| 1. |
- Alexandrou, Christina, et al.
(författare)
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Effectiveness of a Smartphone App (MINISTOP 2.0) integrated in primary child health care to promote healthy diet and physical activity behaviors and prevent obesity in preschool-aged children: randomized controlled trial
- 2023
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Ingår i: International Journal of Behavioral Nutrition and Physical Activity. - : BMC. - 1479-5868. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background:Childhood overweight and obesity is a public health priority. We have previously reported the efficacy of a parent-oriented mobile health (mHealth) app-based intervention (MINISTOP 1.0) which showed improvements in healthy lifestyle behaviors. However, the effectiveness of the MINISTOP app in real-world conditions needs to be established. Objective:To evaluate the real-world effectiveness of a 6-month mHealth intervention (MINISTOP 2.0 app) on childrens intake of fruits, vegetables, sweet and savory treats, sweet drinks, moderate-to-vigorous physical activity, and screen time (primary outcomes), and on parental self-efficacy (PSE) for promoting healthy lifestyle behaviors, and childrens body mass index (BMI) (secondary outcomes). Methods:A hybrid type 1 effectiveness-implementation design was utilized. For the effectiveness outcomes, a two-arm, individually randomized controlled trial was conducted. Parents (n = 552) of 2.5-to-3-year-old children were recruited from 19 child health care centers across Sweden, and, randomized to either a control (standard care) or intervention group (MINISTOP 2.0 app). The 2.0 version was adapted and translated into English, Somali and Arabic to increase reach. All recruitment and data collection were conducted by the nurses. Outcomes were assessed at baseline and after six months, using standardized measures (BMI) and a questionnaire (health behaviors, PSE). Results:Among the participating parents (n = 552, age: 34.1 +/- 5.0 years), 79% were mothers and 62% had a university degree. Twenty-four percent (n = 132) of children had two foreign-born parents. At follow-up, parents in the intervention group reported lower intakes of sweet and savory treats (-6.97 g/day; p = 0.001), sweet drinks (-31.52 g/day; p < 0.001), and screen time (-7.00 min/day; p = 0.012) in their children compared to the control group. The intervention group reported higher total PSE (0.91; p = 0.006), PSE for promoting healthy diet (0.34; p = 0.008) and PSE for promoting physical activity behaviors (0.31; p = 0.009) compared to controls. No statistically significant effect was observed for childrens BMI z-score. Overall, parents reported high satisfaction with the app, and 54% reported using the app at least once a week. Conclusion:Children in the intervention group had lower intakes of sweet and savory treats, sweet drinks, less screen time (primary outcomes) and their parents reported higher PSE for promoting healthy lifestyle behaviors. Our results from this real-world effectiveness trial support the implementation of the MINISTOP 2.0 app within Swedish child health care.
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| 2. |
- Bendtsen, Marcus, 1982-, et al.
(författare)
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mHealth intervention for multiple lifestyle behaviour change among high school students in Sweden (LIFE4YOUth) : Protocol for a randomised controlled trial
- 2021
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Ingår i: Public Health Nursing. - : BMC. - 0737-1209 .- 1525-1446 .- 1471-2458. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundNational surveys in Sweden demonstrate that the majority of young people do not engage in health promoting behaviours at levels recommended by the Public Health Agency of Sweden. The objective of this study is to estimate the effectiveness of a novel mHealth intervention named LIFE4YOUth, which targets multiple lifestyle behaviours (alcohol, diet, physical activity, and smoking) among high school students in Sweden.MethodsA 2-arm parallel groups single blind randomised controlled trial (1:1) will be employed to estimate the effectiveness of the novel mHealth intervention. Students will be recruited at high schools throughout Sweden, and will be included if they fulfil one of six criteria relating to unhealthy behaviours with respect to alcohol, diet, physical activity and smoking. Eligible participants will be randomised to either receive the novel intervention immediately, or to be placed on a waiting list for 4 months. The intervention consists of a combination of recurring screening, text messages, and an interactive platform which is adaptable to individual preferences. Outcome measures with respect to alcohol, diet, physical activity and smoking will be assessed through questionnaires at 2 and 4 months post randomisation.DiscussionThe findings of this trial could be generalised to a diverse high-school student population as our recruitment encompass a large proportion of schools throughout Sweden with various educational profiles. Furthermore, if effective, the mHealth intervention has good potential to be able to be scaled up and disseminated at high schools nationally.Trial registrationRegistered prospectively on 2020-05-20 in ISRCTN (ISRCTN34468623).
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| 3. |
- Bendtsen, Marcus, 1982-, et al.
