardiometabolic health. NWO was defined using data from the National Health and Nutrition Examination Survey (NHANES) for body fat percentage. Data was analyzed by group (NWO vs NWL) and sex. with independent t-tests to investigate continuous data, and chi-square test of independence for categorical data. Rates of NWO for the total sample were 13.8%. Males (n=30) had a higher rate of NWO (26.7%) compared to females (n=64; 7.8%). NWO individuals had higher fat mass (p=0.024), trunk fat (p<0.001), and larger waist to hip ratio (p<0.001) than normal weight lean. NWO also engaged in less vigorous physical activity (p=0.043). The occurrence of NWO among otherwise healthy college students is evident. Identification of these individuals may be an effective component for obesity prevention and treatment. Determining feasible methods to measure body fat in this population is essential, as BMI may mask obesity in a young adult population.

Are Women with Normal-Weight Obesity at Higher Risk for Cardiometabolic Disorders?

OBJECTIVES

This study aimed to evaluate the cardiometabolic abnormalities in women with normal-weight obesity (NWO) in comparison with lean, overweight, and obese women.

METHODS

This cross-sectional study evaluated the assessment of cardiometabolic abnormalities of women with NWO compared to lean, overweight, and obese women. NWO was defined as a BMI < 25 kg.m^-2 and a BFP higher than 30%. Anthropometric variables, cardiometabolic abnormality markers (fasting blood glucose (FBG), blood pressure (BP), lipid profile, insulin resistance, and high-sensitivity C-reactive protein (hs-CRP)), and liver enzymes were also examined.

RESULTS

Significant differences were observed in HDL concentrations between NWO, lean, and obese participants (p < 0.05). There were no significant differences in FBG, insulin resistance, liver enzymes, or cholesterol between groups (p > 0.05). The prevalence of the abnormal metabolic phenotype was higher in NWO compared to the lean group (4.0% and 24.1%, respectively; p < 0.05). Women with type 2 and 3 obesity had abnormal metabolic profiles (60.9% and 73.9%, respectively) compared to NWO participants (p < 0.01). The NWO group had a significantly higher incidence of cardiometabolic abnormalities compared to the lean participants (p < 0.05), while the type 2 and 3 obese individuals had significantly higher incidences compared to the NWO group (p < 0.001 and p < 0.001, respectively).

CONCLUSIONS

Individuals with NWO had a significantly higher incidence of cardiometabolic abnormalities when compared to lean participants. These abnormalities strongly relate to BFP and waist circumferences.

Relationship between body composition and upper limb physical fitness among Chinese students: 4-Year longitudinal follow-up and experimental study

Background: Recently, students' fitness has been declining, and high physical fitness level is crucial in establishing optimal physical/mental health and academic performance. The purpose of this study was to explore the relationship between body composition and upper limb physical fitness and the specific aspects of low physical fitness level in Chinese students. Exploring the development and impact factors for upper limb physical fitness can provide a theoretical basis for the health management strategy of students. Methods: Study 1 collected data from 183 male students over 4 years and used Hierarchical Linear Model (HLM) to explore the quadratic predictive role of body composition on upper limb physical fitness. To further explored which aspects of upper limb physical fitness were affected by body composition, study 2 conducted an experimental investigation among 42 male students, comparing different kinds of upper limb physical fitness within two different body composition groups. Results: Studies found (1) from 2015 to 2018, students' Body-Mass-Index (BMI) showed an upward trend, and BMI differences were significant from year to year. While the upper limb physical fitness showed a downward trend. There were significant differences in the number of pull-outs between 2015 and 2016, 2015 and 2017, and 2015 and 2018. (2) The quadratic term of BMI could predict the upper body physical fitness in the same year and the following year. That is, when BMI was medium, the upper body fitness of the same year and the following year was the best. (3) Chinese students with excellent body composition had greater grip strength, drape height and anaerobic power than those with average body composition. Conclusion: In recent years, male students' BMI has been increasing, and the upper body physical fitness has been decreasing. Furthermore, body composition can predict the upper body mass in the same year and the second year, and male students with better body composition also had greater grip strength, drape height and anaerobic power in their upper limbs.

PECULIARITIES OF PARAMETERS OF AEROBIC AND ANAEROBIC PRODUCTIVITY DEPENDING ON THE COMPONENTS OF BODY WEIGHT IN YOUNG MALES FROM THE MOUNTAINOUS DISTRICTS OF ZAKARPATTIA

OBJECTIVE

The aim: To establish differences in the aerobic and anaerobic capacity in young males with different components of body weight who live in the mountainous districts of Zakarpattia region.

PATIENTS AND METHODS

Materials and methods: 124 young men aged 17-21 were examined to determine the aerobic and anaerobic capabilities of the body, taking into account the components of body weight.

RESULTS

Results: The level of aerobic productivity, which reflects physical health, depends on the component composition of the body. The highest level of aerobic capacity in terms of the VО2 max rel. is found in young males who have normal body weight with a high and a very high relative content of skeletal muscle, a low relative content of fat, and a normal level of visceral fat. As a consequence, their physical health exceeds "safe health level", namely 42 ml∙min-1∙kg-1, and corresponds to "average" according to Ya.P. Piarnat's criteria.

CONCLUSION

Conclusions: A high relative fat content negatively affects the functional capabilities of the body of young males in both aerobic and anaerobic modes of energy supply. With the growth in the relative content of skeletal muscles, the increase of the aerobic capacity of the body, as well as the growth of the capacity of alactic and lactic energy supply processes is observed. None of the examined males had "good" or "excellent" parameters of aerobic processes.

