Cardiorespiratory effects of project energize: a whole-of region primary school nutrition and physical activity programme in New Zealand in 2011 and 2015.

BACKGROUND: Since 2004, Sport Waikato has delivered Project Energize, a through-school nutrition and physical activity program to primary schools in the Waikato. As part of the program's continued assessment and quality control, the programme was evaluated in 2011 and 2015. This paper's aim was to compare the cardiorespiratory fitness (time to run 550 m (T550)) levels of children participating in Project Energize in 2011 and 2015. METHODS: In the 2011 evaluation of Project Energize, gender specific- T550-for-age Z scores (T550AZ) were derived from the T550 of 4832 Waikato children (2527 girls; 2305 boys; 36% Maori) aged between 6 and 12 years. In 2015, T550 was measured for 4798 (2361 girls; 2437 boys; 32% Maori) children, representative of age, gender and school socioeconomic status (SES). The T550AZ for every child in the 2015 study and 2011 evaluation were derived and differences in T550 between 2015 and 2011 by gender, SES and age were determined using independent t-tests. Multiple regression analysis predicted T550 Z score and run time, using year of measurement, gender, ethnicity, age and school SES. RESULTS: With and without adjustment, children in 2015 ran 550 m faster than in 2011 (adjusted Z score 0.06, time 11 s). Specifically, girls ran at a similar speed in 2015 as 2011 but boys were faster than in 2011 (Z score comparison P < 0.001, mean difference 0.18 95%CI 0.12, 0.25). Regression analysis showed time taken to run 550 m was 11 s less in 2015 compared with 2011. Boys ran it 13 s faster than girls (Z score 0.07) and for each 1 year age increase, children were 8 s slower (Z score 0.006). For each 10% decrease in SES, children were 3 s slower (Z score 0.004) and Maori children were 5 s slower than Non-Maori children (Z score 0.15). CONCLUSIONS: The findings from this study support the continuation of the delivery of Project Energize in the Waikato region of New Zealand, as cardiorespiratory fitness scores in 2015, compared to 2011, were improved, particularly for lower SES schools and for Maori children. Ethnically diverse populations, schools with higher deprivation and girls, continue to warrant further attention to help achieve equity.

Metformin in gestational diabetes: the offspring follow-up (MiG TOFU): body composition and metabolic outcomes at 7-9 years of age.

OBJECTIVE: To compare body composition and metabolic outcomes at 7-9 years in offspring of women with gestational diabetes (GDM) randomized to metformin (±insulin) or insulin treatment during pregnancy. RESEARCH DESIGN AND METHODS: Children were assessed at 7 years in Adelaide (n=109/181) and 9 years in Auckland (n=99/396) by anthropometry, bioimpedance analysis (BIA), dual-energy X-ray absorptiometry (DXA), magnetic resonance imaging (MRI) (n=92/99) and fasting bloods (n=82/99). RESULTS: In the Adelaide subgroup, mothers were similar at enrollment. Women randomized to metformin versus insulin had higher treatment glycemia (p=0.002) and more infants with birth weight >90th percentile (20.7% vs 5.9%; p=0.029). At 7 years, there were no differences in offspring measures. In Auckland, at enrollment, women randomized to metformin had a higher body mass index (BMI) (p=0.08) but gained less weight during treatment (p=0.07). Offspring birth measures were similar. At 9 years, metformin offspring were larger by measures of weight, arm and waist circumferences, waist:height (p<0.05); BMI, triceps skinfold (p=0.05); DXA fat mass and lean mass (p=0.07); MRI abdominal fat volume (p=0.051). Body fat percent was similar between treatment groups by DXA and BIA. Abdominal fat percentages (visceral adipose tissue, subcutaneous adipose tissue and liver) were similar by MRI. Fasting glucose, triglyceride, insulin, insulin resistance, glycosylated hemoglobin (HbA1c), cholesterol, liver transaminases, leptin and adiponectin were similar. CONCLUSIONS: Metformin or insulin for GDM was associated with similar offspring total and abdominal body fat percent and metabolic measures at 7-9 years. Metformin-exposed children were larger at 9 years. Metformin may interact with fetal environmental factors to influence offspring outcomes.

Tracking food consumption frequency of children from age 4 to 6 years: the Pacific Islands Families study.

