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Steiman De Visser H, Fast I, Brunton N, Arevalo E, Askin N, Rabbani R, Abou-Setta AM, McGavock J. Cardiorespiratory Fitness and Physical Activity in Pediatric Diabetes: A Systemic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e240235. [PMID: 38393727 PMCID: PMC10891480 DOI: 10.1001/jamanetworkopen.2024.0235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/22/2023] [Indexed: 02/25/2024] Open
Abstract
Importance It is unclear whether cardiorespiratory fitness (CRF) and physical activity are lower among youths with type 1 diabetes (T1D) and type 2 diabetes (T2D) compared with youths without diabetes. Objective To describe the magnitude, precision, and constancy of the differences in CRF and physical activity among youths with and without diabetes. Data Sources MEDLINE, Embase, CINAHL, and SPORTDiscus were searched from January 1, 2000, to May 1, 2022, for eligible studies. Study Selection Observational studies with measures of CRF and physical activity in children and adolescents aged 18 years or younger with T1D or T2D and a control group were included. Data Extraction and Synthesis Data extraction was completed by 2 independent reviewers. A random-effects meta-analysis model was used to estimate differences in main outcomes. The pooled effect estimate was measured as standardized mean differences (SMDs) with 95% CIs. The Preferred Reporting Items for Systematic Review and Meta-Analyses guideline was followed. Main Outcomes and Measures The main outcomes were objectively measured CRF obtained from a graded maximal exercise test and subjective or objective measures of physical activity. Subgroup analyses were performed for weight status and measurement type for outcome measures. Results Of 7857 unique citations retrieved, 9 studies (755 participants) with measures of CRF and 9 studies (1233 participants) with measures of physical activity for youths with T2D were included; for youths with T1D, 23 studies with measures of CRF (2082 participants) and 36 studies with measures of PA (12 196 participants) were included. Random-effects models revealed that directly measured CRF was lower in youths with T2D (SMD, -1.06; 95% CI, -1.57 to -0.56; I2 = 84%; 9 studies; 755 participants) and in youths with T1D (SMD, -0.39; 95% CI, -0.70 to -0.09; I2 = 89%; 22 studies; 2082 participants) compared with controls. Random-effects models revealed that daily physical activity was marginally lower in youths with T1D (SMD, -0.29; 95% CI, -0.46 to -0.11; I2 = 89%; 31 studies; 12 196 participants) but not different among youths with T2D (SMD, -0.56; 95% CI, -1.28 to 0.16; I2 = 91%; 9 studies; 1233 participants) compared with controls. When analyses were restricted to studies with objective measures, physical activity was significantly lower in youths with T2D (SMD, -0.71; 95% CI, -1.36 to -0.05; I2 = 23%; 3 studies; 332 participants) and T1D (SMD, -0.67; 95% CI, -1.17 to -0.17; I2 = 93%; 12 studies; 1357 participants) compared with controls. Conclusions and Relevance These findings suggest that deficits in CRF may be larger and more consistent in youths with T2D compared with youths with T1D, suggesting an increased risk for cardiovascular disease-related morbidity in adolescents with diabetes, particularly among those with T2D. The findings reinforce calls for novel interventions to empower youths living with diabetes to engage in regular physical activity and increase their CRF.
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Affiliation(s)
| | - Isaak Fast
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicole Brunton
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Edward Arevalo
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicole Askin
- Neil John MacLean Library, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rasheda Rabbani
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ahmed M. Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jonathan McGavock
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Research Theme, Winnipeg, Manitoba, Canada
- Diabetes Action Canada, Toronto, Ontario, Canada
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Mainous 3rd AG, Essa JR, Sauer S, Bennett R, Keck S, Jo A. The Daily Mile: The Impact of an Elementary School-Based Exercise Program on Pulmonary Function. Fam Med 2023; 55:677-679. [PMID: 37540535 PMCID: PMC10741716 DOI: 10.22454/fammed.2023.976789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Implementing a structured activity to encourage exercise in children may be a strategy with benefits. We evaluated pulmonary function in elementary school children participating in a school-based exercise program called The Daily Mile. METHODS During the fall semester, we implemented The Daily Mile program in one elementary school and compared pulmonary function in children in the intervention school pre- and postintervention to children in a control school in the same community. The primary outcomes were forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1% (the FEV1/FVC ratio). RESULTS The children in the control school showed no significant change in FEV1% during the semester (P=.06). On the other hand, children in the intervention school showed a significant improvement in FEV1% during the same semester (P=.001). This effect was consistent even when stratifying by asthma and sports participation. CONCLUSIONS The Daily Mile has benefits for pulmonary function in children. Although family physicians should continue to encourage their patients to have a healthy lifestyle, a more effective approach may be to encourage schools to adopt a program that teachers oversee and administer in a structured way.
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Affiliation(s)
- Arch G. Mainous 3rd
- Department of Community Health and Family Medicine, University of FloridaGainesville, FL
- Department of Health Services Research, Management and Policy, University of FloridaGainesville, FL
| | - Jasmine R. Essa
- Department of Health Services Research, Management and Policy, University of FloridaGainesville, FL
| | - Sean Sauer
- Department of Health Services Research, Management and Policy, University of FloridaGainesville, FL
| | - Rachel Bennett
- Department of Health Services Research, Management and Policy, University of FloridaGainesville, FL
| | - Sean Keck
- Department of Community Health and Family Medicine, University of FloridaGainesville, FL
| | - Ara Jo
- Department of Health Services Research, Management and Policy, University of FloridaGainesville, FL
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Stoepker P, Biber D, Davis A, Welk GJ, Meyer A. Contextualizing Adolescent Female Physical Activity Behavior: A Descriptive Study. Int J Environ Res Public Health 2023; 20:3125. [PMID: 36833821 PMCID: PMC9960919 DOI: 10.3390/ijerph20043125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
Physical activity (PA) behavior tends to decline as youth get older, especially in female adolescents. The purpose of this study was to develop an understanding of female adolescent moderate-to-vigorous physical activity (MVPA) behavior. Baseline MVPA data was collected during year one of a female-specific PA related program. The Youth Activity Profile was administered to contextualize current middle school female PA levels. Data were collected on over 600 6th-8th grade youths with even distributions by grade. No significant differences between grade, race/ethnicity, and MVPA minutes were found. The average estimated value for daily MVPA across all grades was 43.93 (+/-12.97) min, which is considerably lower than the public health recommendation of 60 min per days. Similar amounts were observed for weekend days 45.03 (+/-19.98) and weekdays 45.50 (+/-13.14); however, allocations were smaller during school (9.45 +/- 5.13 min) than at home (34.04 +/- 11.15). The findings from this study highlight the need for further investigation in developing sustainable and innovative PA interventions that target adolescent females.
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Affiliation(s)
- Peter Stoepker
- Department of Kinesiology, Kansas State University, Manhattan, KS 66506, USA
| | - Duke Biber
- Department of Health Promotion & Physical Education, Kennesaw State University, Kennesaw, GA 30144, USA
| | - Ashlee Davis
- Department of Sport Management, Wellness, & Physical Education, University of West Georgia, Carrollton, GA 75006, USA
| | - Gregory J. Welk
- Department of Kinesiology, Iowa State University, Ames, IA 50011, USA
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Salama M, Biggs BK, Creo A, Prissel R, Al Nofal A, Kumar S. Adolescents with Type 2 Diabetes: Overcoming Barriers to Effective Weight Management. Diabetes Metab Syndr Obes 2023; 16:693-711. [PMID: 36923685 PMCID: PMC10010139 DOI: 10.2147/dmso.s365829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/09/2023] [Indexed: 03/12/2023] Open
Abstract
The prevalence of type 2 diabetes (T2DM) among children and adolescents has remarkably increased in the last two decades, particularly among ethnic minorities. Management of T2DM is challenging in the adolescent population due to a constellation of factors, including biological, socioeconomic, cultural, and psychological barriers. Weight reduction is an essential component in management of T2DM as weight loss is associated with improvement in insulin sensitivity and glycemic status. A family centered and culturally appropriate approach offered by a multidisciplinary team is crucial to address the biological, psychosocial, cultural, and financial barriers to weight management in youth with T2DM. Lifestyle interventions and pharmacotherapy have shown modest efficacy in achieving weight reduction in adolescents with T2DM. Bariatric surgery is associated with excellent weight reduction and remission of T2DM in youth. Emerging therapies for weight reduction in youth include digital technologies, newer GLP-1 agonists and endoscopic procedures.
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Affiliation(s)
- Mostafa Salama
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bridget K Biggs
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Ana Creo
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rose Prissel
- Division of Endocrinology and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Alaa Al Nofal
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Seema Kumar
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
- Correspondence: Seema Kumar, Email
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5
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Broadney MM, Belcher BR, Ghane N, Sheni R, Jayson MJ, Trenschel RW, Collins SM, Brychta RJ, Davis EK, Brady SM, Yang SB, Courville AB, Smith KP, Rosing DR, Chen KY, Yanovski JA. Effects of interrupting daily sedentary behavior on children's glucose metabolism: A 6-day randomized controlled trial. Pediatr Diabetes 2022; 23:1567-1578. [PMID: 36205036 PMCID: PMC9772039 DOI: 10.1111/pedi.13430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/14/2022] [Accepted: 10/02/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Metabolic disease risk in youth is influenced by sedentary behaviors. Acute in-lab studies show that, during a single day, interrupting a sedentary period with short bouts of physical activity improves glucometabolic outcomes. OBJECTIVE To determine if acutely improved glucose metabolism persists after multi-day interruptions of sitting with walking brief bouts. We hypothesized that children who underwent interrupting sitting on multiple days would demonstrate lower insulin area under the curve during an oral glucose tolerance test compared to uninterrupted sitting. METHODS Healthy, normoglycemic children (N = 109) ages 7-11 years were randomized to one of two conditions: Control (3 h of daily Uninterrupted Sitting) or Interrupted Sitting (3-min of moderate-intensity walking every 30 min for 3 h daily); with dietary intake controlled through provision of foodstuffs for the entire experiment. Participants attended six consecutive daily visits at a research ambulatory unit. The primary outcome was insulin area under the curve during the oral glucose tolerance test on day 6 during interrupted or uninterrupted sitting; secondary outcomes included glucose and c-peptide area under the curve, energy intake at a buffet meal on day 6, and free-living activity. RESULTS Among 93 children (42 uninterrupted sitting, 51 interrupted sitting), daily interrupted sitting resulted in 21% lower insulin (β = 0.102 CI:0.032-0.172, p = 0.005) and a 10% lower C-peptide (β = 0.043, CI:0.001-0.084, p = 0.045) area under the curve. Matsuda and Glucose Effectiveness Indices were also improved (p's < 0.05). There were no group differences in energy intake or expenditure. CONCLUSIONS Sustained behavioral change by interrupting sedentary behaviors is a promising intervention strategy for improving metabolic risk in children.
