Attenuating effect of vigorous physical activity on the risk for inherited obesity: a study of 47,691 runners

The Interplay of Genetic Predisposition, Circadian Misalignment, and Metabolic Regulation in Obesity

PURPOSE OF REVIEW

This review explores the complex interplay between genetic predispositions to obesity, circadian rhythms, metabolic regulation, and sleep. It highlights how genetic factors underlying obesity exacerbate metabolic dysfunction through circadian misalignment and examines promising interventions to mitigate these effects.

RECENT FINDINGS

Genome-wide association Studies (GWAS) have identified numerous Single Nucleotide Polymorphisms (SNPs) associated with obesity traits, attributing 40-75% heritability to body mass index (BMI). These findings illuminate critical links between genetic obesity, circadian clocks, and metabolic processes. SNPs in clock-related genes influence metabolic pathways, with disruptions in circadian rhythms-driven by poor sleep hygiene or erratic eating patterns-amplifying metabolic dysfunction. Circadian clocks, synchronized with the 24-h light-dark cycle, regulate key metabolic activities, including glucose metabolism, lipid storage, and energy utilization. Genetic mutations or external disruptions, such as irregular sleep or eating habits, can destabilize circadian rhythms, promoting weight gain and metabolic disorders. Circadian misalignment in individuals with genetic predispositions to obesity disrupts the release of key metabolic hormones, such as leptin and insulin, impairing hunger regulation and fat storage. Interventions like time-restricted feeding (TRF) and structured physical activity offer promising strategies to restore circadian harmony, improve metabolic health, and mitigate obesity-related risks.

Physiology and Pathophysiology of Marathon Running: A narrative Review

BACKGROUND

Marathon training and running have many beneficial effects on human health and physical fitness; however, they also pose risks. To date, no comprehensive review regarding both the benefits and risks of marathon running on different organ systems has been published.

MAIN BODY

The aim of this review was to provide a comprehensive review of the benefits and risks of marathon training and racing on different organ systems. A predefined search strategy including keywords (e.g., marathon, cardiovascular system, etc.) and free text search was used. Articles covering running regardless of sex, age, performance level, and event type (e.g., road races, mountain marathons) were considered, whereas articles examining only cycling, triathlon, stress-tests or other sports were excluded. In total, we found 1021 articles in PubMed, Scopus, and Google Scholar, of which 329 studies were included in this review. Overall, marathon training offers several benefits for different organ systems and reduces all-cause mortality. As such, it improves cardiovascular risk factors, leads to favorable cardiac adaptations, enhances lung function, and improves quality of life in chronic kidney disease patients. It also enhances gastrointestinal mobility and reduces the risk of specific tumors such as colorectal cancer and hepatocellular carcinoma. Marathon training enhances bone health and skeletal muscle metabolism. It further positively affects hematopoiesis and cytotoxic abilities of natural killer cells, and may act neuroprotective on a long-term basis. After a marathon, changes in biomarkers suggesting pathological events in certain organ systems such as cardiovascular, renal, gastrointestinal, liver, hematological, immune, musculoskeletal, central nervous, and endocrine systems can often be observed. Mostly, these changes are limited to 1-3 days post-race and usually normalize within a week. Moreover, marathon running poses the risk of serious adverse events such as sudden cardiac death or acute liver failure. Concerning lung function, a decrease after a marathon race was observed. Acute kidney injury, as well as electrolyte imbalances, are relatively common amongst marathon finishers. Many runners complain of gastrointestinal symptoms during or after long-distance running. Many runners suffer from running-related musculoskeletal injuries often impairing performance. A marathon is often accompanied by an acute inflammatory response with transient immunosuppression, making runners susceptible to infections. Also, hormonal alterations such as increased cortisol levels or decreased testosterone levels immediately after a race are observed. Disturbances in sleep patterns are commonly found in marathon runners leading up to or directly after the race.

CONCLUSION

All in all, marathon training is generally safe for human health and individual organ systems. Considering the high popularity of marathon running, these findings supply athletes, coaches, sports scientists, and sports medicine practitioners with practical applications. Further large-scale studies examining long-term effects on the cardiovascular, renal, and other system are needed.

