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Pre-Adolescent Cardio-Metabolic Associations and Correlates: PACMAC methodology and study protocol.

ABSTRACT: Although cardiovascular disease is typically associated with middle or old age, the atherosclerotic process often initiates early in childhood. The process of atherosclerosis appears to be occurring at an increasing rate, even in pre-adolescents, and has been linked to the childhood obesity epidemic. This study will investigate the relationships between obesity, lifestyle behaviours and cardiometabolic health in pre-pubescent children aged 8-10 years, and investigates whether there are differences in the correlates of cardiometabolic health between M?ori and Caucasian children. Details of the methodological aspects of recruitment, inclusion/exclusion criteria, assessments, statistical analyses, dissemination of findings and anticipated impact are described.Phase 1: a cross-sectional study design will be used to investigate relationships between obesity, lifestyle behaviours (nutrition, physical activity/fitness, sleep behaviour, psychosocial influences) and cardiometabolic health in a sample of 400 pre-pubescent (8-10 years old) children. Phase 2: in a subgroup (50 Caucasian, 50 M?ori children), additional measurements of cardiometabolic health and lifestyle behaviours will be obtained to provide objective and detailed data. General linear models and logistic regression will be used to investigate the strongest correlate of (1) fatness; (2) physical activity; (3) nutritional behaviours and (4) cardiometabolic health.Ethical approval will be obtained from the New Zealand Health and Disabilities Ethics Committee. The findings from this study will elucidate targets for decreasing obesity and improving cardiometabolic health among preadolescent children in New Zealand. The aim is to ensure an immediate impact by disseminating these findings in an applicable manner via popular media and traditional academic forums. Most importantly, results from the study will be disseminated to participating schools and relevant M?ori health entities.

SUBMITTER: Castro N

PROVIDER: S-EPMC4170204 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Pre-Adolescent Cardio-Metabolic Associations and Correlates: PACMAC methodology and study protocol.

Castro Nicholas N Faulkner James J Skidmore Paula P Williams Michelle M Lambrick Danielle M DM Signal Leigh L Thunders Michelle M Muller Diane D Lark Sally S Hamlin Mike M Lane Andrew M AM Kingi Te Kani TK Stoner Lee L

BMJ open 20140918 9

<h4>Introduction</h4>Although cardiovascular disease is typically associated with middle or old age, the atherosclerotic process often initiates early in childhood. The process of atherosclerosis appears to be occurring at an increasing rate, even in pre-adolescents, and has been linked to the childhood obesity epidemic. This study will investigate the relationships between obesity, lifestyle behaviours and cardiometabolic health in pre-pubescent children aged 8-10 years, and investigates whethe ...[more]

PMID: 25234509

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Project description:The increasing prevalence of childhood obesity is a serious public health problem associated with co-morbidities in adulthood, as well as childhood. This study was conducted to identify associations between total sugar intake and sugar intake from different foods (fruit, milk, and sugar-sweetened beverages (SSBs)), and adiposity and continuous metabolic syndrome scores (cMetS) among Korean children and adolescents using cohort data. The study subjects were children (n = 770) who participated in the 4th year (2008) of the Korean Child-Adolescent Cohort Study (KoCAS). Dietary intake data were collected via three-day 24-h food records, and sugar intake was calculated for the total sugar content of foods using our database compiled from various sources. Anthropometric measurements, assessments of body composition, and blood sample analysis were performed at baseline and at follow-up four years later. The cMetS was calculated based on waist circumference, triglycerides, high-density lipoprotein cholesterol, glucose, and mean arterial blood pressure. According to multiple linear regression analysis, there were no significant associations between total sugar intake and adiposity and cMetS. However, higher intake of fruit sugar at baseline was significantly associated with lower body mass index (BMI) z-scores and body fat percentages at baseline (? = -0.10, p = 0.02 and ? = -0.78, p < 0.01, respectively). At follow-up, sugar intake from fruit at baseline was still negatively associated with the above outcomes, but only the relationship with BMI z-scores retained statistical significance (? = -0.08, p < 0.05). There was a significant positive relationship between consumption of sugar from SSBs and cMetS at baseline (? = 0.04, p = 0.02), but that relationship was not observed at follow-up (p = 0.83). Differences in consumption sugars from fruit and SSBs might play an important role in the risk of adiposity and metabolic disease in children and adolescents. Our results suggest that strategies for reducing sugar intake need to target particular food groups. Consequently, this information could be of value to obesity- and metabolic disease-prevention strategies.