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Affiliation(s)
- Miranda M. Broadney
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA,Current address: Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Britni R. Belcher
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Bethesda, MD, USA,Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Nejla Ghane
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Risha Sheni
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Michael J. Jayson
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Robert W. Trenschel
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Shavonne M. Collins
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Robert J. Brychta
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Elisabeth K. Davis
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Sheila M. Brady
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Shanna B. Yang
- Nutrition Department, Hatfield Clinical Center, Bethesda, MD, USA
| | - Amber B. Courville
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA,Nutrition Department, Hatfield Clinical Center, Bethesda, MD, USA
| | - Kevin P. Smith
- Nursing Department, Hatfield Clinical Center, Bethesda, MD, USA,Cardiovascular Branch, National Heart Lung and Blood Institute, National Institutes of Health, USA
| | - Douglas R. Rosing
- Cardiovascular Branch, National Heart Lung and Blood Institute, National Institutes of Health, USA
| | - Kong Y. Chen
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Jack A. Yanovski
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
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6
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Magge SN, Wolf RM, Pyle L, Brown EA, Benavides VC, Bianco ME, Chao LC, Cymbaluk A, Balikcioglu PG, Halpin K, Hsia DS, Huerta-Saenz L, Kim JJ, Kumar S, Levitt Katz LE, Marks BE, Neyman A, O'Sullivan KL, Pillai SS, Shah AS, Shoemaker AH, Siddiqui JAW, Srinivasan S, Thomas IH, Tryggestad JB, Yousif MF, Kelsey MM. The Coronavirus Disease 2019 Pandemic is Associated with a Substantial Rise in Frequency and Severity of Presentation of Youth-Onset Type 2 Diabetes. J Pediatr 2022; 251:51-59.e2. [PMID: 35985535 PMCID: PMC9383958 DOI: 10.1016/j.jpeds.2022.08.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/31/2022] [Accepted: 08/10/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To evaluate the frequency and severity of new cases of youth-onset type 2 diabetes in the US during the first year of the pandemic compared with the mean of the previous 2 years. STUDY DESIGN Multicenter (n = 24 centers), hospital-based, retrospective chart review. Youth aged ≤21 years with newly diagnosed type 2 diabetes between March 2018 and February 2021, body mass index ≥85th percentile, and negative pancreatic autoantibodies were included. Demographic and clinical data, including case numbers and frequency of metabolic decompensation, were compared between groups. RESULTS A total of 3113 youth (mean [SD] 14.4 [2.4] years, 50.5% female, 40.4% Hispanic, 32.7% Black, 14.5% non-Hispanic White) were assessed. New cases of type 2 diabetes increased by 77.2% in the year during the pandemic (n = 1463) compared with the mean of the previous 2 years, 2019 (n = 886) and 2018 (n = 765). The likelihood of presenting with metabolic decompensation and severe diabetic ketoacidosis also increased significantly during the pandemic. CONCLUSIONS The burden of newly diagnosed youth-onset type 2 diabetes increased significantly during the coronavirus disease 2019 pandemic, resulting in enormous strain on pediatric diabetes health care providers, patients, and families. Whether the increase was caused by coronavirus disease 2019 infection, or just associated with environmental changes and stressors during the pandemic is unclear. Further studies are needed to determine whether this rise is limited to the US and whether it will persist over time.
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Affiliation(s)
- Sheela N Magge
- Division of Pediatric Endocrinology and Diabetes, Johns Hopkins Hospital/Johns Hopkins University School of Medicine, Baltimore, MD
| | - Risa M Wolf
- Division of Pediatric Endocrinology and Diabetes, Johns Hopkins Hospital/Johns Hopkins University School of Medicine, Baltimore, MD
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Anschutz Medical Campus/Children's Hospital Colorado, Aurora, CO
| | - Elizabeth A Brown
- Division of Pediatric Endocrinology and Diabetes, Johns Hopkins Hospital/Johns Hopkins University School of Medicine, Baltimore, MD
| | - Valeria C Benavides
- Department of Pediatrics, Division of Endocrinology, University of Illinois, College of Medicine of Peoria/Children's Hospital of Illinois, Peoria, IL
| | - Monica E Bianco
- Department of Pediatrics, Division of Pediatric Endocrinology, Northwestern University/Ann and Robert H Lurie Children's Hospital, Chicago, IL
| | - Lily C Chao
- Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA
| | - Anna Cymbaluk
- Department of Pediatric Diabetes and Endocrinology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Pinar Gumus Balikcioglu
- Division of Pediatric Endocrinology and Diabetes and Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC
| | - Kelsee Halpin
- Division of Endocrinology and Diabetes, University of Missouri-Kansas City School of Medicine, Children's Mercy Kansas City, Kansas City, MO
| | - Daniel S Hsia
- Our Lady of the Lake Children's Hospital/Pennington Biomedical Research Center, Baton Rouge, LA
| | - Lina Huerta-Saenz
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Penn State Health Children's Hospital/Penn State College of Medicine, Hershey, PA
| | - Jane J Kim
- Department of Pediatrics, Division of Pediatric Endocrinology, University of California San Diego/Rady Children's Hospital San Diego, San Diego, CA
| | - Seema Kumar
- Department of Pediatrics, Division of Pediatric Endocrinology, Mayo Clinic, Rochester, MN
| | - Lorraine E Levitt Katz
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Brynn E Marks
- Division of Endocrinology and Diabetes, Children's National Hospital, Washington DC
| | - Anna Neyman
- Department of Pediatrics, Indiana University School of Medicine/Riley Hospital for Children, Indianapolis, IN
| | - Katie L O'Sullivan
- Section of Adult & Pediatric Endocrinology, Diabetes & Metabolism, University of Chicago Medical Center, Chicago, IL
| | - Sabitha Sasidharan Pillai
- Division of Pediatric Endocrinology, Warren Alpert Medical School of Brown University/Hasbro Children's Hospital, Providence, RI
| | - Amy S Shah
- Division of Pediatric Endocrinology, Cincinnati Children's Hospital Medical Center & The University of Cincinnati, Cincinnati, OH
| | - Ashley H Shoemaker
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, TN
| | | | - Shylaja Srinivasan
- Department of Pediatrics, Division of Endocrinology, University of California, San Francisco, San Francisco, CA
| | - Inas H Thomas
- Department of Pediatrics, Pediatric Endocrinology, University of Michigan, Ann Arbor, MI
| | - Jeanie B Tryggestad
- Department of Pediatrics, Section of Diabetes/Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Maha F Yousif
- Department of Pediatrics, Pediatric Endocrinology, University of Texas Southwestern, Dallas, TX
| | - Megan M Kelsey
- Department of Pediatrics, University of Colorado Anschutz Medical Campus/Children's Hospital Colorado, Aurora, CO.
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Whipple MO, Pinto AJ, Abushamat LA, Bergouignan A, Chapman K, Huebschmann AG, Masters KS, Nadeau KJ, Scalzo RL, Schauer IE, Rafferty D, Reusch JE, Regensteiner JG. Sex Differences in Physical Activity Among Individuals With Type 2 Diabetes Across the Life Span: A Systematic Review and Meta-analysis. Diabetes Care 2022; 45:2163-2177. [PMID: 36044665 PMCID: PMC9472508 DOI: 10.2337/dc22-0576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/06/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Physical activity (PA) is a cornerstone of type 2 diabetes mellitus (T2DM) treatment. Sex differences in PA behavior or barriers/facilitators to PA among individuals with T2DM are unclear. PURPOSE To summarize the evidence related to sex differences in participation in PA and barriers/facilitators to PA among individuals with T2DM across the life span. DATA SOURCES Systematic searches (CRD42021254246) were conducted with Ovid MEDLINE, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), APA PsychInfo, and SPORTDiscus. STUDY SELECTION We included studies with assessment of PA, sedentary behaviors (SB), or barriers/facilitators to PA among individuals with T2DM by sex or gender. DATA EXTRACTION Participant characteristics, meeting PA guidelines, participation in PA and SB, and barriers/facilitators to PA were extracted by two independent reviewers. DATA SYNTHESIS A total of 53 articles (65,344 participants) were included in the systematic review and 21 articles in the meta-analysis. Sex differences were not observed in meeting of PA guidelines among adolescents (odds ratio 0.70 [95% CI 0.31, 1.59]), but males were more likely than females to meet PA guidelines among adults (1.65 [1.36, 2.01]) and older adults (1.63 [1.27, 2.09]). Males performed more moderate-to-vigorous PA (MVPA) than females across all age-groups. Common barriers to PA were lack of time (men) and lack of social support and motivation (women). LIMITATIONS Limitations include heterogeneity of measures used to assess PA and lack of stratification of data by sex. CONCLUSIONS Sex differences in meeting PA guidelines were not observed among adolescents but were apparent among adults and older adults with T2DM. Females consistently engaged in less MVPA than males across the life span.
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Affiliation(s)
- Mary O. Whipple
- School of Nursing, University of Minnesota, Minneapolis, MN
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Ana J. Pinto
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Layla A. Abushamat
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX
| | - Audrey Bergouignan
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO
- Hubert Curien Pluridisciplinary Institute UMR7178, CNRS and Université de Strasbourg, Strasbourg, France
| | - Kristina Chapman
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Amy G. Huebschmann
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kevin S. Masters
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO
- Clinical Health Psychology, Department of Psychology, University of Colorado Denver, Denver, CO
| | - Kristen J. Nadeau
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO
- Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Rebecca L. Scalzo
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Rocky Mountain Regional VA Medical Center, Aurora, CO
| | - Irene E. Schauer
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Rocky Mountain Regional VA Medical Center, Aurora, CO
| | - Deirdre Rafferty
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jane E.B. Reusch
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Rocky Mountain Regional VA Medical Center, Aurora, CO
| | - Judith G. Regensteiner
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
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8
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Vajravelu ME, Hitt TA, Mak N, Edwards A, Mitchell J, Schwartz L, Kelly A, Amaral S. Text Messages and Financial Incentives to Increase Physical Activity in Adolescents With Prediabetes and Type 2 Diabetes: Web-Based Group Interviews to Inform Intervention Design. JMIR Diabetes 2022; 7:e33082. [PMID: 35384850 PMCID: PMC9021947 DOI: 10.2196/33082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/08/2021] [Accepted: 12/09/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Physical activity is a major component of treatment for adolescents with obesity and prediabetes or type 2 diabetes; however, sedentary behavior remains pervasive. An SMS text message-based intervention paired with financial incentives may be an effective way to promote physical activity in this population. OBJECTIVE This study aims to obtain end-user feedback on SMS text message content and assess the acceptability of a planned SMS text messaging intervention with financial incentives to motivate youth with prediabetes or type 2 diabetes to increase physical activity. METHODS Adolescents with overweight or obesity and prediabetes or type 2 diabetes who attended a large academic pediatric endocrinology clinic were recruited to participate in group interviews (2-4/group) via videoconferencing. Participants were asked to share their thoughts on the use of SMS text messages and financial incentives to remind and motivate them to be more physically active. They rated and provided feedback on specific messages to be used in clinical trials. Participants were also asked about their personal experience with rewards to motivate behavior change and their anticipated reactions to rewards provided for goal attainment (gain-framing) versus those provided and then taken away if a goal was not met (loss-framing). The interviews were conducted by 2 trained interviewers and a note-taker. Content analysis was used to explore themes. RESULTS Group interviews were completed with 20 participants (11/20, 55% women; 15/20, 75% with type 2 diabetes; 5/20, 25% with prediabetes) with a mean age of 15 (SD 1; range 12-18) years and a mean BMI of 41 (SD 5) kg/m2 (all >95th percentile for age and sex). Most participants were non-Hispanic Black (14/20, 70%) and 10% (2/20) were Hispanics. Participants frequently cited near-continuous smartphone use and agreed that SMS text messages would serve as good reminders to be physically active, but the consensus about the need for short messages was strong. Favorable content included references to what they were likely to be doing when messages were sent (eg, homework or watching television) and messages that were upbeat or informative. Specific physical activity suggestions were rated favorably. Attitudes toward financial incentives varied, with differing opinions about whether loss-framed incentives would be motivating or discouraging. Many participants highlighted the role of intrinsic, rather than extrinsic, motivation in achieving and sustaining behavior change. CONCLUSIONS The engagement of adolescents with obesity and diabetes or prediabetes allowed for the refinement of SMS text messages for our planned intervention, with an emphasis on short, upbeat, relatable, and informative messages. Although an SMS text messaging intervention using financial incentives to motivate youth with prediabetes or type 2 diabetes to be more physically active is theoretically acceptable, the impact on actual activity levels in this population requires prospective evaluation in a clinical trial.