The Association between Sugar-Sweetened Beverages and Male Pattern Hair Loss in Young Men

We performed this study to investigate the association between sugar-sweetened beverage (SSB) consumption and male pattern hair loss (MPHL) in young men. We conducted this cross-sectional study from January to April 2022 in mainland China. Young people aged 18-45 years (n = 1951) were recruited from 31 provinces in China. We used a self-reported online survey for data collection. We explored the associations between the amount/frequency of SSB consumption and MPHL by using a binary logistic regression model, with adjustments for sociodemographic, hair status, dietary intake, lifestyle, and psychological factors. Among the 1028 participants (27.8 ± 7.2 years) in the final analysis, we found that high SSB consumption is associated with a higher risk of MPHL. We recommend more support to decrease SSB consumption among young people to minimize negative health outcomes.

The Association between Body Mass Index and Muscular Fitness in Chinese College Freshmen

(1) Background: The present study aimed to investigate the association between body mass index (BMI) and muscular fitness in Chinese college freshmen. (2) Methods: A total of 6425 college freshmen in mainland China were recruited. BMI was classified as underweight (<18.5 kg/m²), normal weight (18.5~23.9 kg/m²), overweight (24~27.9 kg/m²), and obese (≥28 kg/m²), according to the Working Group on Obesity in China. Health-related physical fitness components including cardiorespiratory fitness, lower body explosive power, upper body muscular endurance, abdominal muscular endurance, flexibility, and vital capacity were assessed. Physical fitness index and muscular fitness index were calculated, respectively, as the sum score of the standardized values (z-score) of the corresponding components. Three regression models were used to evaluate the potential associations: a linear regression model, a polynomial regression model, and a restricted cubic spline regression model. Adjust R square was used to compare among models. (3) Results: Significant differences were observed among different BMI categories in nearly all physical fitness components as well as physical fitness z-score and muscular fitness z-score (p < 0.001), regardless of gender. Significant linear associations were found between BMI and physical fitness z-score as well as muscular fitness z-score among total, male, and female groups (p < 0.05). However, the restricted cubic spline regression model showed a better fitting effect (adjust R² was 7.9%, 11.2%, and 4.8% in total, male, and female for physical fitness and 7.7%, 15.7%, and 4.0%, for muscular fitness, respectively), compared with the linear and polynomial regression models, presented by a higher adjusted R². Restricted cubic splines analysis showed that BMI value and physical fitness z-score showed a non-linear relationship with an approximate inverted U curve in all groups, while an approximate reversed J-shaped association was observed between BMI and muscular fitness z-score in all groups. (4) Conclusions: The present study showed a nonlinear negative relationship between BMI and physical fitness with underweight and overweight/obese college freshmen having poorer physical fitness and muscular fitness than their normal BMI peers, which may provide useful evidence to the development of public health recommendations and encourage the health management of young adults. Future studies should further explore the relationship between BMI and muscular fitness with multi-centered large sample size studies.

Association between Normal Weight Obesity and Skeletal Muscle Mass Index in Female University Students with Past Exercise Habituation

This study investigated the relationship between normal weight obesity (NW-O) and skeletal muscle mass index (SMI) in 120 female university students who participated in sporting activities during junior and senior high school. The current physical activity level (PAL) was estimated by a factorial method using 24-h physical activity recall. The body mass index (BMI) of the participants ranged from 18.5 to 24.9 kg/m2; their body fat (BF) was classified as NW-O if above the 75th percentile (28.9% BF), normal weight and lean (NW-L) if below the 25th percentile value (21.0%BF), and all others were normal weight (NW). PAL was significantly lower in NW-O than in NW-L. SMI was significantly lower in NW-O than in NW and NW-L, and 60% of NW-O had Low-SMI (<6.3 kg/m2). Although lower limb muscle mass was significantly lower in NW-O than in NW and NW-L, no significant differences were found in the upper limbs. These results suggest that the current PAL is associated with NW-O, and NW-O is associated with a lower SMI, even in young females with past exercise habits. Therefore, the prevention of NW-O in young females is important for the prevention of not only lifestyle-related diseases, but also future sarcopenia.

Polymorphism PLIN1 11482 G>A interacts with dietary intake to modulate anthropometric measures and lipid profile in adults with normal-weight obesity syndrome

Evidence shows that genetic polymorphisms in perilipin 1 gene (PLIN1) are associated with excessive accumulation of body fat and disturbances in cardiometabolic markers. Therefore, the aim of this study was to verify whether the SNP PLIN1 11482 G>A (rs894160) interacts with nutrient intake, anthropometric, body composition and cardiometabolic markers in adults with normal-weight obesity (NWO) syndrome. A cross-sectional study was carried out with 116 individuals aged 20-59 years, with normal BMI and high percentage of body fat. Anthropometric and body composition measures, glycaemic control and serum lipid markers, SNP PLIN1 11482 G>A and nutrient intake were evaluated. Interactions between nutrient intake and the SNP were determined by regression models and adjusted for potential confounders. The SNP frequency was 56·0 % GG, 38·8 % GA and 5·2 % AA. Anthropometric measures and biochemical markers were not different according to genotype, except for total cholesterol (TC), LDL-cholesterol and non-HDL-cholesterol concentrations. However, important interactions between the SNP and dietary intake were observed. Carbohydrate intake interacted with the SNP PLIN1 11482 G>A to modulate waist circumference (WC) and the homeostatic model assessment of insulin resistance index. Interaction of lipid intake and the SNP modulated TC and LDL-cholesterol concentrations, and the interaction between protein intake and the SNP tended to modulate weight, WC and BMI. The SNP PLIN1 11482 G>A seems to modulate responses in anthropometric and lipid profile biomarkers of subjects with NWO depending on the dietary macronutrient composition, which may have long-term impact on cardiometabolic markers.