(författare)
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The Mobile Health Multiple Lifestyle Behavior Interventions Across the Lifespan (MoBILE) Research Program : Protocol for Development, Evaluation, and Implementation
- 2020
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Ingår i: JMIR Research Protocols. - Toronto, Canada : JMIR Publications Inc. - 1929-0748. ; 9:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Clustering of multiple lifestyle risk behaviors has been associated with a greater risk of noncommunicable diseases and mortality than one lifestyle risk behavior or no lifestyle risk behaviors. The National Board of Health and Welfare in Sweden reported in 2018 that it is important to provide additional support to individuals with multiple lifestyle risk behaviors, as risks from these behaviors are multiplicative rather than additive. However, the same report emphasized that there is a lack of knowledge regarding interventions that support changes to unhealthy lifestyle behaviors.Objective: The MoBILE (Mobile health Multiple lifestyle Behavior Interventions across the LifEspan) research program has brought together two Swedish research groups supported by international collaborators. Through this collaboration, we aim to design and evaluate a number of novel and tailored mobile health (mHealth) multiple lifestyle behavior interventions across the life span of different health care populations. In addition, the MoBILE research program will extend ongoing research to include mHealth interventions for migrant pregnant women and children.Methods: Each project within the MoBILE program will focus on a specific group: pregnant women, preschool children, high school and university students, and adults in primary and clinical care. All the projects will follow the same 4 phases: requirements, development, evaluation, and implementation. During the requirements phase, implementers and end users will aid the design of content and functionality of the interventions. In the development phase, findings from the first phase will be synthesized with expert domain knowledge and theoretical constructs to create interventions tailored to the target groups. The third phase, evaluation, will comprise randomized controlled trials conducted to estimate the effects of the interventions on multiple lifestyle risk behaviors (eg, alcohol, nutrition, physical activity, and smoking). The final phase will investigate how the interventions, if found effective, can be disseminated into different health care contexts.Results: The research program commenced in 2019, and the first results will be available in 2020. Projects involving pregnant women, preschool children, and high school and university students will be completed in the first 3 years, with the remaining projects being planned for the program’s final 3 years.Conclusions:The development of evidence-based digital tools is complex, as they should be guided by theoretical frameworks, and requires large interdisciplinary teams with competence in technology, behavioral science, and lifestyle-specific areas. Individual researchers or smaller research groups developing their own tools is not the way forward, as it means reinventing the wheel over and over again. The MoBILE research program therefore aims to join forces and learn from the past 10 years of mHealth research to maximize scientific outcomes, as well as the use of financial resources to expand the growing body of evidence for mHealth lifestyle behavior interventions.
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| 4. |
- Delisle Nyström, Christine, et al.
(författare)
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The paediatric option for BodPod to assess body composition in preschool children: what fat-free mass density values should be used?
- 2018
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Ingår i: British Journal of Nutrition. - : CAMBRIDGE UNIV PRESS. - 0007-1145 .- 1475-2662. ; 120:7, s. 797-802
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Tidskriftsartikel (refereegranskat)abstract
- Air displacement plethysmography utilises a two-component model to assess body composition, which relies on assumptions regarding the density of fat-free mass (FFM). To date, there is no evidence as to whether Lohmans or Wells et al.s FFM density values are more accurate in young children. Therefore, the aims of this study were to compare total body fat percentage (TBF%) assessed using the BodPod with both Lohmans and Wells et al.s FFM density values with TBF% from the three-component (3C) model in forty healthy Swedish children aged 5.5 years. Average TBF% calculated using Lohmans FFM density values underestimated TBF% in comparison with the corresponding value assessed using the 3C model (22.2 (SD 5.7) and 25.1 (SD 5.5)%, respectively; P amp;lt;0.001). No statistically significant difference was observed between TBF% assessed using Wells et al.s FFM density values and the 3C model (24.9 (so 5.5) and 251 (so 5.5)%, respectively; P= 0.614). The Bland and Altman plots for TBF% using both Lohmans and Wells et al.s FFM density values did not show any bias across the range of body fatness (Lohman: r0.056, P= 0.733 and Wells el al.: r-0.006, P= 0.970). These results indicate that Wells Cl al.s FFM density values should be used when assessing body composition with the paediatric option for BodPod in 5-year-old children. However, future studies are needed to confirm these results in other populations, including a wider age range of children.
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| 5. |
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| 6. |
- Forsum, Elisabet, et al.
(författare)
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Fat and fat-free mass of healthy Swedish children show tracking during early life, but there are differences
- 2019
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Ingår i: Acta Paediatrica. - : WILEY. - 0803-5253 .- 1651-2227. ; 108:9, s. 1704-1708
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Tidskriftsartikel (refereegranskat)abstract
- Aim Obesity may start early in life. We investigated relationships between size and body composition variables in infancy and at 4 years of age using valid estimates of body composition. The results were compared to those obtained when body mass index (BMI) was used to estimate body fatness at 4 years. Methods Using air displacement plethysmography, size, fat mass and fat-free mass were studied, between 2007 and 2015, in 253 full-term healthy Swedish children at 1 week, 12 weeks and 4 years of age. Results Positive associations between variables in infancy and at 4 years were found at 1 and 12 weeks for weight, height, BMI, fat-free mass and fat-free mass index (p amp;lt;= 0.002) and for fat mass, per cent body fat and fat mass index (p amp;lt;= 0.04) at 12 weeks. Fat mass gained during infancy correlated positively (p amp;lt;= 0.031) with per cent fat mass, fat mass index and BMI, all at 4 years. In girls, gains in fat-free mass during infancy correlated with BMI (p = 0.0005) at 4 years. Conclusion The results provide information regarding body composition trajectories during early life and demonstrate limitations of BMI as a proxy for body fatness when relating early weight gain to variables, relevant for later obesity risk.
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| 7. |
- Forsum, Elisabet, et al.
(författare)
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Total body fat content versus BMI in 4-year-old healthy Swedish children.
- 2013
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Ingår i: Journal of Obesity. - : Hindawi Publishing Corporation. - 2090-0708 .- 2090-0716. ; 2013
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Tidskriftsartikel (refereegranskat)abstract
- Childhood overweight and obesity, a worldwide problem, is generally identified using BMI (body mass index). However, this application of BMI has been little investigated in children below 5 years of age due to a lack of appropriate methods to assess body composition. Therefore, we used air displacement plethysmography (ADP) to study 4.4-year old boys and girls since this method is accurate in young children if they accept the requirements of the measurement. The purpose was to analyze the relationship between BMI and body fat in these children. Body composition was assessed in 76 (43 boys, 33 girls) of the 84 children brought to the measurement session. Boys and girls contained 25.2 ± 4.7 and 26.8 ± 4.0% body fat, respectively. BMI-based cut-offs for overweight could not effectively identify children with a high body fat content. There was a significant (P < 0.001) but weak (r = 0.39) correlation between BMI and body fat (%). In conclusion, requirements associated with a successful assessment of body composition by means of ADP were accepted by most 4-year-olds. Furthermore, BMI-based cut-offs for overweight did not effectively identify children with a high body fatness and BMI explained only a small proportion of the variation in body fat (%) in this age group.
