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Original Investigation |

Influence of Adiposity, Physical Activity, Fitness, and Screen Time on Insulin Dynamics Over 2 Years in Children

Mélanie Henderson, MD, FRCPC, PhD1,2; Andrea Benedetti, PhD3,4,5; Tracie A. Barnett, PhD1,6; Marie-Eve Mathieu, PhD1,7; Johnny Deladoëy, MD, PhD1,2; Katherine Gray-Donald, PhD8
[+] Author Affiliations
1Centre Hospitalier Universitaire Sainte-Justine Research Center, University of Montreal, Montreal, Quebec, Canada
2Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
3Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
4Department of Medicine, McGill University, Montreal, Quebec, Canada
5Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada
6Epidemiology and Biostatistic Unit, INRS–Institut Armand-Frappier, Laval, Quebec, Canada
7Department of Kinesiology, University of Montreal, Montreal, Quebec, Canada
8School of Dietetics and Human Nutrition, McGill University, Montreal, Quebec, Canada
JAMA Pediatr. 2016;170(3):227-235. doi:10.1001/jamapediatrics.2015.3909.
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Importance  Despite extensive evidence showing that lifestyle habits play a critical role in preventing or delaying the onset of type 2 diabetes in adults, little is known regarding the impact of lifestyle habits on type 2 diabetes risk in childhood.

Objective  To assess whether adiposity, fitness, moderate-to-vigorous physical activity, and screen time predict insulin sensitivity or insulin secretion during a 2-year period in children with a family history of obesity.

Design, Setting, and Participants  This is a prospective longitudinal cohort study of 630 children, having at least 1 obese parent, recruited from schools in Quebec, Canada, between July 2005 and December 2008 in the Quebec Adipose and Lifestyle Investigation in Youth (QUALITY) cohort. Children were assessed at baseline (ages 8-10 years) and 2 years later. Fitness was measured by peak oxygen consumption, percentage of body fat (adiposity) by dual-energy x-ray absorptiometry, moderate-to-vigorous physical activity using accelerometry, and screen time by average daily hours of self-reported television, video game, or computer use. Regression models were adjusted for age, sex, season, and pubertal stage. The current analysis was completed in October 2015.

Main Outcomes and Measures  Insulin sensitivity was measured by the homeostatic model assessment of insulin resistance and an oral glucose tolerance test–based index (Matsuda insulin sensitivity index). Insulin secretion was measured using the area under the curve of insulin to glucose during the first 30 minutes of the oral glucose tolerance test and using the area under the curve of insulin to glucose over 2 hours.

Results  Of 630 children evaluated at baseline (mean [SD] age, 9.6 [0.9] years; 54.4% male; 56.2% normal weight, 19.2% overweight, and 22.7% obese), 564 were evaluated at 2-year follow-up. Adiposity and changes in adiposity were the central predictors of insulin dynamics over time. Every additional 1% of body fat at ages 8 to 10 years decreased insulin sensitivity by 2.9% (95% CI, −3.3% to −2.5%; P < .001) and led to a 0.5% (95% CI, 0.09% to 0.8%; P = .02) increased requirement in the area under the curve of insulin to glucose during the first 30 minutes of the oral glucose tolerance test 2 years later. Higher levels of moderate-to-vigorous physical activity and lower screen time appear to be beneficial to insulin sensitivity in part through their effect on adiposity levels.

Conclusions and Relevance  Adiposity plays a determining role in cardiometabolic health at a young age. Public health strategies that promote healthy body weight, notably physical activity, need to target school-aged and possibly younger children.

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Figure.
Path Diagram for the Total and Indirect Effects of Physical Activity on Insulin Sensitivity

For every additional 10 minutes of moderate-to-vigorous physical activity daily, insulin sensitivity increased by approximately 4% (for both the homeostatic model assessment of insulin resistance and the Matsuda insulin sensitivity index) 2 years later. Every additional hour of screen time daily was associated with a 5% decrease in insulin sensitivity (figure not shown). Every additional 10 minutes of moderate-to-vigorous physical activity was associated with a 4.3% decrease in adiposity, and every hour of screen time was associated with a 3.1% increase in adiposity. In the multivariable model adjusted for adiposity, each 1% increase in adiposity predicted a 3% decrease in insulin sensitivity (for both the homeostatic model assessment of insulin resistance and the Matsuda insulin sensitivity index); moderate-to-vigorous physical activity predicted only a 1.8% increase in insulin sensitivity, and screen time predicted only a 2% decrease in insulin sensitivity. Results from the Sobel tests for mediation were significant, with all P < .02.

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