AIM: To report longitudinal food frequency consumption and evaluate tracking of food frequency among a cohort of New Zealand-born Pacific children. OBJECTIVE: Identify the most commonly consumed foods and estimate tracking among Pacific children aged 4 and 6 years. METHOD: A qualitative food frequency questionnaire was administered to n>1,000 caregivers of children aged 4 and 6 years. Consumption scores were developed from averaged frequency of daily food. Foods and food groups were examined for tracking. RESULTS: Caregivers completed questionnaires for 646 children at both ages. Twelve most frequently consumed foods were identified, accounting for up to 25% of all food consumed daily. Across ages 4 and 6, the association for frequency of the most frequently consumed foods was moderate (r(2)=0.53). Food groups: breads and cereals; meat and alternates; and vegetables and fruit constituted approximately 72% of all foods consumed daily. The association of frequency of consumption within food groups across the two measurement periods was strong (r(2)=0.96). CONCLUSIONS: Pacific children consume similar foods that track from age 4 through age 6 years.

Blood pressure measurement at two years in offspring of women randomized to a trial of metformin for GDM: follow up data from the MiG trial.

BACKGROUND: Offspring born following maternal gestational diabetes are at risk of excessive childhood weight gain and Type 2 diabetes in childhood, which in turn is associated with an increased rate of hypertension. We aimed to determine the systolic and diastolic blood pressure at two years of age in a cohort of children exposed to gestational diabetes mellitus using data from the MiG trial of metformin use in gestational diabetes. The secondary aim was to analyze these data by randomization of treatment to insulin or metformin. METHODS: The offspring of women who had gestational diabetes and had been assigned to either open treatment with metformin (with supplemental insulin if required) or insulin in the MiG trial were followed up at 2 years of age. Oscillometric measurement of BP in the right arm was performed by a researcher using an appropriately sized cuff. RESULTS: A total of 489 measurement blood pressure measurements were obtained in 170 of the 222 children who were seen at a median (range) age of 29 (22-38) months corrected gestational age. At the time of assessment the mean (SD) weight and height was 13.8(2) kg and 90 (4.2) cm respectively. For the whole group the mean (SD) systolic pressure was 90.9 (9.9) mmHg and mean (SD) diastolic pressure was 55.7 (8.1) mmHg. No difference was found between the metformin and insulin treatment arms. In a regression model, height and weight were only two factors associated with the levels of systolic blood pressure. For each additional kg the systolic blood pressure increased by 1.0 mmHg. For each additional cm of height the systolic blood pressure increased by 0.42 mmHg. CONCLUSIONS: Blood pressure data was obtained at approximately two years of age in a substantial cohort of children whose mothers received treatment for GDM. These novel data compare favorably with published norms. CLINICAL TRIALS REGISTRY: This study was registered under the Australian New Zealand Clinical Trials Registry ( ACTRN12605000311651 ).

Pacific Islands Families Study: Signs of puberty are associated with physical growth at ages 9 and 11 years.

AIM: To prospectively observe, at ages 9 and 11, the relationship of parental report of pubertal signs with height, weight, body mass index and birth weight in children of the Pacific Islands Families cohort born in the year 2000. METHOD: At ages 9 and 11 years a parental questionnaire assessed five gender-specific pubertal signs for 619 children and height and weight were objectively measured. At 9 years, body fatness was derived from frequency bioimpedance analysis. Birth weight was obtained from hospital records. Anthropometric measures of children with and without pubertal signs at each age were compared. RESULTS: At both 9 and 11 years, more than 80% of both boys' and girls' parents reported the presence of a growth spurt. The growth trajectory between 9 and 11 years was steep compared to the Centers for Disease Control reference child. At age 11, girls showing pubertal signs had substantially greater height, weight and body mass indexes than girls who did not. Girls with a growth spurt at age 9 years (91%) had a heavier birth weight than those without; a difference of 250 g (95% CI 50, 450 g). CONCLUSION: The relationships between birth weight, rapid growth in childhood and early pubertal signs are complex. In addition to biological factors, food security and socioeconomic factors need to be addressed to ensure that the children of these children are exposed to an environment that is supportive of healthy rates of growth and development.

Body composition in offspring of New Zealand women: ethnic and gender differences at age 1-3 years in 2005-2009.

