Inflammation and fatness in adolescents with and without Down syndrome: UP & DOWN study.

BACKGROUND: The main objective of this study was to describe the inflammatory status of adolescents with Down syndrome (DS) and their relationship with adiposity. METHODS: Ninety-five adolescents with DS (44.2% girls) and a control group of 113 adolescents (47.8% girls), aged between 11 and 18 years old, from the UP & DOWN study were included in this substudy. Serum C-reactive protein, C3 and C4 complement factors, total proteins, interleukin-6, tumour necrosis factor-α, insulin, cortisol, leptin, adiponectin, galactin-3 and visfatin were analysed; homeostatic model assessment index was calculated. In order to evaluate adiposity, we measured the following body fat variables: weight, height, waist circumference and skinfold thicknesses. Birth weight was obtained by questionnaire. In addition, body mass index, waist-to-height ratio (WHtR) and body fat percentage (BF%) were calculated. RESULTS: Down syndrome group showed higher levels of body mass index, WHtR, waist circumference, BF% and lower birth weight than controls (P < 0.001). In the general linear model in the total sample, WHtR was positively associated with C3 and C4 (P < 0.001) as well as with leptin levels (P = 0.015). BF% was positively associated with total proteins (P = 0.093) and leptin levels (P < 0.001). DS was positively associated with total proteins (P < 0.001), C3 (P = 0.047) and C4 (P = 0.019). Despite the higher levels of adiposity found in DS group, no direct association was found between BF% and leptin levels, comparing with the control group. CONCLUSIONS: These findings suggest that abdominal obesity should be controlled in adolescents because of its relationship with acute phase-inflammatory biomarkers but especially in DS adolescents who may show a peculiar metabolic status according to their relationship between adiposity and inflammatory biomarkers.

Criterion-related validity of self-report walking time from the EPIC questionnaire in older adults.

Tools for measuring walking time make use of objective and subjective methods. One subjective approach is to administer physical activity questionnaires (PAQ), mainly because they are inexpensive and easy to give to large groups. The European Prospective Investigation into Cancer and Nutrition (EPIC) study has a brief PAQ (EPIC-PAQ) and includes one question referencing walking time. The objective of this study was to assess the validity of the question about time spent walking included in the EPIC-PAQ. The sample included 200 older adults (113 women). To assess daily walking time, participants responded to the EPIC-PAQ in an interview and wore a portable gait analysis system and physical activity monitor for 48 consecutive hours in free-living condition. Results indicated that the mean of bias between the EPIC-PAQ and objetive measurement was -64.6 min/day. Also, the correlation was low compared to an objective measurement (rho = 0.196) and was positively correlated with the time spent at speeds below 2.5 mph but the correlation was low (slow walking rho = 0.154 and pace walking rho = 0.163). The EPIC-PAQ shows low correlations with the objective measurement of walking time, that suggests it may be inaccurate and affecting the estimate of the EPIC-PAQ's PA energy expenditure in this age group.

Changes in objectively measured physical activity in adolescents with Down syndrome: the UP&DOWN longitudinal study.

BACKGROUND: It is a priority to understand that physical activity behaviour over time is a priority in Down syndrome population in order to design and promote succesfull interventions to maintain or increase levels of physical activity. We aimed to study 1 and 2-year changes in objectively measured physical activity among a relatively large sample of adolescents with Down syndrome. METHODS: This study comprised a total of 99 adolescents with Down syndrome (38 girls) aged from 11 to 20 years old at baseline. Participants with valid accelerometer data at baseline and at least one of the follow-up visits were included in the analysis. RESULTS: Overall, levels of physical activity observed in adolescents with Down syndrome declined from baseline to follow-ups, but these changes were not significant (all P > 0.05). Moderate-to-moderately high tracking of physical activity was observed in adolescents with Down syndrome (all P < 0.001). Youths who met physical activity guidelines at baseline demonstrated a greater decline in physical activity in 1 and 2-year changes (P < 0.05), although they were also more likely to meet physical activity guidelines at 1 and 2-year follow-ups (P < 0.05). CONCLUSIONS: Adolescents with Down syndrome do not change their levels of physical activity at 2-year follow-ups, but those who met physical activity guidelines presented stronger declines in physical activity over time.

The role of fatness on physical fitness in adolescents with and without Down syndrome: The UP&DOWN study.