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Affiliation(s)
- Mary Ellen Vajravelu
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Center for Pediatric Research in Obesity and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Talia Alyssa Hitt
- Division of Pediatric Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - NaDea Mak
- Division of Endocrinology & Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Aliya Edwards
- Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Jonathan Mitchell
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Lisa Schwartz
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Center for Childhood Cancer Research, Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Andrea Kelly
- Division of Endocrinology & Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Sandra Amaral
- Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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9
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Grimes A, Lightner JS, Eighmy K, Steel C, Shook RP, Carlson J. Physical Activity Summer Slide Begins Early with COVID-19 School Closures: A Research Brief. JMIR Form Res 2022; 6:e35854. [PMID: 35297778 PMCID: PMC9014890 DOI: 10.2196/35854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/25/2022] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
Background The COVID-19 pandemic has resulted in the closure of schools and may have inadvertently resulted in decreased physical activity for youth. Emerging evidence suggests that school closures due to the COVID-19 pandemic could have hastened the inactivity of youth, possibly due to a lack of structure outside of school and increased access to sedentary activities. Objective The purpose of this study was to assess changes in physical activity from pre–school closure (before the pandemic) to post–school closure (during the pandemic) among youth in spring 2020. Methods This study used a natural experimental design; youth were enrolled in a physical activity study prior to the lockdown, which was enforced due to the pandemic. The number of device-assessed steps per day and moderate-to-vigorous physical activity minutes per week were measured by using a Garmin Vivofit 4 (Garmin Ltd) accelerometer over 8 weeks. Mixed effects models were used to compare physical activity variables, which were measured before and during the COVID-19 pandemic. Results Youth were primarily Hispanic or Latinx (8/17, 47%) and female (10/17, 59%). The number of daily steps decreased by 45.4% during the school closure, from a pre–school closure mean of 8003 steps per day to a post–school closure mean of 4366 steps per day. Daily moderate-to-vigorous physical activity decreased by 42.5%, from a pre–school closure mean of 80.18 minutes per week to a post–school closure mean of 46.13 minutes per week. Conclusions Youth are engaging in roughly half as much physical activity during the school closure as they were prior to the school closure. If additional evidence supports these claims, interventions are needed to support youths’ engagement in physical activity in the Midwest.
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Affiliation(s)
- Amanda Grimes
- School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, US
| | - Joseph S Lightner
- School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, US
| | - Katlyn Eighmy
- School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, US.,University of Kansas Medical Center, Kansas City, US
| | - Chelsea Steel
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City, Kansas City, US
| | - Robin P Shook
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City, Kansas City, US
| | - Jordan Carlson
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City, Kansas City, US
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10
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Abstract
Several factors, including genetics, family history, diet, physical activity, obesity, and insulin resistance in puberty, appear to increase the risk of type 2 diabetes in youth. Youth-onset type 2 diabetes is often thought of as a single entity but rather exists as a spectrum of disease with differences in presentation, metabolic characteristics, clinical progression, and complication rates. We review what is currently known regarding the risks associated with developing type 2 diabetes in youth. Additionally, we focus on the spectrum of phenotypes of pediatric type 2 diabetes, discuss the pathogenic underpinnings and potential therapeutic relevance of this heterogeneity, and compare youth-onset type 2 diabetes with type 1 diabetes and adult-onset type 2 diabetes. Finally, we highlight knowledge gaps in prediction and prevention of youth-onset type 2 diabetes.
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Affiliation(s)
- Amy S. Shah
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio 45229, USA
| | - Kristen J. Nadeau
- Children’s Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Department of Epidemiology, and Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, USA
| | - Maria J. Redondo
- Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas 77030, USA
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11
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Przybylski R, Craig M, Lippmann M, Mah DY, Shafer KM, Gauthier NS, de Ferranti SD, Triedman JK, Alexander ME. Activity During the COVID-19 Pandemic in Children with Cardiac Rhythm Management Devices. Pediatr Cardiol 2022; 43:784-789. [PMID: 34851446 PMCID: PMC8633092 DOI: 10.1007/s00246-021-02787-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/18/2021] [Indexed: 10/26/2022]
Abstract
Decreased physical activity is associated with cardiovascular, metabolic and mental health disease. While decreases in physical activity during the COVID-19 pandemic have been described in the general population, there is a paucity of data regarding children with underlying cardiovascular disease. We hypothesized there would be a decrease in physical activity at the onset of the COVID-19 pandemic. Performed a single-center, retrospective cohort study of children aged < 19 years with cardiac rhythm management devices. Patients were included if they had device-measured physical activity data from > 80% of dates from February 3, 2020 through June 30, 2020. Patients with significant neurologic/neuromuscular disease were excluded. We identified 144 patients with a median age of 15.4 years. 47% were female. 34% had congenital heart disease, 20% had cardiomyopathy, 19% had an inherited arrhythmia syndrome and 5% had atrioventricular block without congenital heart disease. 47% of patients had an implantable loop recorder, 29% had a permanent pacemaker and 24% had an implantable cardioverter-defibrillator. We observed a significant decrease in device-measured physical activity from baseline (February 3-March 9), with up to a 21% decrease in physical activity during mid-March through early May. Activity levels returned to pre-pandemic levels in June. Physical activity sharply declined in children with cardiac rhythm management devices at the onset of the COVID-19 pandemic. These data highlight the importance of finding strategies to maintain physical activity during the current pandemic and future public health crises.
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Affiliation(s)
- Robert Przybylski
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Molly Craig
- grid.2515.30000 0004 0378 8438Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Matthew Lippmann
- grid.2515.30000 0004 0378 8438Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Douglas Y. Mah
- grid.2515.30000 0004 0378 8438Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Keri M. Shafer
- grid.2515.30000 0004 0378 8438Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Naomi S. Gauthier
- grid.2515.30000 0004 0378 8438Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Sarah D. de Ferranti
- grid.2515.30000 0004 0378 8438Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
| | - John K. Triedman
- grid.2515.30000 0004 0378 8438Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Mark E. Alexander
- grid.2515.30000 0004 0378 8438Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
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12
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BaHammam AS, Alghannam AF, Aljaloud KS, Aljuraiban GS, AlMarzooqi MA, Dobia AM, Alothman SA, Aljuhani O, Alfawaz RA. Joint consensus statement of the Saudi Public Health Authority on the recommended amount of physical activity, sedentary behavior, and sleep duration for healthy Saudis: Background, methodology, and discussion. Ann Thorac Med 2021; 16:225-238. [PMID: 34484437 PMCID: PMC8388569 DOI: 10.4103/atm.atm_32_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/19/2021] [Indexed: 02/06/2023] Open
Abstract
The Saudi Public Health Authority recently prepared a Consensus Statement regarding how much time a person should spend engaged in physical activity, sedentary behavior, and sleep to promote optimal health across all age groups. This paper describes the background literature, methodology, and modified RAND Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach that guided the development process. A Leadership Group and Consensus Panels were formed, and credible existing guidelines were identified. The Panel identified clear criteria to choose the best practice guidelines for the set objectives after evaluation, based on GRADE table evidence, findings table summaries, and draft recommendations. Updating of the selected practice guidelines was performed, and the Consensus Panels separately reviewed the evidence for each behavior and decided to adopt or adapt the selected practice guideline recommendations or create de novo recommendations. Data related to cultural factors that may affect the studied behaviors, such as prayer times, midday napping or "Qailulah," and the holy month of Ramadan, were also reviewed. Two rounds of voting were conducted to reach a consensus for each behavior.
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Affiliation(s)
- Ahmed S. BaHammam
- The University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- National Plan for Science and Technology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah F. Alghannam
- Lifestyle and Health Research Center, Health Sciences Research Center, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Khalid Saad Aljaloud
- Department of Exercise Physiology, College of Sport Sciences and Physical Activity, King Saud University, Riyadh, Saudi Arabia
| | - Ghadeer S. Aljuraiban
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Mezna A. AlMarzooqi
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ali M. Dobia
- Comprehensive Specialized Clinics for the Security Forces in Jazan, General Administration for Medical Services, Ministry of Interior, Riyadh, Saudi Arabia
| | - Shaima A. Alothman
- Lifestyle and Health Research Center, Health Sciences Research Center, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Osama Aljuhani
- Department of Physical Education, College of Sport Sciences and Physical Activity, King Saud University, Riyadh, Saudi Arabia
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13
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Abstract
PURPOSE OF REVIEW The current review summarizes extant knowledge regarding the prevalence of depression in youth-onset type 2 diabetes (T2D) and how depression might impact glycemic control through stress-related behavioral and physiological mechanisms. The current review also discusses depression intervention studies in adult-onset T2D, as there are no such studies in youth-onset T2D, and provides recommendations for clinical research. RECENT FINDINGS The prevalence of elevated depression symptoms in youth-onset T2D is approximately 20%. Some studies suggest depression may negatively impact glycemic control through inadequate medication adherence and disordered eating, but there is a dearth of studies investigating associations with depression and physical activity/sedentary time, sleep, and stress-related physiological mechanisms. In adult-onset T2D, evidence-based behavioral interventions tailored to address diabetes-related issues have shown positive effects for depression and glycemic control. Future research is needed to characterize the epidemiology of depression in youth-onset T2D and test interventions to improve depression, glycemic control, and health outcomes in this specific pediatric population.
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Affiliation(s)
- Lauren D Gulley
- Department of Human Development and Family Studies, College of Health and Human Sciences, Colorado State University, 1570 Campus Delivery, Fort Collins, CO, 80523, USA.
- Section of Endocrinology, Department of Pediatrics, University of Colorado School of Medicine/Anschutz Medical Campus and Children's Hospital Colorado, 13123 E 16th Avenue, B265, Aurora, CO, 80045, USA.
| | - Lauren B Shomaker
- Department of Human Development and Family Studies, College of Health and Human Sciences, Colorado State University, 1570 Campus Delivery, Fort Collins, CO, 80523, USA
- Section of Endocrinology, Department of Pediatrics, University of Colorado School of Medicine/Anschutz Medical Campus and Children's Hospital Colorado, 13123 E 16th Avenue, B265, Aurora, CO, 80045, USA
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, USA
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14
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Kaar JL, Schmiege SJ, Drews K, Higgins J, Walders-Abramson N, Isganaitis E, Willi SM, Marcus MD, Zeitler PS, Kelsey MM. Evaluation of the longitudinal change in health behavior profiles across treatment groups in the TODAY clinical trial. Pediatr Diabetes 2020; 21:224-232. [PMID: 31886931 PMCID: PMC7597379 DOI: 10.1111/pedi.12976] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/28/2019] [Accepted: 09/18/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Individual health behaviors (ie, eating habits and sedentary lifestyle) are associated with type 2 diabetes (T2D). Health behavior profiles specific to adolescents with T2D have not been described. OBJECTIVE To identify health behavior profiles in adolescents with T2D and examine how these profiles change over time. METHODS Diet (via food frequency questionnaire) and activity behaviors (via 3-day physical activity recall) examined at baseline, 6 months, and 24 months from participants in the the Treatment Options for T2D in Adolescents and Youth (TODAY) study were used for this analysis. Latent profile analysis identified profiles of health behaviors within three time points, and latent transition probabilities were estimated to examine the change from baseline to 6 months (n = 450) and baseline to 24 months (n = 415). Multinomial logistic regressions were used to examine if the assigned TODAY treatment group (Metformin [Met], Met + Rosiglitazone [Rosi], or Met + Lifestyle) predicted change in health behavior profiles. RESULTS Three profiles emerged: "most sedentary," "healthy eaters," and "active and eat most." At 6 months, 50% of males and 29% of females in the Met + Lifestyle treatment group improved in their health behavior profile. Among males only, the Met + Lifestyle treatment group were more likely to improve their profiles from baseline to 6 months (P = .01). CONCLUSIONS Three health behavior profiles emerged and shifted over time. A high quality, lifestyle intervention had little effect on improving health behavior profiles. Optimizing outcomes in youth with T2D might require more robust and multifaceted interventions beyond family-level lifestyle, including more extensive psychosocial intervention, novel medication regimen, or bariatric surgery.