Cardiometabolic risk factors in adults with normal weight obesity: A systematic review and meta-analysis

Normal weight obesity (NWO) is a new emerging phenotype of obesity, defined as a normal body mass index with a high body fat percentage. While several studies have described the impact of NWO on cardiometabolic risk factors, the association between them remains uncertain. This meta-analysis systematically evaluated cardiometabolic risk factors in adults with NWO compared to adults with normal weight lean (NWL). A systematic literature search was performed from the inception until September 21, 2021 in order to comprehensively search for all observational studies that had three important variables, including adults (age ≥18 years old), NWO and cardiometabolic risk factors including metabolic syndrome, hypertension, diabetes mellitus, dyslipidaemia or all laboratory findings related to cardiometabolic risk factors. Twenty-four cross-sectional studies with a total of 75 201 subjects are included in the qualitative and quantitative analysis. Overall, older age and female sex are more likely in NWO population. Compared to NWL, NWO is significantly associated with cardiometabolic risk factors, including metabolic syndrome (OR = 2.24 [1.74, 2.89]; p < .001; I²  = 76%, P_{heterogeneity}  < 0.001), hypertension (OR = 1.60[1.36, 1.89]; p < .001; I²  = 76%, P_{heterogeneity}  < 0.001), diabetes mellitus (OR = 1.72[1.54, 1.92]; p < .001; I²  = 47%, P_{heterogeneity}  < 0.001), dyslipidaemia (OR = 1.50 [1.03, 2.18]; p = .03; I²  = 94%, P_{heterogeneity}  < 0.001) and other laboratory findings, except for C-reactive protein in both sexes group; and adiponectin levels in female group. Our meta-analysis showed that NWO was associated with cardiometabolic risk factors. Thus, the traditional definition of obesity using the BMI criteria should be challenged, as those with NWO might still be exposed to a heightened risk of cardiometabolic disorders. Nonetheless, further prospective cohort studies are needed better to understand this syndrome.

Effects of high-intensity interval training on improving arterial stiffness in Chinese female university students with normal weight obese: a pilot randomized controlled trial

Background

High intensity interval training (HIIT) has been reported to exert better effects on cardiovascular fitness in obesity, but little known about the arterial stiffness (AS) in female university students with normal weight obesity (NWO). Thus, this study aimed to investigate the effects of HIIT on the body composition, heart rate (HR), blood pressure (BP), blood lipids metabolism as well as the novel parameters of propensity for AS (arterial velocity pulse index [AVI], arterial pressure volume index [API]) for female university students with NWO.

Methods

Forty female university students with NWO were randomly assigned to control group (n = 20) and HIIT group (3 bouts of 9‑min intervals at 90% of the maximal heart rate [HR_max], interspersed by 1 min rest, 5 days a week, n = 20). Tests were performed before and after 4 weeks of training. Repeated measures ANOVA and simple effect test analysis were used to analyze dependent variable changes.

Results

After 4 weeks HIIT statistically significantly improved the body composition by decreasing the body mass index, body fat percent, total body fat mass (BFM), BFM of left arm, measured circumference of left arm, and obesity degree, and increasing the total body skeletal muscle mass, protein content, total body water, fat free mass, body cell mas, and InBody score. HIIT also statistically significantly decreased the HR and BP. As for the lipid profile, HIIT obviously ameliorated the blood lipids metabolism by decreasing the levels of total cholesterol (TC), triglyceride, low-density lipoprotein, and TC/HDL, and increasing the levels of high-density lipoprotein (HDL). In addition, the AVI and API were markedly decreased via HIIT intervention.

Conclusions

HIIT produced significant and meaningful benefits for body composition, HR, BP, and blood lipids metabolism, and could decrease AS in female university students with NWO. This suggests that HIIT may effectively reduce the risk of arteriosclerosis and protect the cardiovascular function for female university students with NWO.

Trial registration ChiCTR2100050711. Registered 3 September 2021. Retrospectively registered.

Normal weight obesity and unaddressed cardiometabolic health risk-a narrative review

Normal weight obesity (NWO) is defined as having a normal body mass index (BMI), but a high body fat mass. There is growing interest in individuals with NWO, which is an underdiagnosed and understudied group, because of their increased risk for cardiometabolic morbidity and mortality. In this review, we summarized the definition, prevalence, etiology, pathophysiology, and cardiovascular outcomes seen in NWO. We have also summarized the available literature on interventions for NWO. There is a wide variation in the body fat percent cutoffs used to diagnose excess body fat. Hence, the prevalence rates of NWO vary between different populations and studies. It is estimated that about 30 million Americans have NWO and the worldwide prevalence ranges from 4.5% to 22%. Genetics, diet, and physical activity are related to NWO. However, etiological factors are not clear. Changes in body composition, inflammation, oxidative stress are present in NWO in comparison to normal weight lean (NWL) who have a normal BMI and normal body fat amount. Furthermore, cardiometabolic changes are observed and some are subclinical. Thus, screening for NWO will enhance the primary prevention of cardiovascular disease. Due to the use of various body fat percent cutoffs and methods to measure body fat, it is challenging to compare between studies. Researchers working in this field should ideally work towards developing standard body fat percent cutoffs for diagnosing NWO. There are many gaps in the literature on NWO unlike for overt obesity and future studies should explore the etiology, molecular mechanisms, and adipose tissue changes of NWO as well as conduct well planned and executed randomized controlled trials testing dietary, physical, and behavioral interventions for NWO in both males and females of different racial and age groups.