Project description:BACKGROUND:To increase cardiovascular disease prevention efforts, worksite interventions can promote healthy food choices, facilitate health education, increase physical activity and provide social support. This pioneer study will measure the effectiveness of a cafeteria and a behavioral intervention on cardio-metabolic risk in a worksite in Nepal. METHODS:The Nepal Pioneer Worksite Intervention Study is a two-step intervention study conducted in Dhulikhel Hospital in eastern Nepal. In the first step, we will assess the effectiveness of a 6-month cafeteria intervention on cardio-metabolic risk using a pre-post design. In the second step, we will conduct a 6-month, open-masked, two-arm randomized trial by allocating half of the participants to an individual behavioral intervention based on the 'diabetes prevention program' for the prevention of cardio-metabolic risk. We will recruit 366 full time employees with elevated blood pressure, fasting blood sugar, or glycosylated haemoglobin (HbA1c). At baseline, we will measure their demographic variables, lifestyle factors, anthropometry, fasting blood sugar, HbA1c,and lipid profiles. We will measure cardio-metabolic outcomes at 6?months, 12?months, and 18?months. At 12?months, we will compare the proportion of participants who have attained two or more cardio-metabolic risk factor reduction goals (HbA1c decrease ?0.5%; systolic blood pressure decrease ?5?mmHg; or triglycerides decrease ?10?mg/dL) during the cafeteria intervention period and the control period using generalized estimating equations. At 18?months, we will compare the proportion from the 'cafeteria only arm' to the 'cafeteria and behavior arm' for the same outcome using a chi-square test. DISCUSSION:This pioneer study will estimate the effect of environmental-level changes on lowering cardio-metabolic risks; and added benefit of an individual-level dietary intervention. If the study demonstrates a significant effect, a scaled up approach could produce an important reduction in cardiovascular disease burden through environmental and individual level prevention programs in Nepal and similar worksites worldwide. TRIAL REGISTRATION:The trial was retrospectively registered on clincaltrials.gov (Identification Member: NCT03447340 ; Date of Registration: February 27, 2018).

Project description:BackgroundHigh amounts of time spent sitting can increase cardiovascular disease risk and are deleteriously associated cardio-metabolic risk biomarkers. Though evidence suggests that accruing sitting time in prolonged periods may convey additional risk, verification using high-quality measures is needed. We examined this issue in adults from the Australian Diabetes, Obesity and Lifestyle Study, using accurate measures of sitting accumulation.MethodsIn 2011/12, 739 adults aged 36 to 89 years (mean±SD 58±10 years) wore activPAL3™ monitors (which provide accurate objective measures of sitting); 678 provided ?4 valid days of monitor data and complete cardio-metabolic biomarker and confounder data. Multivariable linear regression models examined associations of sitting time, sitting time accrued in ?30 minute bouts (prolonged sitting time), and three measures of sitting accumulation patterns with cardio-metabolic risk markers: body mass index (BMI), waist circumference, blood pressure, high- and low- density lipoprotein (HDL and LDL) cholesterol, triglycerides, glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and 2-hour post-load glucose (PLG). Interactions tests examined whether associations of sitting time with biomarkers varied by usual sitting bout duration.ResultsAdjusted for potential confounders, greater amounts of sitting time and prolonged sitting time were significantly (p<0.05) deleteriously associated with BMI, waist circumference, HDL cholesterol, and triglycerides. Total sitting time was also significantly associated with higher PLG. Sitting accumulation patterns of frequently interrupted sitting (compared to patterns with relatively more prolonged sitting) were significantly beneficially associated with BMI, waist circumference, HDL cholesterol, triglycerides, PLG, and with FPG. Effect sizes were typically larger for accumulation patterns than for sitting time. Significant interactions (p<0.05) showed that associations of sitting time with HDL, triglycerides and PLG became more deleterious the longer at a time sitting was usually accumulated.ConclusionsAdding to previous evidence reliant on low-quality measures, our study showed that accumulating sitting in patterns where sitting was most frequently interrupted had significant beneficial associations with several cardio-metabolic biomarkers and that sitting for prolonged periods at a time may exacerbate some of the effects of sitting time. The findings support sedentary behavior guidelines that promote reducing and regularly interrupting sitting.