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Affiliation(s)
- Jill L Kaar
- Department of Pediatrics, Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado
| | - Sarah J Schmiege
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kimberly Drews
- The Biostatistics Center, George Washington University, Washington DC
| | - Janine Higgins
- Department of Pediatrics, Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado
| | - Natalie Walders-Abramson
- Department of Pediatrics, Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado
| | - Elvira Isganaitis
- Harvard Medical School, Boston, Massachusetts
- Joslin Diabetes Center, Boston, Massachusetts
| | - Steven M Willi
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Marsha D Marcus
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Philip S Zeitler
- Department of Pediatrics, Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado
| | - Megan M Kelsey
- Department of Pediatrics, Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado
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15
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5138] [Impact Index Per Article: 1027.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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16
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McLoughlin GM, Rosenkranz RR, Lee JA, Wolff MM, Chen S, Dzewaltowski DA, Vazou S, Lanningham-Foster L, Gentile DA, Rosen MS, Welk GJ. The Importance of Self-Monitoring for Behavior Change in Youth: Findings from the SWITCH ® School Wellness Feasibility Study. Int J Environ Res Public Health 2019; 16:E3806. [PMID: 31658604 DOI: 10.3390/ijerph16203806] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/22/2019] [Accepted: 10/02/2019] [Indexed: 12/05/2022]
Abstract
School Wellness Integration Targeting Child Health (SWITCH®) is a school wellness implementation initiative focused on building capacity for schools to plan and coordinate wellness programming. Grounded in Social Cognitive Theory (SCT), the purpose of this study was to evaluate the utility of the web-based, self-regulation system on physical activity (PA) behavior outcomes. At pre-test and post-test, students in SWITCH® schools (n = 8) completed the online Youth Activity Profile (YAP) to assess PA and sedentary behavior (SB). Students (n = 513) were categorized into high or low self-monitoring groups (using a median split) based on their use of the web-based self-regulation platform. Linear mixed models were used to assess differences in moderate-to-vigorous PA (MVPA) and sedentary behavior, with school, classroom, student, time-by-school, and time-by-classroom random effects and main and interaction fixed effects for student self-monitoring, gender, and time. Significant self-monitoring-by-time interactions were observed for estimates of PA F(1, 477) = 5.55, p = 0.02 and SB F(1, 477) = 4.90, p = 0.03. Students in the high self-monitoring group had larger gains in PA per day and larger declines in hours per day of sedentary screen time behavior compared to students in the low self-monitoring group. These findings support the utility of web-based self-regulation for facilitating PA change in youth.
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17
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Bruggink SM, Shomaker LB, Kelly NR, Drinkard BE, Chen KY, Brychta RJ, Cassidy O, Demidowich AP, Brady SM, Tanofsky-Kraff M, Yanovski JA. Insulin Sensitivity, Depression/Anxiety, and Physical Fitness in At-Risk Adolescents. Sports Med Int Open 2019; 3:E40-E47. [PMID: 31214645 PMCID: PMC6579727 DOI: 10.1055/a-0889-8653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/14/2019] [Accepted: 03/25/2019] [Indexed: 12/20/2022] Open
Abstract
Poor physical fitness contributes to the early progression of cardiometabolic disease, yet the physiological and psychological factors underpinning poor fitness in at-risk adolescents are not well understood. In this study, we sought to determine the relationship of physical fitness with two developmental phenomena of adolescence, insulin resistance and depression/anxiety symptoms among at-risk youth. We conducted secondary data analyses of 241 overweight or obese adolescents (12–17 years), drawn from two study cohorts. Insulin sensitivity index was derived from oral glucose tolerance tests. Adolescents self-reported depressive symptoms and anxiety symptoms on validated surveys. A walk/run test was administered to determine perceived exertion and physical fitness (distance traveled). Insulin sensitivity was positively associated with walk/run distance (
b
=0.16,
P<
0.01), even after accounting for all covariates. Anxiety symptoms were inversely related to perceived exertion (
b
=–0.11,
P<
0.05), adjusting for covariates. These findings suggest that insulin resistance and anxiety symptoms are associated with different dimensions of physical fitness in overweight or obese adolescents and could both potentially contribute to declining fitness and worsening metabolic outcomes in at-risk youth.
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Affiliation(s)
- Stephanie M Bruggink
- Human Development & Family Studies, Colorado State University College of Health and Human Sciences, Fort Collins, Colorado, United States
| | - Lauren Berger Shomaker
- Human Development & Family Studies, Colorado State University College of Health and Human Sciences, Fort Collins, Colorado, United States
| | - Nichole R Kelly
- Counseling Psychology and Human Services and the Prevention Science Institute, College of Education, University of Oregon, Eugene, Oregon, United States.,Section on Growth and Obesity, Division of Intramural Research, National Institute of Child Health and Human Development, Bethesda, Maryland, United States.,Uniformed Services University of the Health Sciences, Medical and Clinical Psychology, Bethesda, Maryland, United States
| | - Bart E Drinkard
- Rehabilitation Medicine Department, Mark O Hatfield Clinical Research Center, Bethesda, Maryland, United States
| | - Kong Y Chen
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, Maryland, United States
| | - Robert J Brychta
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, Maryland, United States
| | - Omni Cassidy
- Section on Growth and Obesity, Division of Intramural Research, National Institute of Child Health and Human Development, Bethesda, Maryland, United States.,Uniformed Services University of the Health Sciences, Medical and Clinical Psychology, Bethesda, Maryland, United States
| | - Andrew P Demidowich
- Section on Growth and Obesity, Division of Intramural Research, National Institute of Child Health and Human Development, Bethesda, Maryland, United States
| | - Sheila M Brady
- Section on Growth and Obesity, Division of Intramural Research, National Institute of Child Health and Human Development, Bethesda, Maryland, United States
| | - Marian Tanofsky-Kraff
- Section on Growth and Obesity, Division of Intramural Research, National Institute of Child Health and Human Development, Bethesda, Maryland, United States.,Uniformed Services University of the Health Sciences, Medical and Clinical Psychology, Bethesda, Maryland, United States
| | - Jack A Yanovski
- Section on Growth and Obesity, Division of Intramural Research, National Institute of Child Health and Human Development, Bethesda, Maryland, United States
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18
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Conlon BA, Mcginn AP, Isasi CR, Mossavar-Rahmani Y, Lounsbury DW, Ginsberg MS, Diamantis PM, Groisman-Perelstein AE, Wylie-Rosett J. Home Environment Factors and Health Behaviors of Low-income, Overweight, and Obese Youth. Am J Health Behav 2019; 43:420-436. [PMID: 30808480 DOI: 10.5993/ajhb.43.2.17] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objectives: Home environment may influence children's health behaviors associated with obesity. In this study, we examined home environment factors associated with diet and physical activity behaviors of overweight or obese youth. Methods: We analyzed baseline data from child and parent/caregiver dyads enrolled in an urban family weight management program. Multivariable logistic regression examined how home environment (parenting practices, family meal habits, and home availability of fruits/vegetables, sugar-sweetened beverages (SSBs), screen media, and physical activity resources) are related to children's intake of fruit, vegetables, and SSBs, and moderate-vigorous physical activity and sedentary time (ST) after adjusting for potential confounders. Results: Children were more likely to consume fruit if their families frequently ate meals together and infrequently watched TV during meals, and more likely to consume vegetables with high fruit/vegetable availability and low SSB availability. Children were more likely to engage in ST if parents practiced monitoring and frequently watched TV during meals. Conclusions: Overweight or obese children appear to have healthier habits if their families eat meals together without watching TV and if healthy food choices are available in the home. Encouraging parents to focus these practices may promote healthier body weight in children.
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Affiliation(s)
- Beth A. Conlon
- Postgraduate Student, Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY;,
| | - Aileen P. Mcginn
- Associate Professor, Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY
| | - Carmen R. Isasi
- Associate Professor, Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY
| | - Yasmin Mossavar-Rahmani
- Associate Professor, Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY
| | - David W. Lounsbury
- Assistant Professor, Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY
| | - Mindy S. Ginsberg
- Senior Associate, Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY
| | - Pamela M. Diamantis
- Attending Physician, Department of Pediatrics, Children's Health Services Jacobi Medical Center, Bronx, NY
| | | | - Judith Wylie-Rosett
- Professor, Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY
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19
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Abstract
PURPOSE This systematic review of literature analyzed accelerometer use to measure physical activity (PA) in individuals 21 years and younger with Down syndrome (DS). SUMMARY OF KEY POINTS Comprehensive search strategy conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight articles met inclusion criteria. Six studies reported children with DS are not meeting PA guidelines; 4 studies found intensity levels decline with age. Three studies reported children with DS engage in significantly less vigorous PA than control groups. Determination of intensity levels varied, limiting additional comparisons. CONCLUSIONS Children with DS engage in less PA than peers developing typically and are not meeting PA guidelines across age groups, increasing risk for numerous health conditions secondary to decreased activity. RECOMMENDATIONS FOR CLINICAL PRACTICE Promotion of more appropriate levels of PA and elimination of barriers to participation in PA are important for individuals with DS.
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Shomaker LB, Gulley L, Hilkin AM, Clark E, Annameier S, Rao S, Rockette-Wagner B, Kriska A, Wright KP, Stice E, Nadeau KJ, Kelsey MM. Design of a randomized controlled trial to decrease depression and improve insulin sensitivity in adolescents: Mood and INsulin sensitivity to prevent Diabetes (MIND). Contemp Clin Trials 2018; 75:19-28. [PMID: 30342256 PMCID: PMC6249074 DOI: 10.1016/j.cct.2018.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/09/2018] [Accepted: 10/16/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depressive symptoms often manifest in adolescence and predict worsening insulin sensitivity, a key precursor in the path to β-cell failure and type 2 diabetes (T2D). OBJECTIVE To assess the efficacy of a six-week cognitive-behavioral group versus six-week health education group for improving insulin sensitivity and preserving β-cell function in adolescent girls at-risk for T2D with depressive symptoms and evaluate mechanisms underlying the association between depression and insulin dynamics. DESIGN Randomized controlled trial of N = 150 12-17-year-old girls with overweight/obesity (body mass index [BMI; kg/m2] ≥85th percentile), elevated depressive symptoms (Center for Epidemiologic Studies-Depression Scale [CES-D] total score > 20), and diabetes family history. METHODS Girls at-risk for T2D with elevated depressive symptoms are recruited from the Denver-metropolitan area and randomized to participate in one of two six-week interventions. The cognitive-behavioral group is a depression prevention program involving psycho-education, restructuring negative thoughts, and behavioral activation. The health education group is a didactic control that provides knowledge about healthy living. Participants are assessed at baseline, immediate post-intervention, and one-year follow-up. Primary outcomes are insulin sensitivity and β-cell function from oral glucose tolerance tests. Secondary outcomes are disinhibited eating, physical activity, sleep, and cortisol. SUMMARY Results from this adequately powered randomized controlled trial will determine whether decreasing depressive symptoms with a behavioral health program preventatively alters insulin sensitivity and β-cell function trajectories in adolescents at-risk for T2D. Results from the MIND Project will add to knowledge of the contribution of depressive symptoms to T2D risk.
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Affiliation(s)
- Lauren B Shomaker
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, Fort Collins, CO 80523, United States; Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States; Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, United States.
| | - Lauren Gulley
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, Fort Collins, CO 80523, United States; Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
| | - Allison M Hilkin
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
| | - Emma Clark
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, Fort Collins, CO 80523, United States
| | - Shelly Annameier
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, Fort Collins, CO 80523, United States
| | - Sangeeta Rao
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Bonny Rockette-Wagner
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrea Kriska
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kenneth P Wright
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Eric Stice
- Oregon Research Institute, Eugene, OR, United States
| | - Kristen J Nadeau
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
| | - Megan M Kelsey
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
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Wang Z, Zou Z, Wang H, Jing J, Luo J, Zhang X, Luo C, Zhao H, Pan D, Ma J, Dong B, Ma Y. Prevalence and risk factors of impaired fasting glucose and diabetes among Chinese children and adolescents: a national observational study. Br J Nutr 2018; 120:813-9. [PMID: 30153872 DOI: 10.1017/S0007114518002040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The prevalence of impaired fasting glucose (IFG) and diabetes mellitus (DM) has reportedly increased significantly among Chinese children and adolescents. We aimed to examine the prevalence of IFG and DM, the disparities in sex and region and related risk factors among Chinese children and adolescents. A total of 16 434 Chinese children aged 6-17 years were selected from a national cross-sectional survey, and fasting glucose was measured for all participants. Overall, mean fasting plasma glucose (FPG) concentration was (4·64 (sd 0·51)) mmol/l, and the prevalence of DM and IFG was 0·10 and 1·89 %, respectively. Compared with girls, boys had higher FPG concentration (4·69 v. 4·58 mmol/l, r 0·107, P<0·001) and IFG prevalence (2·67 v. 1·07 %, r φ 0·059, P<0·001). Compared with rural children and adolescents, urban children and adolescent had higher FPG concentration (4·65 v. 4·62 mmol/l, r 0·029, P<0·001) and DM prevalence (0·15 v. 0·05 %, r φ 0·016, P<0·01). In addition, self-reported fried foods intake and overweight/obesity were positively associated with IFG, and the proportion of consuming fried foods more than or equal to once per week and overweight/obesity prevalence in boys and urban children and adolescents were significantly higher than girls and rural children and adolescents, respectively (P<0·05). Although the prevalence of IFG and DM was relatively low in Chinese children and adolescents, sex and region disparities were observed, which may be associated with differences in overweight/obesity prevalence and dietary factors.