BACKGROUND/OBJECTIVES: Adolescents with Down syndrome (DS) exhibit higher levels of fatness and low levels of physical fitness compared with those without DS. In adolescents without DS, fatness is tightly associated with physical fitness, but this association is unclear in adolescents with DS. The aim of this study was to examine the association between several markers of fatness and physical fitness in a relative large sample of adolescents with and without DS. SUBJECTS/METHODS: A total of 111 adolescents with DS (41 females) aged 11-20 years participated in this cross-sectional study. We also included a sex-matched control group (ratio 1:2) of 222 adolescents without DS aged 12-18 years, participating in the UP&DOWN Study. The Assessing Level of Physical Activity (ALPHA) health-related fitness test battery for adolescents was used to assess fatness and physical fitness. RESULTS: Our results show that fatness is not associated with low levels of physical fitness in adolescents with DS (that is, 3 of the 16 analyses identified differences in physical fitness variables by groups of fatness). In contrast, fatness, as expected, is associated with levels of physical fitness in adolescents without DS (that is, 13 of the 16 analyses identified differences in physical fitness variables by groups of fatness). CONCLUSIONS: The present finding contributes to new knowledge by suggesting that the role of fatness on physical fitness is different in adolescents with and without DS, and consequently, the poor levels of physical fitness in adolescents with DS may be due to the syndrome rather than the high prevalence of obesity from this population.

Cognition and the risk of eating disorders in Spanish adolescents: the AVENA and AFINOS studies.

UNLABELLED: Eating disorders (ED) can arise from a combination of biological and psychological factors. Some studies suggest that intellectual factors might be important in the development of ED, although the evidence is still scarce. The aim of this study was to examine the association between cognition measurements (cognitive performance and academic achievement) and the risk of developing ED in adolescents considering their weight status. The sample consisted of 3,307 adolescents (1,756 girls), aged 13-18.5 years, who participated in the AVENA (n = 1,430; 783 girls) and AFINOS (n = 1,877; 973 girls) studies. Cognitive performance was measured by the TEA test in the AVENA study, and academic achievement was self-reported in the AFINOS study. ED risk was evaluated in both studies by using the SCOFF questionnaire. Body mass index was calculated to classify adolescents as non-overweight or overweight (including obesity). Overweight adolescents showed a higher risk of developing ED than non-overweight ones in both studies. In the AVENA study, overweight boys with low performance in reasoning ability showed increased risk of ED (p = 0.05). In the AFINOS study, overweight boys with low academic performance in physical education and non-overweight girls with low academic achievement in all the areas analyzed showed higher risk of ED than their peers (all p < 0.05). CONCLUSION: No association between cognitive performance and ED risk was found in adolescents, while academic achievement was associated with ED risk, especially in non-overweight girls. The non-cognitive traits that accompany academic achievement could influence the likelihood of developing ED in these girls.

Physical fitness, overweight and the risk of eating disorders in adolescents. The AVENA and AFINOS studies.

UNLABELLED: What is already known about this subject Eating disorders are among the public health issues facing adolescents. An excess of body fat has been associated with an increased risk of these disorders. The association of physical fitness with eating disorders has not yet been analysed in adolescents. What this study adds This study confirms that the overweight and obesity increase the risk of developing eating disorders. The present study shows that there is an inverse association between physical fitness levels and the risk of eating disorders. This study suggests that physical fitness might attenuate the influence of overweight on the development of eating disorders in adolescents. BACKGROUND: Eating disorders together with the overweight and obesity are important health concerns in adolescents. OBJECTIVE: To analyse the individual and combined influence of overweight and physical fitness on the risk of developing eating disorders in Spanish adolescents. METHODS: The sample consisted of 3571 adolescents (1864 females), aged 13 to 18.5 years, from Spain who participated in the AVENA and AFINOS studies. The risk of eating disorders was evaluated using the SCOFF questionnaire. Body mass index was calculated and the adolescents were classified into two groups: overweight (including obesity) and non-overweight according to Cole's cut-off points. Cardiorespiratory fitness in the AVENA Study was assessed by the 20-m shuttle-run test and the overall physical fitness level was self-reported in the AFINOS Study. RESULTS: Overweight adolescents had a higher risk of developing eating disorders than non-overweight adolescents (odds ratio [OR] = 4.91, 95% confidence interval [CI]: 3.63-6.61 in the AVENA Study and OR = 2.45, 95% CI: 1.83-3.22 in the AFINOS Study). Also, adolescents with medium and low levels of physical fitness had a higher risk of developing eating disorders (OR = 1.51, 95% CI: 1.05-2.16, and OR = 2.25, 95% CI: 1.60-3.19, respectively, in the AVENA Study, and OR = 1.73, 95% CI: 1.37-2.17, and OR = 4.11 95% CI: 2.98-5.65, respectively, in the AFINOS Study) than adolescents with high levels of physical fitness. In both studies, the combined influence of overweight and physical fitness showed that adolescents with lower levels of physical fitness had an increased risk of developing eating disorders in both non-overweight and overweight groups. CONCLUSIONS: Physical fitness might attenuate the influence of overweight on the development of eating disorders in adolescents.