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| 8. |
- Henriksson, Aron, 1985-, et al.
(författare)
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Multimodal fine-tuning of clinical language models for predicting COVID-19 outcomes
- 2023
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Ingår i: Artificial Intelligence in Medicine. - 0933-3657 .- 1873-2860. ; 146
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Tidskriftsartikel (refereegranskat)abstract
- Clinical prediction models tend only to incorporate structured healthcare data, ignoring information recorded in other data modalities, including free-text clinical notes. Here, we demonstrate how multimodal models that effectively leverage both structured and unstructured data can be developed for predicting COVID-19 outcomes. The models are trained end-to-end using a technique we refer to as multimodal fine-tuning, whereby a pre -trained language model is updated based on both structured and unstructured data. The multimodal models are trained and evaluated using a multicenter cohort of COVID-19 patients encompassing all encounters at the emergency department of six hospitals. Experimental results show that multimodal models, leveraging the notion of multimodal fine-tuning and trained to predict (i) 30-day mortality, (ii) safe discharge and (iii) readmission, outperform unimodal models trained using only structured or unstructured healthcare data on all three outcomes. Sensitivity analyses are performed to better understand how well the multimodal models perform on different patient groups, while an ablation study is conducted to investigate the impact of different types of clinical notes on model performance. We argue that multimodal models that make effective use of routinely collected healthcare data to predict COVID-19 outcomes may facilitate patient management and contribute to the effective use of limited healthcare resources.
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| 9. |
- Henriksson, Hanna, et al.
(författare)
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Cardiorespiratory fitness, muscular strength, and obesity in adolescence and later chronic disability due to cardiovascular disease: a cohort study of 1 million men
- 2020
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Ingår i: European Heart Journal. - : OXFORD UNIV PRESS. - 0195-668X .- 1522-9645. ; 41:15, s. 1503-
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Tidskriftsartikel (refereegranskat)abstract
- Aims Cardiorespiratory fitness, muscular strength, and obesity in adulthood are risk factors for cardiovascular disease (CVD). However, Little is known regarding the associations of these risk factors, already in adolescence, with later disability due to chronic CVD. Hence, we investigated associations of cardiorespiratory fitness, muscular strength, and body mass index (BMI) in adolescence with Later chronic disability due to specific causes of CVD disability (i.e. cerebrovascutar disease, ischaemic heart disease and heart failure). Methods and results This population-based cohort study included 1 078 685 male adolescents (16-19 years) from the Swedish military conscription register from 1972 to 1994. Cardiorespiratory fitness (bicycle ergometer test), muscular strength (knee extension strength), and BMI were measured during the conscription examination. Information about disability pension due to CVD was retrieved from the Social Insurance Agency during a mean follow-up of 28.4 years. Cardiorespiratory fitness was strongly and inversely associated with later risk of chronic CVD disability for all investigated causes. The association was particularly strong for ischaemic heart diseases (hazard ratio 0.11, 95% confidence interval 0.05-0.29 for highest vs. lowest fitness-quintiles). Furthermore, overweight/obesity were associated with CVD disability for all investigated causes. Conversely, associations of muscular strength with CVD disability were generally weak. Conclusions This study provides evidence for associations between low levels of cardiorespiratory fitness and obesity with later risk of chronic disability due to CVD. Preventive actions may begin at young ages and include promotion of cardiorespiratory fitness and healthy body weight.
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| 10. |
- Henriksson, Hanna, 1977-, et al.
(författare)
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Hip and wrist accelerometers showed consistent associations with fitness and fatness in children aged 8-12 years
- 2020
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Ingår i: Acta Paediatrica. - : WILEY. - 0803-5253 .- 1651-2227. ; 109:5, s. 995-1003
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Tidskriftsartikel (refereegranskat)abstract
- Aim Physical activity (PA) has traditionally been measured wearing accelerometers on the hip, but they are increasingly being worn on the wrist. We compared hip and wrist accelerometers with regard to their acceptability and any associations between PA and fatness and fitness. Methods This cross-sectional study comprised 103 children aged 8-12 years (62% boys) who participated in the ActiveBrains trial by the University of Granada, Spain, in 2014-2016. The children wore both ActiGraph GT3X+ hip and wrist accelerometers round the clock for 7 days. The acceptability of both placements was evaluated by a questionnaire, while the childrens fat mass index, waist circumference and cardiorespiratory fitness (CRF) were assessed. Results Wearing wrist accelerometers caused less disturbance, mainly because hip accelerometers caused more issues during the night. The measurements from both placements showed that lower PA levels were associated with fatness and that higher PA levels were associated with better CRF. Conclusion Both placements showed consistent results with regard to measuring associations between PA levels and fatness and fitness. However, wearing them on the wrist caused less discomfort at night. Future studies are needed to confirm the best placement for accelerometers during PA studies.
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| 11. |
- Henriksson, Hanna, et al.