Characteristics of Body Composition and Lifestyle in Chinese University Students with Normal-Weight Obesity: A Cross-Sectional Study

PURPOSE

Normal weight obesity (NWO), defined as normal body mass index (BMI) and excessive body fat percentage (BF%), has been shown to be associated with a significantly higher risk of developing metabolic syndrome, cardiometabolic dysfunction and with higher mortality. However, there is limited literature regarding the potential associations between NWO and lifestyles. This study aimed to investigate the associations of lifestyles with NWO in Chinese university students.

PARTICIPANTS AND METHODS

A total of 279 university students with normal BMI were recruited and divided into NWO and normal weight non-obesity (NWNO) groups by BF%. Body composition and anthropometrics were measured, and participants were asked to finish the Healthy Lifestyle Scale for University Students (HLSUS) questionnaire.

RESULTS

A total of 26 male (25.5%) and 71 female (40.1%) students were identified as NWO. Compared to NWNO students, body weight, BMI, body fat mass, visceral fat area, waist circumference and hip circumference of NWO students were all significantly higher both in male and female students (P < 0.05). The body fat mass, BF% and visceral fat area were significantly negatively correlated with the total HLSUS, physical exercise behavior, and dietary nutrition behavior scores in NWNO males, NWO and NWNO females (P < 0.05). The risk of NWO was lower in those students with higher scores in physical exercise behavior in both males (OR = 0.298, 95% CI = 0.121~0.733) and females (OR = 0.653, 95% CI = 0.505~0.843), while dietary nutrition behavior (OR = 0.759, 95% CI = 0.584~0.986) and stress management behavior (OR = 0.503, 95% CI = 0.335~0.755) decreased the risk of NWO only in females.

CONCLUSION

The incidence of NWO was high among university students, especially in females, which might be related with unhealthy lifestyles. NWO university students should pay attention to lifestyle adjustments, especially physical exercise, dietary nutrition and stress management, for preventing the health risk in NWO.

Epidemiology of health risk behavior among university students

Introduction: Moderate and vigorous physical activity is essential to maintain proper body composition, to reduce the risk of ischemic heart disease, diabetes, and cancer. In addition, it reduces the risk of stroke, hypertension, and depression. Even so, it is an essential determinant of energy expenditure and, therefore, fundamental for energy balance and weight control. Objective: The objective of this epidemiological study is twofold: to quantify and qualify the physical activity of students at the Federal University of Mato Grosso (UFMT) and to compare the level of physical activity of incoming and graduating students. Methodology: The present study used the National College Health Behavior Survey (NCHRBS) questionnaire adapted and validated for use by Brazilian undergraduate students and addressed only aspects related to physical activity. Of the 18,986 students enrolled on UFMT's 5 campuses, 9,720 students accessed the questionnaire. Of these, 7,379 had their answers validated, corresponding to 75.92% of accesses or 38.87% of the universe studied. Results: This study found differences in the level of physical activity among university students, observing less physical activity on the Rondonópolis campus, less physical activity for students in the areas of Linguistics and Letters, when compared with students from other areas, less physical activity in students females when compared to males and less physical activity among freshmen compared to graduates. Conclusion: The study suggest the need for greater investment in policies to promote physical activity among university students in all areas.

Distribution of body fat is associated with physical performance of male amateur triathlon athletes

BACKGROUND

Endurance sports are strongly associated with maximum oxygen uptake, anaerobic threshold, running economy and body fat percentage. Despite the importance for performance of the low-fat mass being a consensus in the literature, there are no data about the importance of the pattern of fat distribution. Therefore, the aim of the present study was to investigate the association between fat mass distribution with triathlon performance and physiological determinants of performance: maximal oxygen consumption (VO2max), ventilatory threshold (AT) and running economy (RE), and to verify the predictive value for performance of gynoid or android fat mass distribution.

METHODS

Thirty-nine triathletes (38.8±6.9 years, 174.8±6.5cm and 74.3±8.8kg) were evaluated for anthropometric (total body mass, fat mass, lean mass, android and gynoid fat mass) and physiological (VO2max, AT and RE) parameters. Split and overall race times were registered.

RESULTS

Overall race time relationship with gynoid fat mass (r=.529, p<.05) was classified as moderate higher than and with android fat mass (r=.416, p<.05) was classified as low. All split times and overall race time presented significant positive correlation with only total fat mass (%) (r =.329 to .574, p<.05) and with gynoid fat mass (%) (r=.359 to .529, p<.05). Overall race time can be better predicted by gynoid fat mass (ß=0.529, t=4.093, p<0.001, r2=0.28) than by android fat mass (ß =0.416, t=2.997, p=0.005, r2=0.17).

CONCLUSIONS

Fat mass distribution is associated with triathlon performance, and the gynoid fat pattern is worse for triathlon performance than the android pattern.