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22
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Short KR, Chadwick JQ, Cannady TK, Branam DE, Wharton DF, Tullier MA, Thompson DM, Copeland KC. Using financial incentives to promote physical activity in American Indian adolescents: A randomized controlled trial. PLoS One 2018; 13:e0198390. [PMID: 29856832 DOI: 10.1371/journal.pone.0198390] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 05/14/2018] [Indexed: 01/13/2023] Open
Abstract
American Indians (AI) have high prevalence of diabetes in youth and may benefit from increasing physical activity as a strategy to improve metabolic health. We tested whether financial incentives would elicit greater frequency and/or duration of exercise in AI youth at high risk for developing diabetes. Overweight/obese AI boys and girls, 11-20 years old, were instructed to exercise on 3 days/week for 48 weeks at a tribal wellness center. The program was divided into three, 16-week-long phases to test different financial incentive strategies. Within each phase participants were randomly assigned to one of two groups that received different payments for exercise. Phase 1 was designed to test whether the size of the incentive would affect exercise frequency. In Phase 1, the number of exercise sessions did not differ between the group receiving a modest fixed-value payment per exercise session and the group receiving enhanced incentives to exercise more frequently (26 ± 3 versus 28 ± 2 sessions, respectively, p = 0.568). In Phase 2, the provision of an enhanced financial incentive to increase exercise duration resulted longer sessions, as the incentivized and standard payment groups exercised 38 ± 2 versus 29 ± 1 minutes per session (p = 0.002), respectively. In Phase 3, the effect of reducing the incentives on maintenance of exercise behaviors was inconclusive due to high participant withdrawal. Aerobic fitness increased 10% during Phase 1 but was unchanged thereafter. Insulin sensitivity and body composition were unchanged during the study. In conclusion, enhanced financial incentives increased the duration of exercise sessions, but had minimal effects on exercise participation. These results indicate that financial incentives hold promise in motivating previously sedentary, overweight/obese adolescents to exercise longer, but motivating them to sustain an exercise program remains the major challenge. TRIAL REGISTRATION ClinicalTrials.gov NCT01848353.
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23
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Abstract
Exercise and sports are an integral part of daily life for millions of Americans, with 16% of the US population older than age 15 years engaged in sports or exercise activities (Bureau of Labor statistics). The physical and psychological benefits of exercise are well-recognized. However, high-profile cases of athletes dying suddenly on the field, often due to undiagnosed genetic cardiomyopathies, raise questions about the risks and benefits of exercise for those with cardiomyopathy.
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24
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4390] [Impact Index Per Article: 731.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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25
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Kriska A, El ghormli L, Copeland KC, Higgins J, Ievers-Landis CE, Katz LEL, Trief PM, Wauters AD, Yasuda PM, Delahanty LM. Impact of lifestyle behavior change on glycemic control in youth with type 2 diabetes. Pediatr Diabetes 2018; 19:36-44. [PMID: 28378429 PMCID: PMC5628101 DOI: 10.1111/pedi.12526] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/27/2017] [Accepted: 03/08/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Little is known about the feasibility and impact of lifestyle intervention, determined by change in diet and cardiovascular fitness (CRF), on glycemic control in youth who are overweight with type 2 diabetes. This was examined in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) clinical trial cohort from across 15 US centers. SUBJECTS TODAY enrolled 699 youth aged 10 to 17 years with type 2 diabetes <2 years and body mass index ≥85th percentile at baseline. METHODS Dietary data were collected by an interviewer-administered food frequency questionnaire; CRF was assessed using a submaximal cycle ergometer test. Change from baseline in these variables was analyzed using generalized linear mixed models for both continuous and categorical measures. Models were adjusted for age, baseline HbA1c, treatment group, and medication adherence. Data were collected at baseline, 6, and 24 months. Trial registration ClinicalTrials.gov NCT00081328. RESULTS At 6 months, ~25% of females and ~33% of males improved CRF. In males, this was related to a decreased HbA1c (P = .001) and a lower percent experiencing glycemic failure (HbA1c ≥8%; P = .007). Females who decreased their saturated fat intake and/or increased their fiber intake had lower HbA1c at month 24 (P = .01 and P = .007, respectively). Males who increased their sweetened beverage intake at 6-month follow-up were at a 1.6-fold higher risk of experiencing glycemic failure (P = .04). CONCLUSIONS Few youth improved fitness and/or diet over time, although those who did showed a beneficial impact on glycemic outcomes. Although lifestyle behaviors are difficult to change in youth with type 2 diabetes, interventions are needed that are feasible (in scope, complexity, and demands), sustainable, and clinically meaningful.
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Affiliation(s)
- Andrea Kriska
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15224
| | - Laure El ghormli
- George Washington University Biostatistics Center, Rockville, Maryland, USA 20852
| | - Kenneth C Copeland
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104
| | - Janine Higgins
- University of Colorado Health Sciences Center, Aurora, Colorado 80045
| | - Carolyn E Ievers-Landis
- Rainbow Babies and Children’s Hospital, University Hospitals Case Medical Center, Cleveland, Ohio 44106
| | - Lorraine E Levitt Katz
- Children’s Hospital of Philadelphia. Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA 19104
| | - Paula M Trief
- SUNY Upstate Medical University, Syracuse, New-York 13210
| | - Aimee D Wauters
- University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229
| | - Patrice M Yasuda
- Children’s Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, California 90033
| | - Linda M Delahanty
- Massachusetts General Hospital Diabetes Center, Harvard Medical School, Boston, Massachusetts 02114
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Abstract
PURPOSE OF REVIEW One-third of US adolescents are obese, and related comorbidities exist in this population. Preventing early indicators of these diseases, such as insulin resistance (IR), may impact future morbidity and mortality. Interventions to date have only focused on diet or exercise. Additional targets to prevent disease are needed. This paper reviews the evidence in adolescents examining multiple health behaviors that have been associated with IR. RECENT FINDINGS Health behaviors (i.e., diet, activity, sleep) have been individually examined as possible contributors to disease, but an understanding of the complex interplay between these behaviors is lacking. A better understanding of how multiple health behaviors contribute to IR in adolescents is needed. Future studies using both advanced statistical methodology and robust measures of each health behavior may facilitate better understanding of the impact of lifestyle factors on IR and guide intervention strategies to reduce the risk of disease.
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Affiliation(s)
- Jill L Kaar
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, 13123 East 16th Avenue, Box 265, Aurora, CO, 80045, USA.
| | - Stacey L Simon
- Department of Pediatrics, Division of Pulmonology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, 13123 East 16th Avenue, Box 395, Aurora, CO, 80045, USA
| | - Sarah J Schmiege
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13120 East 19th Avenue, Mail Stop C288-04, Aurora, CO, 80045, USA
| | - Kristen J Nadeau
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, 13123 East 16th Avenue, Box 265, Aurora, CO, 80045, USA
| | - Megan M Kelsey
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, 13123 East 16th Avenue, Box 265, Aurora, CO, 80045, USA
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Elmesmari R, Reilly JJ, Martin A, Paton JY. Accelerometer measured levels of moderate-to-vigorous intensity physical activity and sedentary time in children and adolescents with chronic disease: A systematic review and meta-analysis. PLoS One 2017. [PMID: 28640907 PMCID: PMC5480890 DOI: 10.1371/journal.pone.0179429] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Context Moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) are important for child and adolescent health. Objective To examine habitual levels of accelerometer measured MVPA and ST in children and adolescents with chronic disease, and how these levels compare with healthy peers. Methods Data sources: An extensive search was carried out in Medline, Cochrane library, EMBASE, SPORTDiscus and CINAHL from 2000–2017. Study selection: Studies with accelerometer-measured MVPA and/or ST (at least 3 days and 6 hours/day to provide estimates of habitual levels) in children 0–19 years of age with chronic diseases but without co-morbidities that would present major impediments to physical activity. In all cases patients were studied while well and clinically stable. Results Out of 1592 records, 25 studies were eligible, in four chronic disease categories: cardiovascular disease (7 studies), respiratory disease (7 studies), diabetes (8 studies), and malignancy (3 studies). Patient MVPA was generally below the recommended 60 min/day and ST generally high regardless of the disease condition. Comparison with healthy controls suggested no marked differences in MVPA between controls and patients with cardiovascular disease (1 study, n = 42) and type 1 diabetes (5 studies, n = 400; SMD -0.70, 95% CI -1.89 to 0.48, p = 0.25). In patients with respiratory disease, MVPA was lower in patients than controls (4 studies, n = 470; SMD -0.39, 95% CI -0.80, 0.02, p = 0.06). Meta-analysis indicated significantly lower MVPA in patients with malignancies than in the controls (2 studies, n = 90; SMD -2.2, 95% CI -4.08 to -0.26, p = 0.03). Time spent sedentary was significantly higher in patients in 4/10 studies compared with healthy control groups, significantly lower in 1 study, while 5 studies showed no significant group difference. Conclusions MVPA in children/adolescents with chronic disease appear to be well below guideline recommendations, although comparable with activity levels of their healthy peers except for children with malignancies. Tailored and disease appropriate intervention strategies may be needed to increase MVPA and reduce ST in children and adolescents with chronic disease.
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Affiliation(s)
- Rabha Elmesmari
- School of Medicine, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, Scotland
- Al-Fatah Hospital, Medical School, Benghazi University, Benghazi, Libya
| | - John J. Reilly
- University of Strathclyde, Physical Activity for Health Group, Glasgow, Scotland
| | - Anne Martin
- Usher Institute for Population Health Sciences and Informatics, Edinburgh, Scotland
| | - James Y. Paton
- School of Medicine, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, Scotland
- * E-mail:
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28
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Abstract
PURPOSE Evidence suggests that female adolescents and those living in urban environments may have lower physical activity (PA) levels compared with their peers. Yet few studies report PA for urban adolescent females, and there is no consensus regarding potential causes for low PA in this subgroup. We examined PA levels, in a large, diverse cohort of 14- to 17-yr-old urban-dwelling females and assessed the effect of socioeconomic, personal, and neighborhood/environmental factors on PA. METHODS One week of time-stamped step count data were collected on 926 girls from the Pittsburgh Girls Study at four annual visits. Valid recordings (worn at least 10 h on 3+ d) were examined and compared with normalized step count values from a U.S. population-representative sample. Relationships between important covariates and average steps per day were examined with regression models. RESULTS Adjusted mean ± SD step counts per day at baseline were 5614 ± 2434 after controlling for important covariates with less than 6% of girls achieving at least 10,000 steps per day. The girls from the Pittsburgh Girls Study accrued ~45% of their steps during school hours. Age-specific median step counts per day for study participants were similar to the 25th percentile of U.S. population normalized values and did not significantly change during follow-up. Non-Hispanic African American race/ethnicity was associated with higher average step counts per day; obesity and a recent childbirth were associated with lower average step counts per day. CONCLUSIONS Step counts in this cohort of urban adolescent girls were considerably lower than expected for U.S. adolescent females. Targeted efforts to improve PA levels in urban youth should consider the importance of school-based activity while increasing PA opportunities outside of school.