Project description:BACKGROUND:Physical activity, sedentary time and sleep have been shown to be associated with cardio-metabolic health. However, these associations are typically studied in isolation or without accounting for the effect of all movement behaviours and the constrained nature of data that comprise a finite whole such as a 24?h?day. The aim of this study was to examine the associations between the composition of daily movement behaviours (including sleep, sedentary time (ST), light intensity physical activity (LIPA) and moderate-to-vigorous activity (MVPA)) and cardio-metabolic health, in a cross-sectional analysis of adults with pre-diabetes. Further, we quantified the predicted differences following reallocation of time between behaviours. METHODS:Accelerometers were used to quantify daily movement behaviours in 1462 adults from eight countries with a body mass index (BMI) ?25?kg·m-?2, impaired fasting glucose (IFG; 5.6-6.9?mmol·l-?1) and/or impaired glucose tolerance (IGT; 7.8-11.0?mmol•l-?1 2?h following oral glucose tolerance test, OGTT). Compositional isotemporal substitution was used to estimate the association of reallocating time between behaviours. RESULTS:Replacing MVPA with any other behaviour around the mean composition was associated with a poorer cardio-metabolic risk profile. Conversely, when MVPA was increased, the relationships with cardiometabolic risk markers was favourable but with smaller predicted changes than when MVPA was replaced. Further, substituting ST with LIPA predicted improvements in cardio-metabolic risk markers, most notably insulin and HOMA-IR. CONCLUSIONS:This is the first study to use compositional analysis of the 24?h movement composition in adults with overweight/obesity and pre-diabetes. These findings build on previous literature that suggest replacing ST with LIPA may produce metabolic benefits that contribute to the prevention and management of type 2 diabetes. Furthermore, the asymmetry in the predicted change in risk markers following the reallocation of time to/from MVPA highlights the importance of maintaining existing levels of MVPA. TRIAL REGISTRATION:ClinicalTrials.gov (NCT01777893).

Project description:AimsTo describe the distribution and examine the associations of diabetes, hypertension and hypercholesterolaemia across and within population groups, gender and body mass index (BMI) categories.MethodsThis national cross-sectional study was conducted in 2013 among ≥18-year-old black African, coloured, white and Indian adults self-selected for screening. Data collection included self-reported behavioural risk factors and clinical measurements comprising blood pressure, anthropometry and point-of-care random blood glucose and cholesterol assessments.ResultsAmong the 7711 participants, 2488 men and 5223 women, the prevalence of diabetes and hypertension increased by BMI category across population groups. Compared with white men and women, black African men (odds ratio: 2.66, 95% confidence interval: 1.70-4.16) and women (2.10, 1.49-2.96), coloured men (2.28, 1.44-3.60) and women (2.15, 1.52-3.05) and Indian men (4.38, 2.65-7.26) and women (3.64, 2.50-5.32) were significantly more likely to have diabetes. The odds for hypertension were significantly higher only in coloured men compared with white men (1.37, 1.02-1.83), while it was significantly higher in black African, coloured and Indian women compared with white women. The odds for hypercholesterolaemia were significantly lower in black African men (0.64, 0.49-0.84) and women (0.52, 0.43-0.62) compared with white men and women, and significantly higher in Indian men (1.47, 1.05-2.08) compared with white men. Black African women compared with their male counterparts were less likely to have diabetes (0.64, 0.46-0.89). Black African (0.66, 0.54-.082), coloured (0.65, 0.50-0.84) and white (0.69, 0.53-0.88) women were significantly less likely to have hypertension compared with their male counterparts. The odds for hypercholesterolaemia were higher in coloured (1.44, 1.16-1.80) and white (1.47, 1.18-1.84) women compared with their counterparts.ConclusionsThe cardio-metabolic diseases of diabetes, hypertension and hypercholesterolaemia were differentially associated with population groups and gender in South Africa. The insights obtained highlight the need for multi-disciplinary targeted management approaches in high-risk populations.

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Pre-Adolescent Cardio-Metabolic Associations and Correlates: PACMAC methodology and study protocol.

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Pre-Adolescent Cardio-Metabolic Associations and Correlates: PACMAC methodology and study protocol.

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