(författare)
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Longitudinal assessment of body composition in healthy Swedish children from 1 week until 4 years of age
- 2017
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Ingår i: European Journal of Clinical Nutrition. - : NATURE PUBLISHING GROUP. - 0954-3007 .- 1476-5640. ; 71:11, s. 1345-1352
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND/OBJECTIVES: Knowledge of longitudinal body composition development is required to identify the mechanisms behind childhood overweight and obesity and to prevent these conditions. However, accurate data on this development in early childhood are lacking. Our aim was to describe the longitudinal body composition development in healthy young Swedish children. SUBJECTS/METHODS: Body size and composition were assessed in 26 children using air-displacement plethysmography (1 and 12 weeks and 4.4 years of age) and isotope dilution (1.5 and 3 years of age) and compared with available reference data. RESULTS: Body fat (%) for boys (n = 16) was 12.8 +/- 3.9 (1 week), 25.6 +/- 4.8 (12 weeks), 28.2 +/- 3.8 (1.5 years), 27.3 +/- 5.1 (3 years) and 26.1 +/- 3.5 (4.4 years). For girls (n = 10) these values were 15.3 +/- 2.9, 25.7 +/- 3.9, 27.9 +/- 3.3, 26.3 +/- 7.2 and 26.0 +/- 5.3, respectively. These values were above the Fomon reference values at 1.5 years of age and later and higher than the Butte reference (Po0.05) for boys at 1.5 years of age. At all ages the coefficients of variation were higher for body fat (%) (12-30%) than for BMI (4-11%). CONCLUSIONS: At 4 years of age our children had more body fat than indicated by reference data. This high level may have already been established at 1.5 years of age but our small sample and the lack of appropriate reference data limit the possibility of drawing firm conclusions. Our results demonstrate the limitations of BMI when investigating overweight and obesity in early life and highlight the need for appropriate reference body composition data in infants and young children.
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| 12. |
- Henriksson, Hanna, et al.
(författare)
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Longitudinal Physical Activity, Body Composition, and Physical Fitness in Preschoolers
- 2017
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Ingår i: Medicine & Science in Sports & Exercise. - : LIPPINCOTT WILLIAMS & WILKINS. - 0195-9131 .- 1530-0315. ; 49:10, s. 2078-2085
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This study aimed to investigate longitudinal associations of objectively measured physical activity (PA) and sedentary behavior (SB) with body composition and physical fitness at a 12-month follow-up in healthy Swedish 4-yr-old children. Methods: The data from the population-based MINISTOP trial were collected between 2014 and 2016, and this study included the 138 children who were in the control group. PA and SB were assessed using the wrist-worn ActiGraph (wGT3x-BT) accelerometer during seven 24-h periods and, subsequently, defined as SB, light-intensity PA, moderate-intensity PA, vigorous-intensity PA (VPA), and moderate-to-vigorous PA (MVPA). Body composition was measured using air-displacement plethysmography and physical fitness (cardiorespiratory fitness, lower and upper muscular strength as well as motor fitness) by the PREFIT fitness battery. Linear regression and isotemporal substitution models were applied. Results: Greater VPA and MVPA at the age of 4.5 yr were associated with higher fat-free mass index (FFMI) at 5.5 yr (P amp;lt; 0.001 and P = 0.044, respectively). Furthermore, greater VPA and MVPA at the age of 4.5 yr were associated with higher scores for cardiorespiratory fitness, lower body muscular strength, and motor fitness at 12-month follow-up (P = 0.001 to P = 0.031). Substituting 5 min.d(-1) of SB, light-intensity PA, or moderate-intensity PA for VPA at the age of 4.5 yr were associated with higher FFMI, and with greater upper and lower muscular strength at 12-month follow-up (P amp;lt; 0.001 to P = 0.046). Conclusion: Higher VPA and MVPA at the age of 4.5 yr were significantly associated with higher FFMI and better physical fitness at 12-month follow-up. Our results indicate that promoting high-intensity PA at young ages may have long-term beneficial effects on childhood body composition and physical fitness, in particular muscular strength.
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| 13. |
- Henriksson, Hanna, et al.
(författare)
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MINISTOP 2.0: a smartphone app integrated in primary child health care to promote healthy diet and physical activity behaviours and prevent obesity in preschool-aged children: protocol for a hybrid design effectiveness-implementation study
- 2020
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Ingår i: BMC Public Health. - : BMC. - 1471-2458. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundChildhood obesity is still a major health problem in many countries, including Sweden. Childhood obesity and obesity-related behaviours in childhood, such as low physical activity and unhealthy eating habits, tend to track into adulthood, which highlights the need for early prevention. Our aims are to evaluate whether a parent-oriented mobile health app (the MINISTOP 2.0 app) integrated into primary child health care can improve diet and physical activity behaviours and reduce the prevalence of overweight and obesity in preschool-aged children as well as to evaluate the implementation among child health care nurses and parents.MethodsThis trial uses a hybrid type 1 effectiveness-implementation design. Families (n=500) who attend a routine visit to one of 15-20 primary child health care centres throughout Sweden, when their child is 2.5years, are offered participation in a randomised controlled trial (effectiveness evaluation). After acceptance, families will be randomised (1:1) to control or intervention groups. The intervention group receives a 6-month parent-oriented smartphone intervention aimed at improving the dietary and activity behaviours of their child (the MINISTOP 2.0 app) and the control group receives routine child health care. Dietary habits, physical activity and screen time (primary outcomes), body weight and height in children, and parental self-efficacy (secondary outcomes) are measured at baseline and at 6months post randomisation. Implementation outcomes (i.e. perceived acceptability, appropriateness, and feasibility) of the intervention will be assessed among primary child health care nurses and parents in the trial through questionnaires and qualitative interviews.DiscussionThis trial will evaluate whether the MINISTOP 2.0 app can be used in primary child health care to improve diet and physical activity behaviours, and prevent overweight and obesity, in preschool-aged children. If effectiveness is proven, and the MINISTOP 2.0 app is considered acceptable, appropriate and feasible, it can be implemented nationally as part of the preventive strategies to combat childhood obesity provided by routine child health care.Trial registrationThe trial was registered at the Clinicaltrials.gov register platform (ID NCT04147039) on 31 October 2019.