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Affiliation(s)
- Bonny Rockette-Wagner
- 1Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA; 2Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA; 3Department of Kinesiology, Health, and Sport Science, University of Indiana, Indiana, PA; and 4School of Medicine, University of Pittsburgh, Pittsburgh, PA
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29
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Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135:e146-e603. [PMID: 28122885 PMCID: PMC5408160 DOI: 10.1161/cir.0000000000000485] [Citation(s) in RCA: 5972] [Impact Index Per Article: 853.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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30
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Rockette-Wagner B, Storti KL, Edelstein S, Delahanty LM, Galvin B, Jackson A, Kriska AM. Measuring Physical Activity and Sedentary Behavior in Youth with Type 2 Diabetes. Child Obes 2017; 13:72-77. [PMID: 26859798 PMCID: PMC5278814 DOI: 10.1089/chi.2015.0151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Lifestyle interventions that encourage increasing physical activity (PA) and losing weight are critical for overweight and obese youth with comorbid conditions. Assessing PA within such lifestyle intervention efforts requires measurement tool(s) that are both accurate and appropriate for these youth. This research compares PA levels and sedentary behavior in an ethnically diverse cohort of overweight/obese youth with type 2 diabetes using both accelerometry and a questionnaire previously validated in the general youth population. METHODS Spearman's correlations were used to compare time spent sedentary and in different PA intensities between a questionnaire, the three-day PA recall (3DPAR), and an objective PA measure, the ActiGraph accelerometer, in 236 overweight/obese youth with diabetes. RESULTS Spearman correlations between 3DPAR and accelerometer results for total PA were small and not significant (rho = 0.11, p > 0.05 for males and females). Correlations for specific PA intensities (moderate/vigorous and light) were also small and not significant. Sedentary time between instruments was significant, but weakly correlated in females (rho = 0.19, p < 0.05), but not in males (rho = 0.07, p = 0.48). CONCLUSIONS Subjective PA measures validated in the general youth population may not be the best method for differentiating levels of movement in overweight/obese youth with type 2 diabetes, who spend most of their time in light-intensity activity and sedentary pursuits with little or no time spent in moderate/vigorous-intensity activities. Objective measures such as accelerometers that can capture the lower end of the movement scale are likely the more appropriate measures under these conditions.
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Affiliation(s)
| | - Kristi L. Storti
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Sharon Edelstein
- Biostatistics Center, George Washington University, Washington, DC
| | - Linda M. Delahanty
- Diabetes Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Bryan Galvin
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA
| | | | - Andrea M. Kriska
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
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Wickrama KAS, Bae D, O'Neal CW. Explaining the Association between Early Adversity and Young Adults' Diabetes Outcomes: Physiological, Psychological, and Behavioral Mechanisms. J Youth Adolesc 2017; 46:2407-2420. [PMID: 28144816 DOI: 10.1007/s10964-017-0639-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 01/20/2017] [Indexed: 11/27/2022]
Abstract
Previous studies have documented that early adversity increases young adults' risk for diabetes resulting in morbidity and comorbidity with adverse health conditions. However, less is known about how inter-related physiological (e.g., body mass index [BMI]), psychological (e.g., depressive symptoms), and behavioral mechanisms (e.g., unhealthy eating and sedentary behavior) link early adversity to young adults' diabetes outcomes, although these mechanisms appear to stem from early stressful experiences. The current study tested the patterning of these longitudinal pathways leading to young adults' diabetes using a nationally representative sample of 13,286 adolescents (54% female) over a period of 13 years. The findings indicated that early adversity contributed to elevated BMI, depressive symptoms, and stress-related health behaviors. The impact of these linking mechanisms on hierarchical diabetes outcomes (i.e., prediabetes and diabetes) remained significant after taking their associations with each other into account, showing that these mechanisms operate concurrently. The findings emphasize the importance of early detection for risk factors of young adults' diabetes in order to minimize their detrimental health effects.
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Affiliation(s)
- Kandauda A S Wickrama
- Department of Human Development and Family Science, The University of Georgia, Athens, GA, USA
| | - Dayoung Bae
- Center for Family Research, The University of Georgia, 1095 College Station Road, Athens, GA, 30602, USA.
| | - Catherine Walker O'Neal
- Department of Human Development and Family Science, The University of Georgia, Athens, GA, USA
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Bacha F, Gidding SS, Pyle L, Katz LL, Kriska A, Nadeau KJ, Lima JAC. Relationship of Cardiac Structure and Function to Cardiorespiratory Fitness and Lean Body Mass in Adolescents and Young Adults with Type 2 Diabetes. J Pediatr 2016; 177:159-166.e1. [PMID: 27499218 PMCID: PMC5037030 DOI: 10.1016/j.jpeds.2016.06.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/18/2016] [Accepted: 06/13/2016] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To investigate the relationships of cardiac structure and function with body composition and cardiorespiratory fitness (CRF) among adolescents with type 2 diabetes in the Treatment Options for Type 2 Diabetes in Adolescents and Youth study. STUDY DESIGN Cross-sectional evaluation of 233 participants (median age 18.3 [min-max 12.4-24.2] years, 63% females, median hemoglobin A1c 6.8%) who had echocardiography measurements of left ventricular (LV) mass, ejection fraction, left atrial dimensions, LV diastolic function (early transmitral flow velocity to early mitral annular velocity ratio from tissue Doppler imaging), and right ventricular function (tricuspid annular plane systolic excursion [TAPSE]) and body composition (dual-energy x-ray absorptiometry) and CRF (cycle ergometry determination of physical work capacity at heart rate of 170 beats per minute). RESULTS LV mass correlated positively with CRF (r = 0.5, P < .0001), lean body mass (LBM) (r = 0.7, P < .0001), and fat mass (FM) (r = 0.2, P = .00047); LV ejection fraction did not. Early transmitral flow velocity to early mitral annular velocity was positively related to FM (r = 0.14, P = .03) and % body fat (r = 0.18, P = .007), and left atrial internal diameter correlated with FM (r = 0.4, P < .0001), LBM (r = 0.3, P < .001), and CRF (r = 0.2, P = .0033). TAPSE weakly correlated with CRF (r = 0.2, P = .0014) and LBM (r = 0.13, P < .05) but not with FM. In multivariable regression analyses, LBM (β = 2.13, P < .0001) and CRF (β = 0.023, P = .008) were related to LV mass independent of race, sex, age, hemoglobin A1c, hypertension, smoking, and diabetes medications. CRF (β = 0.0002, P = .0187) and hemoglobin A1c (β = -0.022, P = .0142) were associated with TAPSE. CONCLUSIONS In youth with type 2 diabetes, LV size is related to physical fitness. LV ejection fraction is within normal limits. LV diastolic function is inversely related to FM. Greater fitness may counteract adverse effects of poor glycemic control on right ventricular function. TRIAL REGISTRATION ClinicalTrials.gov:NCT00081328.
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Affiliation(s)
- Fida Bacha
- Children’s Nutrition Research Center, Baylor College of Medicine, Houston TX 77030 USA
| | - Samuel S. Gidding
- Nemours Cardiac Center, A.I. DuPont Hospital for Children, Wilmington DE 19803 USA
| | - Laura Pyle
- Department of Pediatrics, School of Medicine, University of Colorado Denver, Aurora, CO.
| | - Lorraine Levitt Katz
- Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA 19104 USA
| | - Andrea Kriska
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA 15260 USA
| | - Kristen J. Nadeau
- Childrens Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora CO 80045 USA
| | - Joao A. C. Lima
- Departments of Medicine, Radiology and Epidemiology, Johns Hopkins University, Baltimore MD 21287 USA
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Khanolkar AR, Amin R, Taylor-Robinson D, Viner R, Warner J, Stephenson T. Ethnic Minorities Are at Greater Risk for Childhood-Onset Type 2 Diabetes and Poorer Glycemic Control in England and Wales. J Adolesc Health 2016; 59:354-361. [PMID: 27426206 DOI: 10.1016/j.jadohealth.2016.05.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/12/2016] [Accepted: 05/13/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Ethnic minority children are at a greater risk for type 2 diabetes (T2D). However, current prevalence of T2D among children and young people is unknown in England and Wales. In addition, little is known on glycemic control in pediatric T2D globally. METHODS Using data from the National Paediatric Diabetes Audit for 2012-2013 with >98% coverage of diabetes cases, we estimated (1) the overall, gender- and ethnic-specific prevalence of T2D in children and young people <16 years and (2) whether ethnicity predicts glycemic control (measured by mean HbA1c) in children and young people <19 years. Ethnicity was self-identified and categorized into white, Asian, black, mixed, other, and "not stated." Multivariable linear regression was used to estimate differences in glycemic control by ethnicity adjusting for socioeconomic status, age, diabetes duration, and gender. RESULTS A total of 307 children and young people aged <16 years were identified with T2D in the National Paediatric Diabetes Audit for 2012-2013. Overall prevalence of T2D was 2.9/100,000. Females had a higher prevalence of T2D than males (4.3 vs. 1.5/100,000). The highest prevalence was found in Asian (12.2/100,000) followed by mixed ethnicity (4.4/100,000) females. Children of mixed ethnicity had significantly higher mean HbA1c compared with white children (9.7% [83 mmol/mol] vs. 7.8% [62 mmol/mol], p < .001, and adjusted mean difference of 4.2% [22.3 mmol/mol], 95% confidence interval = 3.1%-5.2% [10.9-33.7 mmol/mol]), but there were no significant differences between the other ethnic minority groups. CONCLUSIONS Children of all ethnic minorities particularly females have an increased prevalence of T2D. Those belonging to mixed ethnic backgrounds are at increased risk for poorer glycemic control.
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Affiliation(s)
- Amal R Khanolkar
- Institute of Child Health, University College London (UCL), London, United Kingdom; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Rakesh Amin
- Institute of Child Health, University College London (UCL), London, United Kingdom
| | - David Taylor-Robinson
- Institute of Child Health, University College London (UCL), London, United Kingdom; Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Russell Viner
- Institute of Child Health, University College London (UCL), London, United Kingdom
| | - Justin Warner
- Department of Child Health, Children's Hospital for Wales, Cardiff, United Kingdom
| | - Terence Stephenson
- Institute of Child Health, University College London (UCL), London, United Kingdom
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Abstract
Childhood obesity has been linked to cardiovascular disease (CVD) risk in adulthood. Of great concern is the expected increase in the population's CVD burden in relation to childhood obesity. This is compounded by the risk related to chronic hyperglycemia exposure in youth with type 2 diabetes. We herein provide an overview of the spectrum of early cardiovascular disease manifestation in youth with obesity and type 2 diabetes, in particular abnormalities in cardiac structure and function. Cardiac remodeling and adverse target organ damage is already evident in the pediatric age group in children with obesity and type 2 diabetes. This supports the importance of intensifying obesity prevention efforts and early intervention to treat comorbidities of obesity in the pediatric age group to prevent cardiac events in early adulthood.
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Affiliation(s)
- Fida Bacha
- USDA/ARS Children's Nutrition Research Center, Texas Children's Hospital, Baylor College of Medicine, 1100 Bates Street, Houston, TX, USA.