Gender-specific influence of health behaviors on academic performance in Spanish adolescents: the AFINOS study.

INTRODUCTION: New paradigms based on the multifactorial etiology of chronic diseases and behavioral outcomes suggest that a combination of health behaviors may have more impact on the outcome of interest than any single factor. OBJECTIVE: To examine the independent and combined influence of four health behaviors on school performance in Spanish adolescents. METHODS: A total of 1825 Spanish adolescents reported their grades in Language and Literature (LL) and Math. Body mass index, family structure and school-related factors (attitude to school, need to repeat > 1-yr and absenteeism) were self-reported. Adolescents were dichotomized as healthy or unhealthy based on meeting or not meeting lifestyle recommendations on physical activity, TV viewing, sleep and fruit intake. Each adolescent was also scored according to the number of healthy recommendations fulfilled. RESULTS: In boys, there were no associations between health behaviors and academic performance. Good academic performance in girls was associated with physical activity (P < 0.05) or fruit consumption (P < 0.05). Moreover, girls who scored 3-4 health behaviors showed higher odds of passing LL (OR = 3.18, P < 0.001), Math (OR = 1.75, P = 0.028) or LL+Math (OR = 2.32, P = 0.001) compared with those with 0-1 health behaviors. All the analyses were adjusted by weight status, family context and different school-related factors. CONCLUSIONS: A combination of health behaviors may have a positive influence on academic performance in adolescent girls.

Associations of physical activity and fitness with adipocytokines in adolescents: the AFINOS Study.

BACKGROUND AND AIMS: Adipocytokines may have a key role in the development of atherosclerosis and type 2 diabetes. The purpose of this study was to examine the independent and joint associations of physical activity (PA), cardiorespiratory fitness (CRF) and muscular fitness (MF) with adiponectin and leptin in adolescents. METHODS AND RESULTS: A sample of 198 adolescents (96 girls), aged 13-17-year, was selected. Participants completed anthropometric measurements (height, weight, and waist circumference) and percentage of body fat (%BF) was estimated by bioelectrical impedance. PA was measured by accelerometer for 7-day. The 20-m shuttle-run test was used to assess CRF and two MF tests (handgrip strength and standing broad jump) were used to create an MF score. A cluster score of health status (0-3 risks) was created. Serum adiponectin and plasma leptin were also determined. Regression analyses controlling for age, sex, pubertal status and waist circumference showed that PA was not significantly associated with adiponectin and vigorous PA showed a significant inverse association with leptin. Both CRF and MF were significantly and inversely associated with adiponectin and leptin. Further analyses revealed that the 'healthy' group (0 risks) had significantly lower adiponectin and leptin than 'medium-healthy' (1 risk) and 'unhealthy' (2-3 risks) status groups. CONCLUSIONS: PA, CRF and MF are inversely and jointly associated with adiponectin and leptin concentrations in adolescents.

Associations of physical activity with muscular fitness in adolescents.

The aim of this study was to examine the associations between objectively assessed physical activity (PA) and muscular fitness (MF) in adolescents, and to determine whether only resistance training exercise is associated with the increase of MF. A sample of 211 Spanish adolescents (105 girls) wore the ActiGraph monitor for 7 days. Participants also completed a fitness evaluation including three MF tests (handgrip strength, a 60-s abdominal test and a standing broad jump), a cardiorespiratory fitness assessment and anthropometric measures. A standardized MF score was computed using the three muscular tests. Adolescent participation in resistance training was self-reported. Linear regression showed that only vigorous PA was significantly (P=0.041) and positively (ß=0.133) associated with MF after adjustment by gender, age, pubertal status, BMI, and cardiorespiratory fitness. Significant differences in MF were found between youth in the lowest and upper tertiles of vigorous PA. Moreover, adolescents who were involved in resistance training had significantly higher MF scores compared with youth in low and medium tertiles of vigorous PA, but no significant differences were found when compared with non-lifters from the highest tertile of vigorous PA (P=0.356). These findings suggest that vigorous activity may be associated with indicators of MF in adolescents.