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| 14. |
- Henriksson, Hanna, 1977-, et al.
(författare)
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Muscular weakness in adolescence is associated with disability 30 years later : a population-based cohort study of 1.2 million men
- 2019
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Ingår i: British Journal of Sports Medicine. - : BMJ Publishing Group Ltd. - 0306-3674 .- 1473-0480. ; 53:19, s. 1221-
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the associations of muscular strength in adolescence with later disability pension (DP), across different body mass index (BMI) categories and in combination with aerobic fitness.METHOD: This prospective cohort study consisted of males aged 16-19 years, recruited from the Swedish military conscription register between 1969 and 1994. A total of 1 212 503 adolescents met all the inclusion criteria and were therefore included in the analyses. Knee extension, handgrip and elbow flexion strength and aerobic fitness (bicycle ergometer test) were measured during conscription. Causes of DP were retrieved from the Social Insurance Office between years 1971 and 2012 (average follow-up time: 29.6 years).RESULTS: Knee extension strength in adolescence was inversely associated with men's risk of obtaining DP due to all causes (HR 1.40, 95% CI 1.36 to 1.44 for lowest vs highest strength quintile). Thus, muscular weakness was associated with DP. The risk associated with low muscular strength differed between specific causes of DP and the strongest associations were found for psychiatric, nervous system and other causes (HRs between 1.47 and 1.90 for lowest vs highest quintile). Being strong was associated with lower DP risk across BMI categories and being unfit, weak and obese was associated with the highest DP risk (HR 3.70, 95% CI 2.99 to 4.58).CONCLUSION: There was a strong association between muscular weakness and disability. A combination of muscular weakness and low aerobic fitness was an especially important risk factor for disability. This adds weight to call for muscular strength and fitness enhancing exercise for adolescents in all BMI categories.
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| 15. |
- Henriksson, Hanna, et al.
(författare)
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Physical Activity Level Using Doubly-Labeled Water in Relation to Body Composition and Physical Fitness in Preschoolers
- 2019
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Ingår i: Medicina (Kaunas). - : MDPI. - 1010-660X .- 1648-9144. ; 55:1
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Tidskriftsartikel (refereegranskat)abstract
- Background and objectives: There is a lack of studies investigating associations of physical activity level (PAL) and activity energy expenditure (AEE) using the doubly-labeled water (DLW) method with body composition and physical fitness in young children. Thus, we aimed to examine cross-sectional associations of PAL and AEE with body composition indices and physical fitness components in Swedish preschool children. Materials and methods: PAL was calculated as total energy expenditure measured using DLW divided by the predicted basal metabolic rate in 40 children aged 5.5 (standard deviation 0.2) years. AEE was calculated as total energy expenditure minus basal metabolic rate and the thermic effect of food, and divided by fat-free mass. Body composition was assessed using the 3-component model by combining measurements based on isotope dilution and air-displacement plethysmography. Physical fitness (muscular strength, motor fitness, and cardiorespiratory fitness) was evaluated using the PREFIT test battery. Multiple linear regression models were conducted. Results: PAL and AEE were negatively associated with body mass index, percent body fat, and fat mass index (PAL: standardized beta -0.35, -0.41, and -0.45, all p amp;lt; 0.036; AEE: standardized beta -0.44, -0.44, and -0.47, all p amp;lt; 0.006, respectively). Furthermore, PAL and AEE were positively associated with the standing long jump test (PAL: standardized beta 0.37, p = 0.017; AEE: standardized beta 0.38, p = 0.014). There were no statistically significant associations found regarding PAL or AEE with fat-free mass index or any other physical fitness test. Conclusions: Greater PAL and AEE at the age 5.5 were significantly associated with body fatness and improved lower-body muscular strength. Therefore, increasing physical activity, and thus energy expenditure, at young ages may be beneficial for preventing overweight/obesity. However, further studies with larger sample sizes are needed to confirm the results.
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| 16. |
- Henriksson, Pontus, et al.
(författare)
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A Smartphone App to Promote Healthy Weight Gain, Diet, and Physical Activity During Pregnancy (HealthyMoms) : Protocol for a Randomized Controlled Trial
- 2019
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Ingår i: JMIR Research Protocols. - : JMIR Publications Inc.. - 1929-0748. ; 8:3
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Excessive gestational weight gain is common and associated with adverse outcomes both in the short and long term. Although traditional lifestyle-based interventions have shown to mitigate excess gestational weight gain, little is known about whether mobile Health (mHealth) apps can promote healthy weight gain, diet, and physical activity during pregnancy.OBJECTIVE: The primary aim of the HealthyMoms trial is to determine the effectiveness of a smartphone app (HealthyMoms) for mitigating excess gestational weight gain during pregnancy. Secondary aims are to determine the effectiveness of the app on dietary habits, physical activity, body fatness, and glycemia during pregnancy.METHODS: HealthyMoms is a two-arm randomized controlled trial. Women are being recruited at routine visits at the maternity clinics in Linköping, Norrköping and Motala, Sweden. Women are randomized to the control or intervention group (n=150 per group). All women will receive standard care, and women in the intervention group will also receive the HealthyMoms smartphone app.RESULTS: Recruitment of participants to the trial was initiated in October 2017, and 190 women have so far completed the baseline measurement. The baseline measures are estimated to be finalized in December 2019, and the follow-up measures are estimated to be completed in June 2020.CONCLUSIONS: This project will evaluate a novel smartphone app intervention integrated with existing maternity health care. If successful, it has great potential to be implemented nationally in order to promote healthy weight gain and health behaviors during pregnancy.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/13011.
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| 17. |
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| 18. |
- Henriksson, Pontus, et al.