BACKGROUND: In multi-ethnic New Zealand the prevalence of obesity and diabetes is increasing and varies by ethnic group. AIM: This study explored ethnic and gender differences in body composition in offspring of women treated for gestational diabetes in the metformin in gestational diabetes (MiG) trial. SAMPLE AND METHODS: Total and regional body composition measured by dual X-ray absorptiometry were investigated in European, Indian, Polynesian and "Other" children aged 2 years (48 boys; 56 girls). RESULTS: By ethnicity, boys were not different by height or weight. Compared with European girls, Indian girls weighed less (2.3 ± 0.58 kg) and Polynesian (1.13 ± 0.53 kg) more, but percentage body fat was not different. Adjusted for age, height and weight boys had less total and appendicular fat and higher abdominal fat mass and total bone mineral density than girls (p < 0.001). Adjusted for age, weight and height Indian boys had more fat in the central and abdominal regions and less total lean mass than European boys (p < 0.05). CONCLUSION: These measurements provide early evidence for gender and ethnic differences in the distribution of fat and might help identify who is most likely to benefit from intervention in the first few years of life to reduce risk of chronic disease including diabetes.

Lifetime cost effectiveness of a through-school nutrition and physical programme: Project Energize.

Project Energize, a multicomponent through-school physical activity and nutrition programme, is delivered to all primary school children in the Waikato region. The programme aim is to improve the overall health and reduce the rate of weight gain of all Waikato primary school children. An existing economic model was used to extrapolate the programme effects, initial costs, lifetime health treatment cost structures, quality-adjusted-life-years gained and increased life expectancy to the general and Maori child population of New Zealand. In March 2011, a sample of 2474 younger (7.58 ± 0.57 years, mean ± SD) and 2330 older (10.30 ± 0.51 years) children (36% Maori) attending Energize schools had body mass index measured and compared using mixed effect modelling with unEnergized comparison children from 2004 and 2006 from the same region. In 2011 the median body mass index reduction compared with the comparison younger children was -0.504 (90% CI -0.435 to -0.663) kg/m(2) and in the older children -0.551 (-0.456 to -0.789) kg/m(2). In 2010 there were 42,067 children attending Energize schools and in the same year NZ$1,891,175 was spent to deliver the programme; a cost of $44.96/child/year. Compared to the comparison children the increment in cost/quality-adjusted-life-year gained was $30,438 for the younger and $24,690 for the older children, and lower for Maori (younger $28,241, older $22,151) and for the middle socioeconomic status schools ($23,211, $17,891). Project Energize would improve quality and length of life and when compared with other obesity prevention programmes previously assessed with this model, it would be relatively cost-effective from the health treatment payer's perspective.

Project Energize: whole-region primary school nutrition and physical activity programme; evaluation of body size and fitness 5 years after the randomised controlled trial.

Project Energize, a region-wide whole-school nutrition and physical activity programme, commenced as a randomised controlled trial (RCT) in the period 2004-6 in 124 schools in Waikato, New Zealand. In 2007, sixty-two control schools were engaged in the programme, and by 2011, all but two of the 235 schools in the region were engaged. Energizers (trained nutrition and physical activity specialists) work with eight to twelve schools each to achieve the goals of the programme, which are based on healthier eating and enhanced physical activity. In 2011, indices of obesity and physical fitness of 2474 younger (7·58 (sd 0·57) years) and 2330 older (10·30 (sd 0·51) years) children attending 193 of the 235 primary schools were compared with historical measurements. After adjusting for age, sex, ethnicity, socio-economic status (SES) and school cluster effects, the combined prevalence of obesity and overweight among younger and older children in 2011 was lower by 31 and 15 %, respectively, than that among 'unEnergized' children in the 2004 to 2006 RCT. Similarly, BMI was lower by 3·0 % (95 % CI - 5·8, - 1·3) and 2·4 % (95 % CI - 4·3, - 0·5). Physical fitness (time taken to complete a 550 m run) was significantly higher in the Energized children (13·7 and 11·3 %, respectively) than in a group of similarly aged children from another region. These effects were observed for boys and girls, both indigenous Maori and non-Maori children, and across SES. The long-term regional commitment to the Energize programme in schools may potentially lead to a secular reduction in the prevalence of overweight and obesity and gains in physical fitness, which may reduce the risk of developing obesity and type 2 diabetes.

Growth centiles of Pacific children living in Auckland, New Zealand.

BACKGROUND: Since 2000, the longitudinal Pacific Island Families study has measured the weight, height and body mass index (BMI) of 582 girls and 643 boys at 2, 4, 6 and 9 year data collection phases. AIM: To extend and record the age-related distribution of weight, height and BMI measures in Pacific children aged 2-10 years and to compare the distribution to population and clinical growth charts. METHODS: Gender-specific age-related centile curves were derived using the LMS method for weight, height and BMI. The 50th centiles from the World Health Organisation growth reference for 2-5 year olds and the Centres for Disease Control (CDC) for 5-10 year olds were compared. Overweight and obesity were defined by the CDC BMI 85th and 95th centiles. RESULTS: The proportion of children whose weight and height were above the reference 50th centile increased with age. At age 10, using CDC criteria, more than 50% of the children were classified as obese and 70% were overweight. CONCLUSIONS: These charts support the need to prioritize interventions for Pacific families to address childhood obesity. These centile curves could help assess the relative growth of Pacific children and identify children for further assessment and treatment.