Sarcopenia prevalence and associated factors among older Chinese population: Findings from the China Health and Retirement Longitudinal Study

Sarcopenia a recognised geriatric syndrome. This study aims to evaluate the prevalence of possible sarcopenia, sarcopenia and severe sarcopenia among older Chinese adults and to identify any associated factors for possible sarcopenia according to the updated diagnostic criteria of the Asian Working Group for Sarcopenia 2019 (AWGS 2019). We used data from the China Health and Retirement Longitudinal Study (CHARLS). The main outcome of this study was possible sarcopenia. Handgrip strength was measured via a dynamometer. The muscle mass was estimated by anthropometric measures. Physical performance was measured by 5-time chair stand test and gait speed test. A multivariate logistic regression model with stepwise method was employed to identify factors associated with possible sarcopenia. A total of 6172 participants aged 60–94 years were included. The prevalence of possible sarcopenia, sarcopenia and severe sarcopenia was 38.5%, 18.6%, and 8.0%, respectively. Age, rural area, falls, higher C-reactive protein (CRP), and chronic diseases (including hypertension, chronic lung diseases, heart disease, psychiatric disease and arthritis) were associated with a higher risk of possible sarcopenia. Conversely, alcohol consumption, higher gait speed and high levels of hemoglobin were associated with decreased risk of possible sarcopenia. However, the associations between possible sarcopenia with alcohol consumption, heart disease, psychiatric disease and hemoglobin were not significant after Bonferroni correction. Our study reported a relatively high prevalence of sarcopenia among older Chinese population, and identified a range of factors associated with sarcopenia. We also found rural elders are more vulnerable to sarcopenia than urban elders. Additionally, we discovered systemic inflammation might be one of the contributing factors between sarcopenia and related comorbidities. We believe the findings of this study would help to identify individuals at high risk of sarcopenia early and therefore implement the prevention and treatment strategies to reduce the disease burden in China.

The Relationship between Locomotive Syndrome Risk, Gait Pattern, and Standing Posture in Young Japanese Women: A Cross-Sectional Study

Young people are also at risk of developing locomotive syndrome for unclear reasons. Therefore, we sought to evaluate the locomotive syndrome risk in young Japanese women and the relationship between standing posture and gait patterns. We used survey materials for physical measurements, locomotive syndrome risk tests, normal and maximum walking test, a standing posture test, and physical activity measures. A questionnaire-based cross-sectional survey was conducted with 100 Japanese female university students. The participants were divided into two groups (high-risk and low-risk groups) based on locomotive syndrome risk tests. The high-risk group accounted for 65.0% of the total participants. The high-risk group had a significantly slower walking speed and lower walking stride length than the low-risk group during maximum walking. Additionally, this high-risk group had a more prone posture than the low-risk group. Furthermore, the low-risk group included more individuals who belonged to middle and high school athletic clubs than the high-risk group. The locomotive syndrome risk was related to the walking pattern, standing posture, and past exercise habits. Therefore, long stride length, correct standing posture, and exercise habits acquired from a young age are important measures for preventing locomotive syndrome in young adults.

Impaired Cardiorespiratory Fitness and Muscle Strength in Children with Normal-Weight Obesity

Despite the health-related implications of normal-weight obesity in children, very little research has explored the fundamental associations between this status and important long-term health parameters. Therefore, the aim of the current study was to investigate the physical fitness of children with normal-weight obesity, in comparison to normal-weight non obese and overweight and obese counterparts. A total of 328 middle-school-aged children (9.8 ± 0.5 y) took part in this study (n = 44 normal-weight obese; n = 237; normal-weight non obese; n = 47 overweight and obese). Height, weight, and body-fatness were measured. Four physical fitness tests were conducted: (1) Multistage fitness test; (2) shuttle run 4 × 10 m; (3) sit-ups for 60 s; (4) the broad jump. Welch’s analysis of variance (ANOVA), stratified by sex, with post-hoc testing where necessary, was performed. Children with normal-weight obesity had significantly (p < 0.01) lower cardio-respiratory and muscular fitness than normal-weight non obese peers. In addition, normal-weight obese and overweight and obese boys had comparable deficits in strength and explosiveness of lower limbs, speed coordination, and endurance, compared to normal-weight non obese counterparts. Normal-weight obese children appear to have similar deficits in PF as their overweight and obese peers, compared to normal-weight non obese counterparts, whilst boys had larger deficits than girls.

Mandatory Physical Education Classes of Two Hours per Week Can Be Comparable to Losing More than Five Kilograms for Chinese College Students

Despite releases of governmental guidelines for promoting physical fitness among the youth in China, the performance of college students in fitness tests has been declining over the past three decades. Obesity and physical inactivity have been proposed as two main causes. However, their relative importance for improving physical fitness remains unclear. To address this knowledge gap, we collected longitudinal data spanning four consecutive years on the physical fitness test for students from Nanjing University, China. Physical education classes of two hours per week were mandatory for the first two years. Using mixed effects models, we quantify the within-subject effects of weight, muscular endurance, sex, and mandatory physical education courses, among other variables, on physical fitness total score. We found that, in spite of the dominance of normal weight among the students, losing weight was positively associated with the total score, with significant sex differences in the associations. Compulsory exercise provided by physical education classes per week had strong positive impacts on the total score, comparable to losing weight of roughly 15-17 kg for males and 5-10 kg for females. Half sex difference in the total score was explained by male students' poor performance in the muscular endurance represented by pull-ups. Our results suggest that college students in China should engage in physical activity of higher levels to improve their physical fitness, with a heightened awareness of extra fat under normal weight and insufficient muscular endurance.