(författare)
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Fitness and Body Mass Index During Adolescence and Disability Later in Life A Cohort Study
- 2019
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Ingår i: Annals of Internal Medicine. - : AMER COLL PHYSICIANS. - 0003-4819 .- 1539-3704. ; 170:4, s. 230-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Low physical fitness, obesity, and the combination of the two in adolescence may be related to risk for disability in adulthood, but this has rarely been studied. Objective: To examine individual and combined associations of cardiorespiratory fitness and obesity in male adolescents with later receipt of a disability pension due to all and specific causes. Design: Population-based cohort study. Setting: Sweden. Participants: 1 079 128 Swedish adolescents aged 16 to 19 years who were conscripted into the military between 1972 and 1994. Measurements: Cardiorespiratory fitness and body mass index (BMI) were measured at conscription and were related to information on later receipt of a disability pension obtained from the Social Insurance Agency. Results: Over a median follow-up of 28.3 years, 54 304 men were granted a disability pension. Low cardiorespiratory fitness was strongly associated with later receipt of a disability pension due to all causes (hazard ratio, 3.74 [95% CI, 3.55 to 3.95] for lowest vs. highest fitness decile) and specific causes (psychiatric, musculoskeletal, injuries, nervous system, circulatory, and tumors). Obesity was associated with greater risk for receipt of a disability pension due to all and specific causes, with the greatest risks observed for class II and III obesity. Compared with being unfit, being moderately or highly fit was associated with attenuated risk for receipt of a disability pension across BMI categories. Limitation: The cohort did not include women, had data on smoking and alcohol intake only in a subsample, and lacked repeated measures of exposures and covariates. Conclusion: Low cardiorespiratory fitness, obesity, and the combination of the two were strongly associated with later chronic disability due to a wide range of diseases and causes. Although additional well-designed studies are required, these findings support the importance of high cardiorespiratory fitness and healthy body weight during adolescence to prevent later chronic disease.
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| 19. |
- Henriksson, Pontus, 1982-, et al.
(författare)
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Physical fitness in relation to later body composition in pre-school children
- 2019
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Ingår i: Journal of Science and Medicine in Sport. - : Elsevier. - 1440-2440 .- 1878-1861. ; 22:5, s. 574-579
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesAlthough physical fitness is considered a marker of health in youth, little is known whether physical fitness in pre-school age is related to later body composition. Thus, this study investigated (i) associations of physical fitness at 4.5 years of age with body composition 12 months later and (ii) whether improvements in physical fitness during the 12-month follow-up were associated with changes in body composition.DesignThis study included 142 children, measured at 4.5 and 5.5 years, from the control group of the MINISTOP trial.MethodsPhysical fitness (cardiorespiratory fitness, lower- and upper-body muscular strength and motor fitness) was measured using the PREFIT test battery. Body composition was assessed using air-displacement plethysmography.ResultsIn adjusted regression analyses, greater cardiorespiratory fitness, lower-body muscular strength and motor fitness at 4.5 years were associated with a lower fat mass index at 5.5 years (standardized β= −0.182 to −0.229, p ≤ 0.028). Conversely, greater cardiorespiratory fitness, lower- and upper-body muscular strength as well as motor fitness at 4.5 years of age were associated with a higher fat-free mass index (standardized β = 0.255–0.447, p ≤ 0.001). Furthermore, improvements in cardiorespiratory fitness, lower-body muscular strength and motor fitness during the 12-month follow-up period were associated with decreases in fat mass index and/or % fat mass.ConclusionsIn conclusion, the results of this study provide evidence of the importance of physical fitness early in life. Nevertheless, further studies are needed in order to clarify the influence of physical fitness in the pre-school age with later health outcomes.
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| 20. |
- Migueles, Jairo H., et al.
(författare)
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Effects of an Exercise Program on Cardiometabolic and Mental Health in Children With Overweight or Obesity A Secondary Analysis of a Randomized Clinical Trial
- 2023
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Ingår i: JAMA Network Open. - : AMER MEDICAL ASSOC. - 2574-3805. ; 6:7
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Tidskriftsartikel (refereegranskat)abstract
- Importance Childhood obesity is a risk factor associated with type 2 diabetes, cardiovascular disease, and mental disorders later in life. Investigation of the parallel effects of a defined exercise program on cardiometabolic and mental health in children with overweight or obesity may provide new insights on the potential benefits of exercise on overall health. Objective To investigate the effects of a 20-week exercise program on cardiometabolic and mental health in children with overweight or obesity. Design, Setting, and Participants This secondary analysis of a parallel-group randomized clinical trial was conducted in Granada, Spain, from November 1, 2014, to June 30, 2016. Data analyses were performed between February 1, 2020, and July 14, 2022. Children with overweight or obesity aged 8 to 11 years were eligible, and the study was performed in an out-of-school context. Intervention The exercise program included 3 to 5 sessions/wk (90 min/session) of aerobic plus resistance training for 20 weeks. The wait-list control group continued with their usual routines. Main Outcomes and Measures Cardiometabolic outcomes as specified in the trial protocol included body composition (fat mass, fat-free mass, and visceral adipose tissue), physical fitness (cardiorespiratory, speed-agility, and muscular), and traditional risk factors (waist circumference, blood lipid levels, glucose levels, insulin levels, and blood pressure). Cardiometabolic risk score (z score) was calculated based on age and sex reference values for levels of triglycerides, inverted high-density lipoprotein cholesterol, and glucose, the mean of systolic and diastolic blood pressure, and waist circumference. An additional cardiometabolic risk score also included cardiorespiratory fitness. Mental health outcomes included an array of psychological well-being and ill-being indicators. Results The 92 participants included in the per-protocol analyses (36 girls [39%] and 56 boys [61%]) had a mean (SD) age of 10.0 (1.1) years. The exercise program reduced the cardiometabolic risk score byapproximately0.38 (95% CI, -0.74 to -0.02) SDs; decreased low-density lipoprotein cholesterol level by -7.00 (95% CI, -14.27 to 0.37) mg/dL (to convert to mmol/L, multiply by 0.0259), body mass index (calculated as weight in kilograms divided by height in meters squared) by -0.59 (95% CI, -1.06 to -0.12), fat mass index by -0.67 (95% CI, -1.01 to -0.33), and visceral adipose tissue by -31.44 (95% CI, -58.99 to -3.90) g; and improved cardiorespiratory fitness by 2.75 (95% CI, 0.22-5.28) laps in the exercise group compared with the control group. No effects were observed on mental health outcomes. Conclusions and Relevance In this secondary analysis of a randomized clinical trial, an aerobic plus resistance exercise program improved cardiometabolic health in children with overweight or obesity but had no effect on mental health.