Cardiological Functional Assessment of National Olympic Team of Kazakhstan

Athletes carry an increased risk of cardiovascular (CV) conditions. Due to the relatively high loads and intensity of the training process, athletes' CV systems undergo various adaptations, which can combine in the future and provoke unexpected outcomes. Most CV screening protocols have several successive steps. The aim of our study was to perform a cardiological functional assessment of the National Olympic Team of Kazakhstan via several noninvasive protocols to close the gaps between the approaches and collect solid data for the prevention of sudden cardiac death (SCD) incidence among Kazakhstani athletes.

METHODS

The methods used in this study were 12-lead resting electrocardiography (ECG), echocardiography, cardiointervalography, cardiopulmonary exercise testing (CPET), and HyperQ stress testing.

RESULTS

One case was detected via 12-lead resting ECG. Another case of the slowdown of the heart rate (HR) recovery was detected via cardiointervalography with no clinical signs and normal ECG. The HyperQ stress testing of the women's basketball team detected a positive result in four leads in one athlete.

CONCLUSION

Our results demonstrate that the CV systems of athletes require the implementation of several diagnostic methods in rest and stress conditions for more precise evaluation, with each of the methods fulfilling the whole picture for the prevention of such tragic events as sudden cardiac death and sudden cardiac arrest.

Parenting Styles in Relation to Childhood Obesity, Smoking and Drinking: A Gene-Environment Interaction Study

OBJECTIVES

This study assessed gene-environment interactions linking maternal parenting styles to childhood obesity and alcohol and tobacco use.

METHODS

Data was retrieved from the first wave of the German Twin Family Panel. Participants comprised 3 birth cohorts aged 5, 11, and 17 years, with approximately 500 pairs of same-sex monozygotic twins and 500 pairs of same-sex dizygotic twins per cohort. Self-reported parenting styles were measured in 5 dimensions: emotional warmth, psychological control, negative communication, monitoring, and inconsistent parenting. Outcome variables included children's body mass index z-score (BMIz) and smoking and alcohol drinking frequency. Gene-environment interaction models were used to assess how parenting styles might moderate genetic and environmental influences on BMIz and smoking and drinking behaviors.

RESULTS

A positive interaction of genetic effects with psychological control was found for BMIz at age 5, indicating that genetic influences on BMIz increased with psychological control. No interaction effect was found for BMIz at age 11 and 17. Regarding adolescent smoking, positive interaction between genetic effects and negative communication was found, indicating that genetic influences on smoking increased with negative communication. There was no significant moderating effect of parenting styles on adolescent drinking.

CONCLUSIONS

This study found some preliminary evidence that parenting styles moderated genetic and environmental impacts on body weight status and smoking. Moderation effects of parenting on BMIz were observed only at a very young age. The moderating effects of parenting influenced adolescent smoking but not drinking. This article is protected by copyright. All rights reserved.

Effects of a 6-Week Faroese Chain Dance Programme on Postural Balance, Physical Function, and Health Profile in Elderly Subjects: A Pilot Study