- Division of Pediatric Endocrinology and Diabetes, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
| | - Samuel S Gidding
- Nemours Cardiac Center, A.I. DuPont Hospital for Children, Wilmington, DE, USA
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Kazemi A, Zahraei NN, Nazarian N. The relation between intra- and interpersonal factors and food consumption level among Iranian adolescent girls. Iran J Nurs Midwifery Res 2016; 21:147-52. [PMID: 27095987 PMCID: PMC4815369 DOI: 10.4103/1735-9066.178235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background: Poor nutrition habits in adolescent girls endanger their health and are followed by serious systemic diseases in adulthood and negative effects on their reproductive health. To design health promotion programs, understanding of the intra- and interpersonal associated factors with treatment is essential, and this was the aim of this study. Materials and Methods: This cross-sectional study was conducted on 193 adolescent girls of age 11-15 years. Random cluster selection was used for sample selection. Food group consumption pattern was assessed by food frequency questionnaire. Also, perceived susceptibility/severity and nutritional attitude as intrapersonal factors and social support as interpersonal factor were assessed. The relationship between food group consumption level and nutritional attitude and perceived treat (susceptibility/severity) as intrapersonal factors and perceived social support as interpersonal factor were assessed by linear multiple regression and analysis of variance (ANOVA). Results: Results showed that the level of sweetmeat food consumption was related to perceived social support (P = 0.03) and nutritional attitude (P = 0.01) negatively. In addition, an inverse and significant association was found between the level of junk food intake and informational perceived social support (P = 0.004). The association between the level of fast food intake and the perceived parental social support for preparation of healthy food was negatively significant (P = 0.03). Breakfast consumption was related to nutritional attitude (P = 0.03), social support (P = 0.03), and perceived severity (P = 0.045). Conclusions: Results revealed that perceived social support and nutritional attitude are the important and related factors in dietary intake among girls, and promotion of social support and modification of nutritional attitude may lead to healthy nutritional behaviors among them.
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Affiliation(s)
- Ashraf Kazemi
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nafisehsadat Nekuei Zahraei
- Department of Midwifery, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Naser Nazarian
- Department of Social Sciences, Organization of Isfahan Education, Isfahan, Iran
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Bai Y, Chen S, Laurson KR, Kim Y, Saint-Maurice PF, Welk GJ. The Associations of Youth Physical Activity and Screen Time with Fatness and Fitness: The 2012 NHANES National Youth Fitness Survey. PLoS One 2016; 11:e0148038. [PMID: 26820144 PMCID: PMC4731469 DOI: 10.1371/journal.pone.0148038] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 01/12/2016] [Indexed: 12/17/2022] Open
Abstract
The purpose of the study is to examine the associations of youth physical activity and screen time with weight status and cardiorespiratory fitness in children and adolescents, separately, utilizing a nationally representative sample. A total of 1,113 participants (692 children aged 6-11 yrs; 422 adolescents aged 12-15 yrs) from the 2012 NHANES National Youth Fitness Survey. Participants completed physical activity and screen time questionnaires, and their body mass index and cardiorespiratory fitness (adolescents only) were assessed. Adolescents completed additional physical activity questions to estimate daily MET minutes. Children not meeting the screen time guideline had 1.69 times the odds of being overweight/obese compared to those meeting the screen time guideline, after adjusting for physical activity and other control variables. Among adolescent, screen time was significantly associated with being overweight/obese (odds ratio = 1.82, 95% confidence interval: 1.06-3.15), but the association attenuated toward the borderline of being significant after controlling for physical activity. Being physically active was positively associated with cardiorespiratory fitness, independent of screen time among adolescents. In joint association analysis, children who did not meet physical activity nor screen time guidelines had 2.52 times higher odds of being overweight/obese than children who met both guidelines. Adolescents who did not meet the screen time guideline had significantly higher odds ratio of being overweight/obese regardless of meeting the physical activity guideline. Meeting the physical activity guideline was also associated with cardiorespiratory fitness regardless of meeting the screen time guideline in adolescents. Screen time is a stronger factor than physical activity in predicting weight status in both children and adolescents, and only physical activity is strongly associated with cardiorespiratory fitness in adolescents.
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Affiliation(s)
- Yang Bai
- Department of Kinesiology, Iowa State University, Ames, Iowa, United States of America
- * E-mail:
| | - Senlin Chen
- Department of Kinesiology, Iowa State University, Ames, Iowa, United States of America
| | - Kelly R. Laurson
- School of Kinesiology and Recreation, Illinois State University, Normal, Illinois, United States of America
| | - Youngwon Kim
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | | | - Gregory J. Welk
- Department of Kinesiology, Iowa State University, Ames, Iowa, United States of America
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Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2015; 133:e38-360. [PMID: 26673558 DOI: 10.1161/cir.0000000000000350] [Citation(s) in RCA: 3698] [Impact Index Per Article: 410.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
Understanding the physical activity patterns of youth is an essential step in preparing programming and interventions needed to change behavior. To date, little is known about the intricacies of youth physical activity across various physical activity segments (i.e. in school, out of school, recess, classroom physical activity, physical education, weekends, etc.). Therefore, the purpose of the study was to examine the physical activity patterns of elementary school children across various segments and during two seasons. A total of 287 fourth and fifth graders from the Southwest US wore the Yamax Digiwalker SW-200 pedometer for 7 consecutive days during the Fall and Spring seasons. Children were prompted to record their step counts when arriving and leaving school, before and after physical education and recess, as well as on the weekends. Means and standard deviations were calculated and ANOVAs and t tests were utilized to examine difference by sex, season, and segment. Youth were more active outside of school and on weekdays (p<0.05). Boys were generally more active than girls and all youth were more active during the milder Spring season. There is a clear need for Comprehensive School Physical Activity Programming and weekend physical activity opportunities. Furthermore, greater emphasis is needed on PE and across other activity segments for girls to increase their physical activity levels.
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Affiliation(s)
- Timothy A Brusseau
- Department of Exercise and Sport Science, Sport Pedagogy and Physical Activity Assessment Laboratory, University of Utah
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Martin R, Buchan DS, Baker JS, Young J, Sculthorpe N, Grace FM. Sprint interval training (SIT) is an effective method to maintain cardiorespiratory fitness (CRF) and glucose homeostasis in Scottish adolescents. Biol Sport 2015; 32:307-13. [PMID: 26681833 PMCID: PMC4672162 DOI: 10.5604/20831862.1173644] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 06/05/2015] [Accepted: 08/09/2015] [Indexed: 12/12/2022] Open
Abstract
The present study examined the physiological impact of a school based sprint interval training (SIT) intervention in replacement of standard physical education (SPE) class on cardio-respiratory fitness (CRF) and glucose homeostasis during the semester following summer vacation. Participants (n=49) were randomly allocated to either intervention (SIT; n=26, aged 16.9 ± 0.3 yrs) or control group who underwent standard physical education (SPE; n=23, aged 16.8 ± 0.6 yrs). CRF (VO2max) and glucose homeostasis were obtained prior-to and following 7 weeks of SIT exercise. Significant group x time interaction was observed for CRF (P < 0.01) with non-significant trends for fasting insulin (P= 0.08), and HOMA-IR (P=0.06). CRF decreased (P < 0.01) in SPE such that POST intervention CRF was significantly lower (P< 0.05) in SPE. Fasting plasma glucose (P < 0.01), insulin (P< 0.01) and HOMA-IR (P< 0.01) increased significantly amongst SPE. The main finding of the present study is that 7-weeks of SIT exercise is an effective method of maintaining (but not improving) CRF and fasting insulin homeostasis amongst school-going adolescents. SIT exercise demonstrates potential as a time efficient physiological adjunct to standard PE class in order to maintain CRF during the school term.
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Affiliation(s)
- R Martin
- Institute of Clinical Exercise and Health Science, School of Sport & Science, University of the West of Scotland Hamilton, South Lanarkshire, Scotland, United Kingdom
| | - D S Buchan
- Institute of Clinical Exercise and Health Science, School of Sport & Science, University of the West of Scotland Hamilton, South Lanarkshire, Scotland, United Kingdom
| | - J S Baker
- Institute of Clinical Exercise and Health Science, School of Sport & Science, University of the West of Scotland Hamilton, South Lanarkshire, Scotland, United Kingdom
| | - J Young
- Institute of Clinical Exercise and Health Science, School of Sport & Science, University of the West of Scotland Hamilton, South Lanarkshire, Scotland, United Kingdom
| | - N Sculthorpe
- Institute of Clinical Exercise and Health Science, School of Sport & Science, University of the West of Scotland Hamilton, South Lanarkshire, Scotland, United Kingdom
| | - F M Grace
- Institute of Clinical Exercise and Health Science, School of Sport & Science, University of the West of Scotland Hamilton, South Lanarkshire, Scotland, United Kingdom
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Khan UI, McGinn AP, Isasi CR, Groisman-Perelstein A, Diamantis PM, Ginsberg M, Wylie-Rosett J. Differences in Cardiometabolic Risk between Insulin-Sensitive and Insulin-Resistant Overweight and Obese Children. Child Obes 2015; 11:289-96. [PMID: 25774664 PMCID: PMC4485365 DOI: 10.1089/chi.2014.0112] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND It is known that 15-30% overweight/obese adults do not suffer cardiometabolic consequences. There is limited literature examining factors that can be used to assess cardiometabolic health in overweight/obese children. If such factors can be identified, they would aid in differentiating those most in need for aggressive management. METHODS Baseline data from 7- to 12-year-old, overweight, and obese children enrolled in a weight management program at an urban hospital were analyzed. Homeostatic model assessment for insulin resistance (HOMA-IR) <2.6 was used to define insulin-sensitive and HOMA-IR ≥2.6 was used to defined insulin-resistant participants. Demographics, physical activity measures, and cardiometabolic risk factors were compared between the two phenotypes. Odds ratios (ORs) examining the association between intermediate endpoints (metabolic syndrome [MetS], nonalcoholic fatty liver disease [NAFLD], systemic inflammation, and microalbuminuria) and the two metabolic phenotypes were evaluated. RESULTS Of the 362 overweight/obese participants, 157 (43.5%) were insulin sensitive and 204 (56.5%) were insulin resistant. Compared to the insulin-sensitive group, the insulin-resistant group was older (8.6±1.6 vs. 9.9±1.7; p<0.001) and had a higher BMI z-score (1.89±0.42 vs. 2.04±0.42; p=0.001). After multivariable adjustment, compared to the insulin-sensitive group, the insulin-resistant group had higher odds of having MetS (OR, 5.47; 95% confidence interval [CI]: 1.72, 17.35; p=0.004) and NAFLD (OR, 8.66; 95% CI, 2.48, 30.31; p=0.001), but not systemic inflammation (OR, 1.06; 95% CI: 0.56, 2.03; p=0.86) or microalbuminuria (OR, 1.71; 95% CI, 0.49, 6.04; p=0.403). CONCLUSIONS Using a HOMA-IR value of ≥2.6, clinical providers can identify prepubertal and early pubertal children most at risk. Focusing limited resources on aggressive weight interventions may lead to improvement in cardiometabolic health.
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Affiliation(s)
- Unab I. Khan
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Aileen P. McGinn
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Carmen R. Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | | | | | - Mindy Ginsberg
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Judith Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
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Pivovarov JA, Taplin CE, Riddell MC. Current perspectives on physical activity and exercise for youth with diabetes. Pediatr Diabetes 2015; 16:242-55. [PMID: 25754326 DOI: 10.1111/pedi.12272] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 02/05/2015] [Accepted: 02/06/2015] [Indexed: 12/19/2022] Open
Abstract
Regular physical activity (PA) for youth with diabetes improves cardiorespiratory fitness, body composition, bone health, insulin sensitivity, and psychosocial well-being. However many youth with diabetes or pre-diabetes fail to meet minimum PA guidelines and a large percentage of youth with diabetes are overweight or obese. Active youth with type 1 diabetes tend to have lower HbA1c levels and reduced insulin needs, whereas activity in adolescents at-risk for type 2 diabetes improves various measures of metabolism and body composition. Insulin and nutrient adjustments for exercise in type 1 diabetes is complex because of varied responses to exercise type and because of the different times of day that exercise is performed. This review highlights the benefits of exercise and the established barriers to exercise participation in the pediatric diabetes population. A new exercise management algorithm for insulin and carbohydrate intake strategies for active youth with type 1 diabetes is presented.