Associations of physical activity, cardiorespiratory fitness and fatness with low-grade inflammation in adolescents: the AFINOS Study.

OBJECTIVE: To examine the independent associations of objectively measured physical activity (PA), cardiorespiratory fitness (CRF) and fatness with low-grade inflammatory markers in adolescents. DESIGN: Cross-sectional study in Spain. SUBJECTS: A sample of 192 adolescents aged 13-17 years. MEASUREMENTS: PA was assessed with an accelerometer for 7 days. A 20-m shuttle-run test was used to assess CRF. Skinfold thicknesses at six sites and WCs were measured. BMI was calculated from measured height and weight. C-reactive protein (CRP), interleukin-6 (IL-6) and complement factors C3 and C4 were assayed. The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated from glucose and insulin. Regression analysis adjusted for potential confounders and HOMA-IR was used to determine the associations between PA, CRF and fatness with low-grade inflammatory markers. RESULTS: Total PA, vigorous PA and MVPA were positively associated with CRF (r=0.25-0.48), whereas vigorous PA was negatively associated with skinfolds (r=-0.27). CRF was inversely associated with fatness, (r=-0.30 to -0.48). CRF and fatness were inversely and positively associated with HOMA-IR (r=-0.16 and 0.21, respectively). PA variables were not independently associated with inflammatory markers. CRF and fatness were inversely and positively associated with CRP, C3 and C4, respectively. Only body fat explained a relevant amount of the variance of the model in CRP (4%) and C4 (19%), whereas CRP and body fat jointly explained the variance in C3 (25%). All these observations were independent of HOMA-IR. CONCLUSIONS: These findings support the key role of CRF and fatness on low-grade inflammation, as well as the possible indirect role of habitual PA through CRF and body fat in adolescents.

Preliminary evidence of physical activity levels measured by accelerometer in Spanish adolescents: the AFINOS Study.

BACKGROUND: It is necessary to know the levels of physical activity (PA) for a better understanding of the development of chronic diseases in youth. The aim of this study was to assess levels of total PA and time spent in different PAintensities in Spanish adolescents by accelerometer. METHODS: A sub-sample of 214 healthy Spanish adolescents (107 females), aged 13-16 years, enrolled in the AFINOS Study was selected for this study. Participants wore the ActiGraph GT1M accelerometer for 7 consecutive days. Total PA and time spent in sedentary, light, moderate, vigorous, and moderate to vigorous physical activity (MVPA) was estimated using the accelerometer. Adiposity was measured in the sample using sum of 6 skinfoldthickness, waist circumference and BMI. RESULTS: Adolescent boys were engaged in higher levels of total PA, moderate PA, vigorous PA and MVPA than adolescent girls, whereas girls were engaged in higher levels of light PA. Differences between age groups showed that the 15-16 years group did more total PA (P = 0.008) than the 13-14 years group. Adolescents with highest levels of body fat were less active and spent less time in vigorous PA and MVPA than adolescents with less body fat. Among the current sample, 71.1% of the adolescents (82.2% adolescent boys and 60.7% adolescent girls) reached the recommendation of > or = 60 min in MVPA. CONCLUSIONS: Although these findings suggest that Spanish adolescents have similar PA levels than other European adolescents, further cross-sectional and longitudinal studies must assess PA levels in free-living conditions in Spanish children and adolescents using objective methods such as accelerometers, heart rate monitors and pedometers.

The role of physical activity and fitness on the metabolic syndrome in adolescents: effect of different scores. The AFINOS Study.

The aim of this study was to examine the associations of objectively measured physical activity (PA) and cardiorespiratory fitness (CRF) with different continuous metabolic syndrome (MetS) scores in adolescents. A cross-sectional sub-sample of 202 adolescents (99 girls), aged 13-17 years, were selected from the AFINOS Study. Body mass index, sum of 6 skindfold, waist circumference, systolic and diastolic blood pressure, insulin, glucose, triacylglycerol, and HDL-cholesterol levels were determined. Moderate PA (MPA), vigorous PA (VPA) and moderate to vigorous PA (MVPA) were assessed by the ActiGraph accelerometer for 7 consecutive days and CRF was estimated by the 20-m shuttle run test. Three continuous MetS scores were calculated according to the methodology of the Corpus Christi Child Heart Study (CCCHS), the Aerobic Center Longitudinal Study (ACLS), and the European Youth Heart Study (EYHS). VPA and MVPA were significantly related with CRF. Only CRF, and not patterns of PA, was inversely and independently associated with the three MetS scores although with different magnitudes (ranged: beta = 0.22 to 0.36, p < 0.05). A significant VPA x CRF interaction (p = 0.011) was found using the ACLS MetS score. Trends across VPA-CRF groups were significantly different with ACLS and EYHS (p = 0.002 and p = 0.006, respectively), but not with CCCHS (p = 0.313) continuous MetS scores. These findings support the key role of CRF on the MetS and the relevance of PA, especially VPA, to provide CRF in adolescents. A unified pediatric definition of MetS might minimize the discrepancies among studies.