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| 21. |
- Müssener, Ulrika, et al.
(författare)
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Promoting Healthy Behaviors Among Adolescents and Young Adults With Intellectual Disability : Protocol for Developing a Digital Intervention With Co-Design Workshops
- 2023
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Ingår i: JMIR Research Protocols. - : JMIR Publications Inc.. - 1929-0748. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Intellectual disability (ID) is a neurodevelopmental disorder associated with a poorer health profile and higher mortality. Young people with ID have more sedentary lifestyles than their typically developing peers. Consequently, this group is at significant risk of developing lifestyle diseases (ie, noncommunicable diseases) later in life. Increasing physical activity and eating a healthier diet have been argued to be effective ways to improve the health of adolescents and young adults with ID. Digital interventions are a viable option for improving health behaviors. Objective: This research protocol describes a co-design approach using workshops to develop a digital intervention that promotes healthy behaviors, including increasing physical activity and eating a healthier diet, among adolescents and young adults with ID. Methods: A participatory design using a co-design approach will be applied as a strategy to include potential users of the digital intervention and other stakeholders in the research process, comprising research design, data collection, and data analysis. A total of 7 to 10 workshops will be conducted aimed at developing a digital intervention and will include procedures for assessing needs; facilitators and barriers to health promotion; physical, mental, and social well-being; participation; and relationships. The workshops will include 12 to 18 stakeholders with experience of clinical practice and research related to young people with ID, including relatives, as well as adolescents and young adults (aged 16-25 years) with mild to moderate ID. Participants will perform a mixture of individual and group work using whiteboards, sticky notes, felt-tip pens, cards, balls, stickers, and wireframe templates. Data analysis will take place concurrently with data collection as an iterative process. Transcribed data from the audio and video recordings of the groups’ discussions will be analyzed following a qualitative methodological procedure. Results: This study protocol provides a systematic record of the scientific methodologies used when developing the digital intervention and provides insights into the potential practical solutions and challenges when following a co-design approach in which relatives and professionals, as well as adolescents and young adults with ID, are included as research partners. Recruitment of participants started in April 2023. Data collection, analysis, and reporting will be completed in December 2023. Conclusions: This study will explore the effectiveness of workshops at gathering rich, reliable, and valid data in a co-design approach with participants. The results will provide increased knowledge in how to use technology to develop novel, evidence-based, and scalable interventions that adolescents and young adults with ID can and want to use to motivate physical activity and a healthier diet. The project will provide a simple and cognitively accessible digital solution for promoting lifestyle behaviors tailored to the needs of adolescents and young adults with ID.
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| 22. |
- Nyström, Christine Delisle, et al.
(författare)
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A 12-month follow-up of a mobile-based (mHealth) obesity prevention intervention in pre-school children: the MINISTOP randomized controlled trial
- 2018
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Ingår i: BMC Public Health. - : BIOMED CENTRAL LTD. - 1471-2458. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background: To date, few mobile health (mHealth) interventions aimed at changing lifestyle behaviors have measured long term effectiveness. At the 6-month follow-up the MINISTOP trial found a statistically significant intervention effect for a composite score comprised of fat mass index (FMI) as well as dietary and physical activity variables; however, no intervention effect was observed for FMI. Therefore, the aim of this study was to investigate if the MINISTOP intervention 12-months after baseline measurements: (i) improved FMI and (ii) had a maintained effect on a composite score comprised of FMI and dietary and physical activity variables. Methods: A two-arm parallel randomized controlled trial was conducted in 315 healthy 4.5 year old children between January 2014 and October 2015. Parents of the participating children either received the MINISTOP intervention or a basic pamphlet on dietary and physical activity behaviors (control group). After 6 months, participants did not have access to the intervention content and were measured again 6 months later (i.e. the 12-month follow-up). The Wilcoxon rank-sum test was then used to examine differences between the groups. Results: At the 12-month follow-up, no statistically significant difference was observed between the intervention and control groups for FMI (p = 0.57) and no maintained effect for the change in composite score was observed (mean +/- standard deviation for the intervention and control group: + 0.53 +/- 1.49 units and + 0.35 +/- 1.27 units respectively, p = 0.25 between groups). Conclusions: The intervention effect observed at the 6-month follow-up on the composite score was not maintained at the 12-month follow-up, with no effect on FMI being observed at either follow-up. Future studies using mHealth are needed to investigate how changes in obesity related markers in young children can be maintained over longer time periods.
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| 23. |
- Pawar, Yash, et al.