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Affiliation(s)
- Jacklyn A Pivovarov
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, Ontario, Canada
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von Hertzen L, Beutler B, Bienenstock J, Blaser M, Cani PD, Eriksson J, Färkkilä M, Haahtela T, Hanski I, Jenmalm MC, Kere J, Knip M, Kontula K, Koskenvuo M, Ling C, Mandrup-Poulsen T, von Mutius E, Mäkelä MJ, Paunio T, Pershagen G, Renz H, Rook G, Saarela M, Vaarala O, Veldhoen M, de Vos WM. Helsinki alert of biodiversity and health. Ann Med 2015; 47:218-25. [PMID: 25904094 DOI: 10.3109/07853890.2015.1010226] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Urban living in built environments, combined with the use of processed water and food, may not provide the microbial stimulation necessary for a balanced development of immune function. Many chronic inflammatory disorders, including allergic, autoimmune, metabolic, and even some behavioural disorders, are linked to alteration in the human commensal microbiota. Sedentary lifestyle is associated with reduced exposure to a broad spectrum of environmental micro-organisms and surplus energy balance, both risk factors of chronic inflammatory disorders. According to the Biodiversity Hypothesis, an environment with diverse macrobiota and microbiota modifies and enriches the human microbiota, which in turn is crucial in the development and maintenance of appropriate immune function. These issues were discussed in the symposium 'Chronic Inflammation, Lifestyle and Environment', held in Helsinki, 20-22 August 2014, under the sponsorship of the Yrjö Jahnsson Foundation. This paper briefly outlines the recent findings in the context of the environment, lifestyle, and health; discusses the forces that undermine immune tolerance in urban environments; and highlights the possibilities to restore broken immune tolerance among urban dwellers, summarizing the main messages in four statements and calling for actions to combat major public health threats.
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PAOLI A, BIANCO A. What Is Fitness Training? Definitions and Implications: A Systematic Review Article. Iran J Public Health 2015; 44:602-14. [PMID: 26284201 PMCID: PMC4537617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/21/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND This review based upon studies searched from the major scientific libraries has the objective of clarifying what is fitness training in modern days, the implications that it has on health in both youth and elderly and finally discuss fitness training practical implications. METHODS The PRISMA statement was partially adopted and a number of 92 items were selected, according to the inclusion criteria. Results were discussed in 4 main sections: 1. Children and adolescents fitness levels; 2. Fitness training in the elderly; 3. Pathology prevention through fitness training; 4. Training through Fitness activities. RESULTS This review pointed out the fact that nowadays there is a large variety of fitness activities available within gyms and fitness centers. Even though they significantly differ with each other, the common aim they have is the wellbeing of the people through the improvement of the physical fitness components and the psychological balance. CONCLUSION Fitness instructors' recommendations should be followed in gym context and should be contingent upon an individual's objectives, physical capacity, physical characteristics and experience.
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Affiliation(s)
- Antonio PAOLI
- Dept. of Biomedical Sciences, University of Padua, Padova, Italy
| | - Antonino BIANCO
- Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy,Corresponding Author:
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Abstract
Type 2 diabetes (T2D) in youth is a relatively novel condition facing paediatric health care providers. Few experimental trials exist to guide clinical management in this population. Supporting and prescribing modifiable lifestyle behaviours is cornerstone in the management of T2D in adults. Clinical trials in obese adolescents suggest that intensive lifestyle interventions that include both dietary changes and increased physical activity elicit clinically meaningful reductions in weight and improve cardiovascular risk profiles. Observational studies in youth with T2D suggest that better diet quality and increased physical activity are associated with better metabolic control; however, the limited experimental data available does not support these observations. Trials evaluating lifestyle monotherapy for the treatment of hyperglycaemia in youth with T2D do not exist, and the only study evaluating combined lifestyle and pharmacologic therapy did not show additional benefit over pharmacologic treatment with metformin alone. Physiological and psychosocial differences between youth and adults with T2D likely contribute to the differences in the effectiveness of lifestyle therapy for improving glycaemic control. The current review describes these topics in detail and provides recommendations for paediatric health care providers for the promotion of lifestyle therapy for the management of hyperglycaemia and cardiovascular risk factors for youth with T2DM.
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Affiliation(s)
- Jonathan McGavock
- Department of Pediatrics and Child Health, Faculty of Medicine, Manitoba Institute of Child Health, University of Manitoba, 511 JBRC 715 McDermot ave., Winnipeg, MB, R3E 3P4, Canada,
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Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation 2014; 131:e29-322. [PMID: 25520374 DOI: 10.1161/cir.0000000000000152] [Citation(s) in RCA: 4431] [Impact Index Per Article: 443.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Kehler DS, Stammers AN, Susser SE, Hamm NC, Kimber DE, Hlynsky MW, Duhamel TA. Cardiovascular complications of type 2 diabetes in youth. Biochem Cell Biol 2014; 93:496-510. [PMID: 25629355 DOI: 10.1139/bcb-2014-0118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The prevalence of type 2 diabetes mellitus (T2DM) in youth has increased dramatically over the past decades. The literature also suggests that the progression from an impaired glucose tolerance state to established T2DM is more rapid in youth, compared to adults. The presence of significant cardiovascular complications in youth with T2DM, including cardiac, macrovascular, and microvascular remodeling, is another major issue in this younger cohort and poses a significant threat to the healthcare system. However, this issue is only now emerging as a major public health concern, with few data to support optimal treatment targets and strategies to reduce cardiovascular disease (CVD) risk in youth with T2DM. Accordingly, the purpose of this minireview is to better understand the cardiovascular complications in youth with T2DM. We briefly describe the pathophysiology from youth studies, including oxidative stress, inflammation, renin-angiotensin aldosterone system, and epigenetics, which link T2DM and CVD. We also describe the literature concerning the early signs of CVD in youth and potential treatment options to reduce cardiovascular risk.
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Affiliation(s)
- D Scott Kehler
- a Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University Of Manitoba.,b Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre
| | - Andrew N Stammers
- a Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University Of Manitoba.,b Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre
| | - Shanel E Susser
- b Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre.,c Department of Physiology, University of Manitoba
| | - Naomi C Hamm
- a Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University Of Manitoba.,b Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre
| | - Dustin E Kimber
- a Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University Of Manitoba.,b Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre
| | - Michael W Hlynsky
- a Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University Of Manitoba.,b Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre
| | - Todd A Duhamel
- a Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University Of Manitoba.,b Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre.,c Department of Physiology, University of Manitoba.,d Manitoba Institute of Child Health, Winnipeg, Manitoba, Canada
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Kummer S, Stahl-Pehe A, Castillo K, Bächle C, Graf C, Straßburger K, Salgin B, Mayatepek E, Giani G, Holl RW, Meissner T, Rosenbauer J. Health behaviour in children and adolescents with type 1 diabetes compared to a representative reference population. PLoS One 2014; 9:e112083. [PMID: 25384048 DOI: 10.1371/journal.pone.0112083] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 10/13/2014] [Indexed: 12/30/2022] Open
Abstract
Objective We provide a population-based overview of health behaviours of children and adolescents with type 1 diabetes in comparison to the general population, and analyse their relevance for glycaemic control and self-rated health status. Methods Data from questionnaires of 11- to 17-year-old children and adolescents with diabetes (n = 629) were compared to a representative sample (n = 6,813). Results Children and adolescents with type 1 diabetes had a significantly increased odds of infrequent physical activity (adjusted OR 1.56), short overall duration of physical activity per week (OR 1.55, difference -1.3 hours/week), and high daily computer use (OR 2.51). They had a lower odds of active and passive smoking (OR 0.31 and OR 0.29), and high daily television time (OR 0.68). The odds of an at least good and excellent self-rated health status was increased with intense physical activity, and decreased with active smoking and prolonged daily use of computer and television. Active smoking and prolonged daily use of computer were associated with higher HbA1c. Conclusions Children and adolescents with type 1 diabetes showed a different profile of health behaviour. Their overall health may improve if their education stresses specifically frequent physical activity with longer overall duration and less frequent television or computer use.
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Abstract
Over the past 5 years, the fastest growing new area of physical activity research centered around the concept that the large amount of time people spend sitting inactive may have significant physiological consequences hazardous to human health, including risk for type 2 diabetes and poor metabolism of lipids and glucose. Meta-analysis (10 studies) suggests there is a 112% greater relative risk associated with a large duration of sedentary behavior for type 2 diabetes. Meta-analysis also indicates significantly greater odds for metabolic syndrome. We also summarize results for 7 studies using objective measures of total sedentary time and focusing on cardiometabolic risks in persons at high risk for type 2 diabetes or already diagnosed with type 2 diabetes. The underlying hypothesis introduced in 2004 by the inactivity physiology paradigm has been that frequent and abundant contractile activity by certain types of skeletal muscle can have a potent influence on key physiological processes, even when the intensity is below that achieved through exercise. We explain some of the mechanisms for why the metabolism in slow-twitch oxidative skeletal muscle is key for understanding the healthy responses to low-intensity physical activity (LIPA). Findings from objective measures from inclinometry indicated that the quartile range for weekly sedentary time is ∼29 h/week. The total daily time that people sit, stand, and accumulate nonexercise steps is independent of traditionally recommended moderate-vigorous physical activity. The large amount of sedentary time associated with risk for disease can only be reduced significantly with safe and nonfatiguing LIPA, especially in the most at-risk proportion of the population. Importantly, experimental studies are starting to indicate that it will be especially insightful to understand the acute dose-response effects of LIPA in order to understand why reducing sedentary time can improve lipid and glucose metabolism for the prevention and treatment of chronic disorders related to type 2 diabetes.
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Affiliation(s)
- Marc T Hamilton
- Pennington Biomedical Research Center, Baton Rouge, La., USA
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Abstract
The incidence of overweight and obesity among children has increased dramatically in recent decades, with about one-third of children in the U.S. currently being either overweight or obese. Being overweight in early childhood increases risk for later obesity. There is evidence for the efficacy of family-based behavioral treatment to control weight and improve health outcomes. Obesity-related health risks have been documented, including metabolic syndrome. There is also increasing incidence of type 2 diabetes (T2D) among youth in recent years, with obesity and family history of T2D generally present. Lower income and ethnic minority status are associated with both obesity and T2D in youth. Most youth with T2D do not achieve optimal glycemic control, and are at high risk for later health complications. Obesity and T2D represent significant public health issues with potentially great personal and societal cost. Research addressing the prevention of obesity and T2D among youth is urgently needed.
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Affiliation(s)
- Elizabeth R Pulgaron
- Department of Pediatrics, University of Miami Miller School of Medicine, 1601 NW 12th Ave, Miami, FL, USA, 33136
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Saunders TJ, Chaput JP, Tremblay MS. Sedentary behaviour as an emerging risk factor for cardiometabolic diseases in children and youth. Can J Diabetes 2014; 38:53-61. [PMID: 24485214 DOI: 10.1016/j.jcjd.2013.08.266] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/12/2013] [Accepted: 08/19/2013] [Indexed: 11/16/2022]
Abstract
Sedentary behaviour (e.g. TV viewing, seated video game playing, prolonged sitting) has recently emerged as a distinct risk factor for cardiometabolic diseases in children and youth. This narrative review provides an overview of recent evidence in this area and highlights research gaps. Current evidence suggests that North American children and youth spend between 40% and 60% of their waking hours engaging in sedentary pursuits. Although data are lacking concerning temporal trends of objectively measured sedentary time, self-reported sedentary behaviours have increased over the past half century, with a rapid increase since the late 1990s. Excessive sedentary behaviour has been found to have independent and deleterious associations with markers of adiposity and cardiometabolic disease risk. These associations are especially consistent for screen-based sedentary behaviours (TV viewing, computer games, etc), with more conflicting findings observed for overall sedentary time. The above associations are possibly mediated by the influence of screen-based sedentary behaviours on energy intake. Although excessive sitting has been reported to have adverse acute and chronic metabolic impacts in adults, research on children is lacking. Research is particularly needed to investigate the impact of characteristics of sedentary behaviour (i.e. type/context, sedentary bout length, breaks in sedentary time, etc), as well as interventions that examine the health and behavioural impacts of sitting per se.
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Affiliation(s)
- Travis J Saunders
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.
| | - Jean-Philippe Chaput
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark S Tremblay
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
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