Physical Fitness but Not Diet Quality Distinguishes Lean and Normal Weight Obese Adults

BACKGROUND

Individuals with normal weight obesity (NWO) have increased cardiometabolic disease and mortality risk, but factors contributing to NWO development are unknown.

OBJECTIVE

The objective of this study was to determine whether diet quality scores and physical fitness levels differed between adults classified as lean, NWO, and overweight-obese. Secondary objectives of the study were to compare clinical biomarkers and food groups and macronutrient intakes between the three groups, and to test for associations between body composition components with diet quality scores and physical fitness levels.

DESIGN

This is a secondary data analysis from a cross-sectional study that included metropolitan university and health care system employees. Body composition was measured by dual energy x-ray absorptiometry. Individuals with a body mass index <25 kg/m2 and body fat >23% for men and >30% for women were classified as having NWO. Alternate Healthy Eating Index, Dietary Approaches to Stop Hypertension score, and Mediterranean Diet Score were calculated from Block food frequency questionnaires. Physical fitness was assessed by measuring maximal oxygen uptake (VO2 maximum) during treadmill testing.

PARTICIPANTS/SETTING

This study included 693 adults (65% women, mean age 48.9 ± 11.5 years) enrolled between 2007 and 2013 in Atlanta, GA.

MAIN OUTCOME MEASURES

The main outcome measures were Alternate Healthy Eating Index, Dietary Approaches to Stop Hypertension, and Mediterranean Diet Score diet quality scores and maximal oxygen uptake.

STATISTICAL ANALYSES

Multiple linear regression analyses with post hoc comparisons were used to investigate group differences in fitness, diet quality, and biomarkers. Regression analyses were also used to examine relationships between diet quality scores and fitness with body composition.

RESULTS

VO2 maximum was significantly lower in the NWO compared with the lean group (36.2 ± 0.8 mL/min/kg vs 40.2 ± 1.0 mL/min/kg; P < 0.05). Individuals with NWO reported similar diet quality to lean individuals and more favorable Alternate Healthy Eating Index and Dietary Approaches to Stop Hypertension scores than individuals with overweight-obesity (P < 0.05). Diet quality scores and physical fitness levels were inversely associated with percent body fat and visceral adipose tissue (P < 0.05), regardless of weight status. Individuals with NWO exhibited higher fasting blood insulin concentrations, insulin resistance, low-density lipoprotein cholesterol, and triglyceride levels, and significantly lower high-density lipoprotein cholesterol levels than lean individuals (P < 0.05).

CONCLUSIONS

Physical fitness was significantly decreased in individuals with NWO compared with lean individuals. Higher diet quality was associated with decreased total and visceral fat but did not distinguish individuals with NWO from lean individuals.

Bipedal hopping as a new measure to detect subtle sensorimotor impairment in people with multiple sclerosis

BACKGROUND

Bipedal hopping has the potential to detect subtle multiple sclerosis (MS)-related impairments, especially among patients who "pass" typical movement tests. In this narrative review, we outline the biomechanics of bipedal hopping and propose its usefulness as a novel outcome measure for people with MS having mild disability.

METHODS

We summarize articles that (1) examined the biomechanics of jumping or hopping and (2) tested the validity and/or reliability of hopping tests. We consolidated consistencies and gaps in research and opportunities for future development of the bipedal hop test.

RESULTS

Bipedal hopping requires immense power, coordination, balance, and ability to reduce co-contraction; movement components typically affected by MS. These impairments can be measured and differentiated by examining specific variables, such as hop length (power), symmetry (coordination), center of pressure (balance), and coefficient of variability (co-contraction/spasticity). Bipedal hopping challenges these aspects of movement and exposes sensorimotor impairments that may not have been apparent during walking.

CONCLUSIONS

Testing of bipedal hopping on an instrumented walkway may detect and monitor sensorimotor control in people with MS who do not currently present with clinical deficits. Early measurement is imperative for precise rehabilitation prescription to slow disability progression prior to onset of measurable gait impairment.Implications for rehabilitationJumping and hopping tests detect lower limb and balance impairments in children, athletes, and older adults.Bipedal hop test measures multiple domains: power, coordination, balance, and muscle timing.Bipedal hop test may expose subtle sensorimotor impairments in people with multiple sclerosis.Multiple variables measured can discern type of sensorimotor impairment to direct personalized rehabilitation programs.

Early life high-fat diet exposure evokes normal weight obesity

Obesity is becoming one of the most severe global health problems. However, risk of developing normal weight obesity, where an individual has a high percentage of body fat despite a normal body mass index, is gaining attention since such individuals also develop systemic inflammation and metabolic dysregulation.

In this study, juvenile (3-week-old) and adult (8-week-old) rats were fed a high fat diet (HFD) for 9 weeks and compared them with normal chow diet (NCD) fed rats. The HFD fed adult group showed increase in energy intake, body weight (BW), total fat, visceral fat and subcutaneous fat compared with an age-matched NCD group. In addition, the percentage of muscle mass to BW in the adult HFD group was significantly lower compared with the NCD group. When HFD feeding was started from the juvenile stage, there were almost no differences in energy intake and BW between the HFD and NCD groups. However, the juvenile HFD group showed a 1.7-fold increase in total fat, visceral fat and subcutaneous fat compared with their age-matched NCD group. The percentage of muscle mass to BW was significantly lower in the juvenile HFD group compared with the NCD group. In addition, increased plasma insulin levels and decreased insulin sensitivity was observed only in juvenile HFD group, but not in adult HFD group. These results suggest that HFD feeding in growth period induces insulin resistance and normal weight obesity.