The present pilot study investigates the impact of a Faroese chain dance intervention on health profile, mobility, and postural balance in elderly subjects. Healthy elderly subjects (n=27; age 75 ± 5 yrs) were randomised into an intervention group (IG) and a control group (CG). IG performed twice-weekly sessions of Faroese chain dance over 6 weeks. Dancing sessions lasted 30 min in the initial 3 weeks and 45 min in the final 3 weeks. Health profile was determined before and after intervention by measuring blood pressure, resting heart rate, muscle mass, and body fat content. Postural balance was evaluated using the Berg Balance Scale (BBS) and Fullerton Advanced Balance Scale (FAB) tests, while mobility was assessed using the Short Physical Performance Battery (SPPB), the Timed Up & Go (TUG) test, the 6-min walk test, and the 30-s sit-to-stand test. Systolic and diastolic blood pressure were lowered (9 ± 6 and 6 ± 3 mmHg, respectively) in IG, with a tendency (P=0.07) for a greater change score than in CG. Mean arterial pressure declined (P<0.05) by 7 ± 3 mmHg in IG, which tended (P=0.09) to be greater than in CG. IG improved (P<0.05) on BBS and FAB scores by 3.6 ± 2.1% and 15.8 ± 8.3%, with the change score for FAB being greater (P<0.05) than in CG (0.3 ± 1.6). Moreover, the postintervention SPPB score was improved (P<0.05) more in IG (13.9 ± 7.4%) compared to CG, while performance in the 30-s sit-to-stand, 6-min walk, and TUG tests improved (4–15%; P<0.05) in IG only. Body fat content was reduced (P<0.05) from 36.3 ± 2.8% to 34.8 ± 2.8% in IG, with no between-group differences and no change in CG (34.1 ± 2.8% to 33.7 ± 3.1%). In conclusion, a 6-week Faroese chain dance programme lowers blood pressure and improves postural balance and physical function in elderly.

The Effects of Brain Breaks on Motives of Participation in Physical Activity among Primary School Children in Malaysia

Brain breaks is a physical activity (PA) video designed for school settings that is used to stimulate student's health and learning. The purpose of this study is to measure the effects of brain breaks on motives of participation in PA among primary school children in Malaysia. Purposive sampling was used to divide 159 male and 176 female students aged 10 to 11 years old, mean (standard deviation (SD)) = 10.51 (0.50), from two schools in Kelantan, Malaysia into intervention (n = 183) and control (n = 152) groups. Students undertook brain breaks activities on school days (five minutes per session) spread out for a period of four months. Mixed factorial analysis of variance (ANOVA) was used to test the students' motives of participation in PA for pre-, mid-, and post-tests using the Physical Activity and Leisure Motivation Scale-Youth-Malay (PALMS-Y-M). Mixed factorial ANOVA showed significant changes in enjoyment, F(2, 392) = 8.720, p-value (ηp2) = 0.001 (0.043); competitiveness, F(2, 195) = 4.364, p-value (ηp2) = 0.014 (0.043); appearance, F(2, 392) = 5.709, p-value (ηp2) = 0.004 (0.028); and psychological condition, F(2, 392) = 4.376, p-value (ηp2) = 0.013 (0.022), whereas mastery, affiliation, and physical condition were not significant (p < 0.05). Further post-hoc analysis revealed a significant downward trend in the control group (p < 0.05). Brain breaks is successful in maintaining students' motives for PA in four of the seven factors.

The importance of gene-environment interactions in human obesity

The worldwide obesity epidemic has been mainly attributed to lifestyle changes. However, who becomes obese in an obesity-prone environment is largely determined by genetic factors. In the last 20 years, important progress has been made in the elucidation of the genetic architecture of obesity. In parallel with successful gene identifications, the number of gene-environment interaction (GEI) studies has grown rapidly. This paper reviews the growing body of evidence supporting gene-environment interactions in the field of obesity. Heritability, monogenic and polygenic obesity studies provide converging evidence that obesity-predisposing genes interact with a variety of environmental, lifestyle and treatment exposures. However, some skepticism remains regarding the validity of these studies based on several issues, which include statistical modelling, confounding, low replication rate, underpowered analyses, biological assumptions and measurement precision. What follows in this review includes (1) an introduction to the study of GEI, (2) the evidence of GEI in the field of obesity, (3) an outline of the biological mechanisms that may explain these interaction effects, (4) methodological challenges associated with GEI studies and potential solutions, and (5) future directions of GEI research. Thus far, this growing body of evidence has provided a deeper understanding of GEI influencing obesity and may have tremendous applications in the emerging field of personalized medicine and individualized lifestyle recommendations.

Sudden Cardiac Death in Athletes

There are clear health benefits to exercise; even so, patients with cardiac conditions who engage in exercise and athletic competition may on rare occasion experience sudden cardiac death (SCD). This article reviews the epidemiology and common causes of SCD in specific athlete populations. There is ongoing debate about the optimal mechanism for SCD prevention, specifically regarding the inclusion of the ECG and/or cardiac imaging in routine preparticipation sports evaluation. This controversy and contemporary screening recommendations are also reviewed.