Use of pedometers to identify less active children and time spent in moderate to vigorous physical activity in the school setting.

OBJECTIVES: To examine in the context of a school day whether a pedometer, compared to an accelerometer, was an effective tool to identify children with low physical activity levels. Additionally, to characterise within the school day, patterns of variation in level and timing of activity of the most active and least active children. DESIGN: Observational study to compare two methods (accelerometer and pedometer) of identifying less active children and intensity of activity. METHOD: During school hours, for three consecutive days, children (n=47, aged 8-11 years) in two classes wore an accelerometer and sealed pedometer. Accelerometers were programmed to record at 15s epochs and the number of pedometer steps taken were recorded at the end of each school day. Patterns of activity by total accelerometer counts, and with cutoffs applied, were examined against time and the number of steps taken. RESULTS: Based on the accelerometer (>1500 counts/min), the majority (68%) of children spent more than 60 min in moderate to vigorous physical activity (MVPA) during the school day. Overall, time spent in MVPA was three times greater during break times compared to classroom time, with no apparent differences by class/age or gender. Total accelerometer counts and pedometer steps were correlated (r=0.60). One minute of MVPA was equivalent to 45 (95% CI 20 to 70) pedometer steps. CONCLUSION: The pedometer, a practical, relatively inexpensive tool, is suitable for the identification of less active children and has some utility to assess the relative intensity of activities in the context of a school day.

An exometabolomics approach to monitoring microbial contamination in microalgal fermentation processes by using metabolic footprint analysis.

The early detection of microbial contamination is crucial to avoid process failure and costly delays in fermentation industries. However, traditional detection methods such as plate counting and microscopy are labor-intensive, insensitive, and time-consuming. Modern techniques that can detect microbial contamination rapidly and cost-effectively are therefore sought. In the present study, we propose gas chromatography-mass spectrometry (GC-MS)-based metabolic footprint analysis as a rapid and reliable method for the detection of microbial contamination in fermentation processes. Our metabolic footprint analysis detected statistically significant differences in metabolite profiles of axenic and contaminated batch cultures of microalgae as early as 3 h after contamination was introduced, while classical detection methods could detect contamination only after 24 h. The data were analyzed by discriminant function analysis and were validated by leave-one-out cross-validation. We obtained a 97% success rate in correctly classifying samples coming from contaminated or axenic cultures. Therefore, metabolic footprint analysis combined with discriminant function analysis presents a rapid and cost-effective approach to monitor microbial contamination in industrial fermentation processes.

Metformin in gestational diabetes: the offspring follow-up (MiG TOFU): body composition at 2 years of age.

OBJECTIVE: In women with gestational diabetes mellitus, who were randomized to metformin or insulin treatment, pregnancy outcomes were similar (Metformin in Gestational diabetes [MiG] trial). Metformin crosses the placenta, so it is important to assess potential effects on growth of the children. RESEARCH DESIGN AND METHODS: In Auckland, New Zealand, and Adelaide, Australia, women who had participated in the MiG trial were reviewed when their children were 2 years old. Body composition was measured in 154 and 164 children whose mothers had been randomized to metformin and insulin, respectively. Children were assessed with anthropometry, bioimpedance, and dual energy X-ray absorptiometry (DEXA), using standard methods. RESULTS: The children were similar for baseline maternal characteristics and pregnancy outcomes. In the metformin group, compared with the insulin group, children had larger mid-upper arm circumferences (17.2 ± 1.5 vs. 16.7 ± 1.5 cm; P = 0.002) and subscapular (6.3 ± 1.9 vs. 6.0 ± 1.7 mm; P = 0.02) and biceps skinfolds (6.03 ± 1.9 vs. 5.6 ± 1.7 mm; P = 0.04). Total fat mass and percentage body fat assessed by bioimpedance (n = 221) and DEXA (n = 114) were not different. CONCLUSIONS: Children exposed to metformin had larger measures of subcutaneous fat, but overall body fat was the same as in children whose mothers were treated with insulin alone. Further follow-up is required to examine whether these findings persist into later life and whether children exposed to metformin will develop less visceral fat and be more insulin sensitive. If so, this would have significant implications for the current pandemic of diabetes.