Here we show a method for generating a normal weight obesity model, as well as raising the alarm for developing normal weight obesity when children are exposed to high-fat meals.

Normal-Weight Obesity Is Associated with Poorer Cardiometabolic Profile and Lower Physical Fitness Levels in Children and Adolescents

Normal-weight obesity (NWO) syndrome has been shown to be associated with cardiometabolic dysfunction. However, little is known regarding this potential relationship in Latin American children and adolescents. The aim of this study was two-fold: (i) to investigate whether Colombian youth with NWO syndrome have a poorer cardiometabolic profile and physical fitness performance than normal-weight lean (NWL) peers; and (ii) to determine if physical fitness levels are related to prevalence of normal-weight obesity in youth. This was an analytical cross-sectional study of 1919 youths (9-179 years old, 53.0% girls) in the capital area of Colombia. NWO was defined as a body mass index < 25 kg/m² and a validated body fat percentage above the sex-age-specific 90th percentile for Colombian children and adolescents. Body fat was estimated using bioelectrical impedance analysis, cardiorespiratory fitness (CRF) was estimated using the 20-meter shuttle run test, and muscular fitness with the handgrip test. Biochemical profile blood samples were collected for cardiometabolic risk factors. After adjusting for chronological age, pubertal stage, and Mediterranean diet adherence, the NWO group (boys and girls) had significantly higher values for cardiometabolic risk factors, and waist circumference (WC) than the NWL group. The prevalence of NWO was lower in youth classified with healthy CRF (boys, odds ratio (OR) = 0.54, 95% confidence interval (CI) 0.37 to 0.78; girls, OR = 0.35, 95% CI 0.24 to 0.50), p < 0.001. Our findings indicate that using only body mass index for the assessment of cardiometabolic risk likely misrepresents true adiposity and suggest the need to include the assessment of body fat in the routine clinical evaluation of individuals during childhood and adolescence.

Normal-Weight Obesity Is Associated with Increased Cardiometabolic Risk in Young Adults

Normal-weight obesity (NWO) has been shown to be associated with cardiometabolic dysfunction. However, little is known regarding this potential relationship in early adulthood. The aim of this study was to investigate the associations between NWO and cardiometabolic risk factors in a large population of Colombian young adults. A cross-sectional study was conducted on 1354 subjects (61% women), aged from 18 to 30. Anthropometric data, including body mass index (BMI) and waist circumference (WC), were estimated, and the percentage of fat mass was measured through bioelectrical impedance analysis (BIA). Muscular fitness was determined by using a handgrip strength test and normalized grip strength (NGS = handgrip (kg)/body mass (kg)). A cardiometabolic risk Z-score was derived by assessing WC, triglycerides, high-density lipoprotein cholesterol (HDL-C) cholesterol, fasting glucose, and systolic blood pressure. NWO was defined by the combination of excess %BF (over 25.5% for men and 38.9% for women) and a BMI < 25 kg/m². The overall prevalence of NWO was 29.1%. Subjects with NWO have an increased risk of cardiometabolic risk compared to the normal-weight lean group (OR = 3.10). Moreover, NWO was associated with an increased risk of presenting low HDL-C (OR = 2.34), high abdominal obesity (OR = 7.27), and low NGS (OR = 3.30), p < 0.001. There is a high prevalence of NWO in American Latin young adults and this condition is associated with an increased cardiovascular risk, high blood pressure, low HDL-C, high abdominal obesity, and low muscular strength early in life. Screening for adiposity in subjects with a normal BMI could help to identify young adults at a high risk of cardiometabolic abnormalities.

Physical fitness and nutritional status in female adolescents with anorexia nervosa

ABSTRACT Objective This study aimed to determine whether physical fitness is related to nutritional status in a sample of female adolescents with anorexia nervosa, to contrast the nourished and undernourished patients, and to compare the physical fitness in these patients with normative data of healthy subjects stratified by age and gender. Methods Nutritional status was determined using the body mass index Z-score, fat mass, fat-free mass (bioelectrical impedance analysis), and the Controlling Nutritional Status score in 15 anorexic adolescents with 14.3±1.6 years. Physical fitness was assessed using the ALPHA-Fitness Battery (handgrip strength, standing broad jump, 4x10m shuttle run, and 20m shuttle run tests). Results Handgrip strength was significantly associated with all variables of nutritional status, except with the three blood components of the Controlling Nutritional Status score. The undernourished anorexic patients showed significantly worse physical fitness than the nourished anorexic patients in all tests, except in the standing broad jump and the 4x10m shuttle run tests. The physical fitness tests of the female anorexic adolescents showed scores significantly worse than those of the normative European female adolescent population. Conclusion The observation of female adolescents with anorexia nervosa showed associations between higher physical fitness levels and better nutritional statuses. Handgrip strength and 20m shuttle run tests may be options of additional indicators of undernutrition in anorexic female adolescents. The undernourished anorexic patients showed worse physical fitness than the nourished ones. According to normative data for healthy sex- and agematched adolescents, physical fitness is severely impaired in anorexic female adolescents.