Marathon performance but not BMI affects post-marathon pro-inflammatory and cartilage biomarkers

We tested the hypothesis that changes in serum cartilage oligomeric matrix protein (COMP), tumour necrosis factor α (TNF-α), interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) concentration after regular endurance training and running a marathon race depend on body mass index (BMI) and/or on marathon performance. Blood samples were collected from 45 runners of varying BMI and running experience before and after a 10-week marathon training programme and before, immediately and 24 h after a marathon race. Serum biomarker concentrations, BMI and marathon finishing time were measured. The mean (95% confidence interval (CI)) changes from before to immediately after the marathon were COMP: 4.09 U/L (3.39-4.79 U/L); TNF-α: -1.17 mg/L (-2.58 to 0.25 mg/L); IL-6: 12.0 pg/mL (11.4-12.5 pg/mL); and hsCRP: -0.08 pg/mL (-0.14 to -0.3 pg/mL). The mean (95% CI) changes from immediately after to 24 h after the marathon were COMP: 0.35 U/L (-0.88 to 1.57 U/L); TNF-α: -0.43 mg/L (-0.99 to 0.13 mg/L); IL-6: -9.9 pg/mL (-10.5 to -9.4 pg/mL); and hsCRP: 1.52 pg/mL (1.25-1.79 pg/mL). BMI did not affect changes in biomarker concentrations. Differences in marathon finishing time explained 32% of variability in changes in serum hsCRP and 28% of variability in changes in serum COMP during the 24 h recovery after the marathon race (P < 0.001). Slower marathon finishing time but not a higher BMI modulates increases in pro-inflammatory markers or cartilage markers following a marathon race.

Effects of Running on Chronic Diseases and Cardiovascular and All-Cause Mortality

Considerable evidence has established the link between high levels of physical activity (PA) and all-cause and cardiovascular disease (CVD)-specific mortality. Running is a popular form of vigorous PA that has been associated with better overall survival, but there is debate about the dose-response relationship between running and CVD and all-cause survival. In this review, we specifically reviewed studies published in PubMed since 2000 that included at least 500 runners and 5-year follow-up so as to analyze the relationship between vigorous aerobic PA, specifically running, and major health consequences, especially CVD and all-cause mortality. We also made recommendations on the optimal dose of running associated with protection against CVD and premature mortality, as well as briefly discuss the potential cardiotoxicity of a high dose of aerobic exercise, including running (eg, marathons).

Reproducibility and validity of the myotest for measuring step frequency and ground contact time in recreational runners

The purpose of this study was to assess the reproducibility (test-retest reliability and agreement) and concurrent validity of the Myotest for measuring step frequency (SF) and ground contact time (GCT) in recreational runners. Based on a within-subjects design (test and retest), SF and GCT of 14 participants (11 males, 3 females) were measured at three different running speeds with the Myotest during two test sessions. SF and GCT were also assessed with a foot-mounted accelerometer (Gold Standard, previously validated by comparing to force plate data) during the first test session. Levels of test-retest reliability and concurrent validity were expressed with intraclass correlation coefficients (ICC), agreement with standard errors of measurement (SEM). For SF, test-retest reliability (ICC's > 0.75) and agreement of the Myotest were considered as good at all running speeds. For GCT, test-retest reliability was found to be moderate at a running speed of 14 km/h and poor at speeds of 10 and 12 km/h (ICC < 0.50). Agreement of the Myotest for GCT at all three running speeds was considered not acceptable given the SEM's calculated. Concurrent validity of the Myotest with the foot-mounted accelerometer (Gold Standard) at all three running speeds was found to be good for SF (ICC's > 0.75) and moderate for GCT (0.50 < ICC's < 0.75). The conclusion of our study is that estimates obtained with the Myotest are reproducible and valid for SF but not for GCT.

Motives for adult participation in physical activity: type of activity, age, and gender

Background

In recent years, there has been a decline in physical activity among adults. Motivation has been shown to be a crucial factor in maintaining physical activity. The purpose of this study was to examine whether motives for participation could accurately discriminate gender, age, and type of physical activity.