Comparison of the ActiGraph accelerometer and Bouchard diary to estimate energy expenditure in Spanish adolescents.

INTRODUCTION: The aim of this study was to evaluate the agreement between the ActiGraph accelerometer and the Bouchard diary to estimate energy expenditure (EE) in a Spanish adolescent population. METHODS: Sixty-one Spanish adolescents, aged 12-16 years, were recruited for this study. The Bouchard diary and the ActiGraph were administered for 3 consecutive days. EE estimated by the Bouchard diary was calculated using 2 different MET category values (BD-Bouchard and BD-Bratteby). EE estimated by the ActiGraph was calculated using 3 predictive equations (AC-Trost, AC-Freedson, and AC-Ekelund). Participants with complete 24 h data were also analyzed to control the possible loss of accuracy. Agreement was examined by Pearson and concordance correlations, paired t-test, and Bland-Altman method. RESULTS: Thirty-seven adolescents were included in the analyses with complete 72 h. Relationships between EE calculated by the Bouchard diary and the ActiGraph were high (ranged: r = 0.61-0.78). Concordance correlations were moderate (r c = 0.60) by BD-Bratteby and AC-Trost, and low using BD-Bratteby and AC-Ekelund (r c = 0.15). EE estimated by BD-Bratteby and AC-Trost also showed no significant differences (P> 0.05) and absolutely agree 0.0 +/- 5.0 MJ/d (95% confidence interval: +/- 0.90 MJ/d), but with wide limits of agreement (+/- 9.80 MJ/d). Relationships were higher and differences were smaller in the 72 h sample than in the 24 h sample. CONCLUSIONS: The Bouchard diary and the ActiGraph showed high relationships, moderate concordance, and large differences to estimate EE in Spanish adolescents. Advantages, disadvantages, and agreements between both instruments must be taking into consideration for health-related research.

Shifts in clostridia, bacteroides and immunoglobulin-coating fecal bacteria associated with weight loss in obese adolescents.

OBJECTIVE: To evaluate the effects of a multidisciplinary obesity treatment programme on fecal microbiota composition and immunoglobulin-coating bacteria in overweight and obese adolescents and their relationship to weight loss. DESIGN: Longitudinal intervention study based on both a calorie-restricted diet (calorie reduction=10-40%) and increased physical activity (calorie expenditure=15-23 kcal/kg body weight per week) for 10 weeks. PARTICIPANTS: Thirty-nine overweight and obese adolescents (BMI mean 33.1 range 23.7-50.4; age mean 14.8 range, 13.0-16.0). MEASUREMENTS: BMI, BMI z-scores and plasma biochemical parameters were measured before and after the intervention. Fecal microbiota was analyzed by fluorescent in situ hybridization. Immunoglobulin-coating bacteria were detected using fluorescent-labelled F(ab')2 antihuman IgA, IgG and IgM. RESULTS: Reductions in Clostridium histolyticum and E. rectale-C. coccoides proportions significantly correlated with weight and BMI z-score reductions in the whole adolescent population. Proportions of C. histolyticum, C. lituseburense and E. rectale-C. coccoides dropped significantly whereas those of the Bacteroides-Prevotella group increased after the intervention in those adolescents who lost more than 4 kg. Total fecal energy was almost significantly reduced in the same group of adolescents but not in the group that lost less than 2.5 kg. IgA-coating bacterial proportions also decreased significantly in participants who lost more than 6 kg after the intervention, paralleled to reductions in C. histolyticum and E. rectale-C. coccoides populations. E. rectale-C. coccoides proportions also correlated with weight loss and BMI z-score reduction in participants whose weight loss exceeded 4 kg. CONCLUSIONS: Specific gut bacteria and an associated IgA response were related to body weight changes in adolescents under lifestyle intervention. These results suggest interactions between diet, gut microbiota and host metabolism and immunity in obesity.