Characteristics of Physical Fitness and Cardiometabolic Risk in Chinese University Students with Normal-Weight Obesity: A Cross-Sectional Study

PURPOSE

To (i) describe the characteristics of physical fitness and cardiometabolic risk in Chinese university students with normal-weight obesity (NWO); (ii) assess the association between NWO with physical fitness and cardiometabolic risk.

METHODS

A total of 249 participants from the 2018 Shanghai University of Sport Alumni Health Cohort Study in China formed the study cohort. NWO was defined as normal body mass index (17.9-23.9 kg/m² for males; 17.2-23.9 kg/m² for females) but with excess body-fat percentage (≥20% for males; ≥30% for females). Body composition was assessed by dual-energy X-ray absorptiometry. Physical-fitness scores were calculated from a battery of sex-specific tests. Cardiometabolic risk was calculated using a continuous clustered risk (MetS) score.

RESULTS

We found that 16.7% of male and 45.3% of female university students were classified as having NWO. Participants with NWO showed worse cardiorespiratory fitness than those with normal weight (NW) (male NWO (37±8) vs male NW (41±6) mL/kg/min, p<0.01; female NWO (31±4) vs female NW (33±6) mL/kg/min, p<0.01). NWO was associated negatively with the fitness score (OR = 0.853; 95% CI = 0.793-0.917) and was associated positively with the MetS score (1.280; 1.162-1.410).

CONCLUSION

University students with NWO were characterized by higher cardiometabolic risk and lower levels of physical fitness. Our findings implied that university students with NWO should be mindful of the potential hidden health risks of excess body fat and participate in exercise to enhance physical fitness.

Normal Weight Obesity: An Underrecognized Problem in Individuals of South Asian Descent

PURPOSE

Obesity has attained pandemic proportions across the world, and its prevalence in developing countries is also on the rise. Nevertheless, there is still a large gap in understanding the reasons behind a disproportionately high prevalence of diabetes as opposed to a lesser degree of obesity seen in individuals of South Asian origin. This research letter highlights the importance of identifying individuals with normal weight obesity, which may partially bridge this knowledge gap.

METHODS

We reviewed recently published evidence on normal weight obesity.

FINDINGS

Normal weight obesity is a common public health problem and may be prevalent in up to one-third of individuals of certain Asian ethnicities. Literature is emerging on its pathophysiology and association with metabolic diseases, such as type 2 diabetes mellitus, hypertension, and dyslipidemia. More recently, normal weight obesity was also identified as an independent strong predictor of cardiovascular mortality. However, evidence is particularly lacking on its appropriate management.

IMPLICATIONS

Normal weight obesity is an underrecognized yet widely prevalent problem in individuals of Asian descent. Further research on pathogenic mechanisms, diagnostic modalities, and therapeutic options in individuals with normal weight obesity is needed to appropriately manage this condition.

Role of physical performance measures for identifying functional disability among Chinese older adults: Data from the China Health and Retirement Longitudinal Study

Background

Functional disability is a common health burden in older adults and follows a hierarchical pattern. Physical performance measures are useful for the objective estimation of functional disability. This study primarily aimed to compare the validity of handgrip strength and gait speed, alone and in combination, for recognizing the functional disability among Chinese older adults. This study also aimed to stratify the functional disability according to the criterion-referenced values of handgrip strength and gait speed.

Methods

We selected 6127 respondents from the 2011 wave of the China Health and Retirement Longitudinal Study. Here, we defined functional disability as needing any help in any items of activities of daily living (ADL) and instrumental activities of daily living (IADL). To assess the validity of physical performance measures alone and in combination for the recognition of functional disability, we conducted the receiver operating characteristic analysis.

Results

Compared with handgrip strength, the gait speed could better discriminate ADL disability and showed a satisfactory discriminant validity (area under the curve ≥ 0.7) in men. However, this finding was not found in the recognition of IADL disability. When combining these two measures, the parallel test showed a high sensitivity with a poor specificity, whereas the serial test showed a perfect specificity with a poor sensitivity.

Conclusion

We developed the hierarchical cut-off values of handgrip strength and gait speed for identifying and stratifying the functional disability among Chinese adults over 60 years old. The speed test was superior to handgrip strength in identifying ADL disability. The parallel tests of those with high sensitivity perhaps could help identify the functional disability. Further work on cost-utility analysis is warranted.

Tracking Changes of Chinese Pre-Service Teachers' Aerobic Fitness, Body Mass Index, and Grade Point Average Over 4-years of College

Although increasing attention has been given to student academic achievement, usually measured by grade point average (GPA), and fitness in children and adolescents, much fewer studies have been conducted in higher education settings, especially in China. This study investigated the longitudinal associations of aerobic fitness (AF), body mass index (BMI), and GPA in Chinese pre-service teachers at a university. A longitudinal research design was employed to track changes in AF, BMI, and GPA, for a total of 1980 students for four years. Multi-level growth models were used to examine the interactive changes of the above three variables. It was found that GPA and BMI increased each year, while AF declined dramatically at the fourth year. The three-way interaction among GPA, gender, and BMI was significant, suggesting females who were overweight/obese had lower GPA. The data from the current study suggested that AF did not impact students' GPA. Class standing (i.e., the fourth year) and gender (i.e., females) need to be taken into consideration when designing interventions to improve student overall fitness and academic performance in Chinese pre-service teacher populations.