Methods

A quantitative, cross-sectional descriptive research design was employed. The Physical Activity and Leisure Motivation Scale (PALMS) was used to assess motives for physical activity in 1,360 adults (703 males, 657 females) who had been exercising regularly for at least six months. The PALMS consists of 40 items that constitute eight sub-scales (mastery, enjoyment, psychological condition, physical condition, appearance, others’ expectations, affiliation, competition/ego). Respondents were divided into two age groups (young adults aged 20 to 40 years and middle-aged adults 41 to 64 years) and five types of activity (individual racing sports plus bowls, team sports, racquet sports, martial arts, and exercise).

Results

The group discriminant function analyses revealed significant canonical functions correctly classifying the cases into gender (82%), age group (83%), team sport players 76%, individual racing sport plus bowls players 91%, racquet sport players 90%, exercisers 84%, and martial art players 91%. The competition/ego, appearance, physical condition, and mastery sub-scales contributed most to gender differences. Five sub-scales (mastery, psychological condition, others’ expectations, affiliation, and enjoyment) contributed most to the discriminant function for age. For type of activity, different sub-scales were the strongest contributors to the discriminant function for each type of PA.

Conclusion

The findings in this study suggest that strong and important motives for participation in physical activity are different across type of activity, age, and gender in adults. Understanding the motives that influence physical activity participation is critical for developing interventions to promote higher levels of involvement.

Exercise behavior of ultramarathon runners: baseline findings from the ULTRA study

Little is known about exercise habits of those who compete in foot races longer than the standard 42-km marathon distance. The purpose of this work was to describe the past-year and lifetime exercise patterns of a large cohort of ultramarathon runners. Information on exercise history was collected on 1,345 current and former ultramarathon runners as baseline data for participation in a longitudinal observational study. Median age at the first ultramarathon was 36 years, and the median number of years of regular running before the first ultramarathon was 7 (interquartile range, 3-15). Age at first ultramarathon did not change across the past several decades, but there was evidence of an inverse relationship (r = -0.13, p < 0.0001) between number of years of regular running before the first ultramarathon and calendar year. The active ultramarathon runners (n = 1,212) had a previous year median running distance of 3,347 km, which was minimally related to age (r = -0.068, p = 0.018), but mostly related to their longest ultramarathon competition of the year (p < 0.0001). Running injuries represented the most common reason for discontinuation of regular running, whereas work and family commitments were reported as the main reasons for not running an ultramarathon in the previous year among those who were regularly running and intending to run ultramarathons again. We conclude that runners tend to be well into adulthood and with several years of running experience before running their first ultramarathon, but 25% have only been regularly running for 3 years or less at the time of their first ultramarathon.

Validating the Physical Activity and Leisure Motivation Scale (PALMS)

Background

Although there is abundant evidence to recommend a physically active lifestyle, adult physical activity (PA) levels have declined over the past two decades. In order to understand why this happens, numerous studies have been conducted to uncover the reasons for people’s participation in PA. Often, the measures used were not broad enough to reflect all the reasons for participation in PA. The Physical Activity and Leisure Motivation Scale (PALMS) was created to be a comprehensive tool measuring motives for participating in PA. This 40-item scale related to participation in sport and PA is designed for adolescents and adults. Five items constitute each of the eight sub-scales (mastery, enjoyment, psychological condition, physical condition, appearance, other’s expectations, affiliation, competition/ego) reflecting motives for participation in PA that can be categorized as features of intrinsic and extrinsic motivation based on self-determination theory. The aim of the current study was to validate the PALMS in the cultural context of Malaysia, including to assess how well the PALMS captures the same information as the Recreational Exercise Motivation Measure (REMM).

Method

To do so, 502 Malaysian volunteer participants, aged 18 to 67 years (mean ± SD; 31.55 ± 11.87 years), from a variety of PA categories, including individual sports, team sports, martial arts and exercise, completed the study.

Results

The hypothesized 8-factor model demonstrated a good fit with the data (CMIN/DF = 2.820, NFI = 0.90, CFI = 0.91, RMSEA = 0.06). Cronbach’s alpha coefficient (α = 0.79) indicated good internal consistency for the overall measure. Internal consistency for the PALMS subscales was sound, ranging from 0.78 to 0.82. The correlations between each PALMS sub-scale and the corresponding sub-scale on the validated REMM (the 73-item questionnaire from which the PALMS was developed) were also high and varied from 0.79 to 0.95. Also, test-retest reliability for the questionnaire sub-scales was between 0.78 and 0.94 over a 4-week period.

Conclusions

In this sample, the PALMS demonstrated acceptable factor structure, internal consistency, test-retest reliability, and criterion validity. It was applicable to diverse physical activity contexts.

Exercise as a therapeutic strategy for primary mitochondrial cytopathies

Patients with mitochondrial cytopathies often experience exercise intolerance and may have fixed muscle weakness, leading to impaired functional capacity and lower quality of life. Endurance exercise training increases Vo 2 max, respiratory chain enzyme activity, and improves quality of life. Resistance exercise training increases muscle strength and may lower mutational burden in patients with mitochondrial DNA deletions. Both modes of exercise appear to be well tolerated. Patients with mitochondrial cytopathy should consider alternating both types of exercise to derive the benefits from each (endurance = greater aerobic fitness; resistance = greater strength). Patients should start an exercise program at a low intensity and duration, gradually increasing duration and intensity. They should "listen to their body" and not exercise on days they have fever, superimposed illness, muscle pain, or cramps, and/or if they have fasted for more than 12 hours. Children often respond best to play-based exercise and tend to enjoy intermittent activity.

Prevalence of a characteristic gene profile in high-level rhythmic gymnasts

High-level physical performance in rhythmic gymnastics is influenced by numerous skills and anthropometric factors. In order to understand if genetic predisposition could play a role to define the elite rhythmic gymnast phenotype, we analysed the frequency of common polymorphisms linked to genes correlated with body mass (ADRB2 and FTO), explosive strength (ACTN3 and ACE), and joint mobility (COL5A1), in 42 gymnasts involved in National and International events, and in 42 control girls. Our results demonstrated that high-level rhythmic gymnasts constituted a genetically selected population showing higher frequency of: (a) ADRB2 and FTO alleles linked to low body mass index and low fat mass; (b) COL5A1 CT genotype linked to high joint mobility and to the occurrence of genu recurvatum, but also to a higher incidence of injuries. ACTN3 and ACE polymorphisms did not appear to be connected with the phenotype of high-level rhythmic gymnast. Based on these data, it can be assumed that these polymorphisms could positively affect the phenotype and performance of gymnasts.

Considerations for initiating and progressing running programs in obese individuals

Running has rapidly increased in popularity and elicits numerous health benefits, including weight loss. At present, no practical guidelines are available for obese persons who wish to start a running program. This article is a narrative review of the emerging evidence of the musculoskeletal factors to consider in obese patients who wish to initiate a running program and increase its intensity. Main program goals should include gradual weight loss, avoidance of injury, and enjoyment of the exercise. Pre-emptive strengthening exercises can improve the strength of the foot and ankle, hip abductor, quadriceps, and trunk to help support the joints bearing the loads before starting a running program. Depending on the presence of comorbid joint pain, nonimpact exercise or walking (on a flat surface, on an incline, and at high intensity) can be used to initiate the program. For progression to running, intensity or mileage increases should be slow and consistent to prevent musculoskeletal injury. A stepwise transition to running at a rate not exceeding 5%-10% of weekly mileage or duration is reasonable for this population. Intermittent walk-jog programs are also attractive for persons who are not able to sustain running for a long period. Musculoskeletal pain should neither carry over to the next day nor be increased the day after exercising. Rest days in between running sessions may help prevent overuse injury. Patients who have undergone bariatric surgery and are now lean can also run, but special foci such as hydration and energy replacement must be considered. In summary, obese persons can run for exercise, provided they follow conservative transitions and progression, schedule rest days, and heed onset of pain symptoms.

Differences between men and women in self-reported body mass index and its relation to drug use

Background

Obesity is a public health problem of alarming proportions, including among the university population in Latin America. The purpose of this study was to determine the relation between the self-reported body mass index and the associated drug use and health-risk behaviors.

Methods

We performed a cross-sectional, descriptive study of 3,311 Chilean university students (17–24 years). The variables weight, height, frequency of physical activity, diet quality index, and drug use were evaluated by way of a self-report questionnaire.

Results

16.7% of students were overweight and 2.1% were obese. Higher rates of overweight and obesity were observed in the men compared to women. There was a significant but moderate association between self-perceived obesity and being men and higher age, and just low with greater use of analgesics and tranquilizers with or without a prescription.

Conclusions

The punctual prevalence rates of self-reported obesity, in this sample, are consistent with other Latin American studies. The risk behaviors associated with perceived obesity in terms of gender, particularly the different pattern of drug use, highlight the importance of considering gender when designing strategies to promote health in a university setting.

Gene × environment interactions in obesity: the state of the evidence

BACKGROUND/AIMS

Obesity is a pervasive and highly prevalent disease that poses substantial health risks to those it affects. The rapid emergence of obesity as a global epidemic and the patterns and distributions of the condition within and between populations suggest that interactions between inherited biological factors (e.g. genes) and relevant environmental factors (e.g. diet and physical activity) may underlie the current obesity epidemic.

METHODS

We discuss the rationale for the assertion that gene × lifestyle interactions cause obesity, systematically appraise relevant literature, and consider knowledge gaps future studies might seek to bridge.

RESULTS

We identified >200 relevant studies, of which most are relatively small scale and few provide replication data.

CONCLUSION

Although studies on gene × lifestyle interactions in obesity point toward the presence of such interactions, improved data standardization, appropriate pooling of data and resources, innovative study designs, and the application of powerful statistical methods will be required if translatable examples of gene × lifestyle interactions in obesity are to be identified. Future studies, of which most will be observational, should ideally be accompanied by appropriate replication data and, where possible, by analogous findings from experimental settings where clinically relevant traits (e.g. weight regain and weight cycling) are outcomes.

Non-alcoholic fatty liver disease (NAFLD) is associated with low level of physical activity: a population-based study

BACKGROUND

High intensity exercise improves metabolic status and may potentially mobilise hepatic fat.

AIM

To assess the level of physical activity (PA) of subjects with non-alcoholic fatty liver disease (NAFLD).

METHODS

Data were obtained from NHANES (2003-2006). Activity counts obtained from accelerometer readings (ActiGraph, Fort Walton Beach, FL), from 7 consecutive days quantified total PA and time spent engaged in different levels of activity. All measures were counts/minutes/day: (sedentary <100; light 100-0027; moderate, 2020-5999 and vigorous, 6000+). NAFLD was defined as a fatty liver index >60 (FLI) in the absence of other chronic liver disease. Subjects with NAFLD were compared to controls using stratum-specific Chi-squared and t-tests. Simple linear regression analyses (with Taylor series linearised variance estimation and weighting) were used to determine the association between PA levels and NAFLD. P-values <0.05 were considered significant. Statistical analyses were conducted using sudaan version 10.1 and sas version 9.1.

RESULTS

We included 3056 participants. NAFLD patients were older, had higher BMI, larger waist circumference, higher sum of skinfolds, more likely to have insulin resistance (HOMA > 3.0) and type-2 diabetes (all P-values <0.01). Average PA for NAFLD subjects was about 28.7 counts/minute/day less than controls (P < 0.01). Furthermore, NAFLD subjects spent less time participating in activity at any level (P < 0.01). Subjects with NAFLD and DM were in the lowest quartile of average PA as well as moderate-vigorous PA (P < 0.01).

CONCLUSIONS

Data from this study show that non-alcoholic fatty liver disease patients have low level of physical activity and, when they have diabetes mellitus, they perform at the lowest quartile of physical activity and moderate-vigorous physical activity.