(författare)
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Leveraging Clinical BERT in Multimodal Mortality Prediction Models for COVID-19
- 2022
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Ingår i: In Proceedings of IEEE International Symposium on Computer-Based Medical Systems (CMBS 2022). - : IEEE. - 9781665467704 ; , s. 199-204
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Konferensbidrag (refereegranskat)abstract
- Clinical prediction models are often based solely on the use of structured data in electronic health records, e.g. vital parameters and laboratory results, effectively ignoring potentially valuable information recorded in other modalities, such as free-text clinical notes. Here, we report on the development of a multimodal model that combines structured and unstructured data. In particular, we study how best to make use of a clinical language model in a multimodal setup for predicting 30-day all-cause mortality upon hospital admission in patients with COVID-19. We evaluate three strategies for incorporating a domain-specific clinical BERT model in multimodal prediction systems: (i) without fine-tuning, (ii) with unimodal fine-tuning, and (iii) with multimodal fine-tuning. The best-performing model leverages multimodal fine-tuning, in which the clinical BERT model is updated based also on the structured data. This multimodal mortality prediction model is shown to outperform unimodal models that are based on using either only structured data or only unstructured data. The experimental results indicate that clinical prediction models can be improved by including data in other modalities and that multimodal fine-tuning of a clinical language model is an effective strategy for incorporating information from clinical notes in multimodal prediction systems.
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| 24. |
- Åsberg, Katarina, et al.
(författare)
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Digital multiple health behaviour change intervention targeting online help seekers : protocol for the COACH randomised factorial trial
- 2022
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Ingår i: BMJ Open. - : BMJ Publishing Group. - 2044-6055. ; 12:7
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Unhealthy lifestyle behaviours continue to be highly prevalent, including alcohol consumption, unhealthy diets, insufficient physical activity and smoking. There is a lack of effective interventions which have a large enough reach into the community to improve public health. Additionally, the common co-occurrence of multiple unhealthy behaviours demands investigation of efforts which address more than single behaviours. Methods and analysis The effects of six components of a novel digital multiple health behaviour change intervention on alcohol consumption, diet, physical activity and smoking (coprimary outcomes) will be estimated in a factorial randomised trial. The components are designed to facilitate behaviour change, for example, through goal setting or increasing motivation, and are either present or absent depending on allocation (ie, six factors with two levels each). The study population will be those seeking help online, recruited through search engines, social media and lifestyle-related websites. Included will be those who are at least 18 years of age and have at least one unhealthy behaviour. An adaptive design will be used to periodically make decisions to continue or stop recruitment, with simulations suggesting a final sample size between 1500 and 2500 participants. Multilevel regression models will be used to analyse behavioural outcomes collected at 2 months and 4 months postrandomisation. Ethics and dissemination Approved by the Swedish Ethical Review Authority on 2021-08-11 (Dnr 2021-02855). Since participation is likely motivated by gaining access to novel support, the main concern is demotivation and opportunity cost if the intervention is found to only exert small effects. Recruitment began on 19 October 2021, with an anticipated recruitment period of 12 months.
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| 25. |
- Åsberg, Katarina, et al.
(författare)
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Multiple lifestyle behaviour mHealth intervention targeting Swedish college and university students : protocol for the Buddy randomised factorial trial
- 2021
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Ingår i: BMJ Open. - : BMJ Publishing Group. - 2044-6055. ; 11:12
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Tidskriftsartikel (refereegranskat)abstract
- Introduction The time during which many attend college or university is an important period for developing health behaviours, with potentially major implications for future health. Therefore, it is concerning that many Swedish students excessively consume alcohol, have unhealthy diets, are not physical active and smoke. The potential of digital interventions which integrate support for change of all of these behaviours is largely unexplored, as are the dismantled effects of the individual components that make up digital lifestyle behaviour interventions. Methods and analysis A factorial randomised trial (six factors with two levels each) will be employed to estimate the effects of the components of a novel mHealth multiple lifestyle intervention on alcohol consumption, diet, physical activity and smoking among Swedish college and university students. A Bayesian group sequential design will be employed to periodically make decisions to continue or stop recruitment, with simulations suggesting that between 1500 and 2500 participants will be required. Multilevel regression models will be used to analyse behavioural outcomes collected at 2 and 4 months postrandomisation. Ethics and dissemination The study was approved by the Swedish Ethical Review Authority on 2020-12-15 (Dnr 2020-05496). The main concern is the opportunity cost if the intervention is found to only have small effects. However, considering the lack of a generally available evidence-based multiple lifestyle behaviour support to university and college students, this risk was deemed acceptable given the potential benefits from the study. Recruitment will begin in March 2021, and it is expected that recruitment will last no more than 24 months. A final data set will, therefore, be available in July 2023, and findings will be reported no later than December 2023.
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| 26. |
- Alam, Mahbub Ul, et al.
(författare)
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Deep Learning from Heterogeneous Sequences of Sparse Medical Data for Early Prediction of Sepsis
- 2020
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Ingår i: Proceedings of the 13th International Joint Conference on Biomedical Engineering Systems and Technologies, Volume 5: HEALTHINF. - Setúbal : SciTePress. - 9789897583988 ; , s. 45-55
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Konferensbidrag (refereegranskat)abstract
- Sepsis is a life-threatening complication to infections, and early treatment is key for survival. Symptoms of sepsis are difficult to recognize, but prediction models using data from electronic health records (EHRs) can facilitate early detection and intervention. Recently, deep learning architectures have been proposed for the early prediction of sepsis. However, most efforts rely on high-resolution data from intensive care units (ICUs). Prediction of sepsis in the non-ICU setting, where hospitalization periods vary greatly in length and data is more sparse, is not as well studied. It is also not clear how to learn effectively from longitudinal EHR data, which can be represented as a sequence of time windows. In this article, we evaluate the use of an LSTM network for early prediction of sepsis according to Sepsis-3 criteria in a general hospital population. An empirical investigation using six different time window sizes is conducted. The best model uses a two-hour window and assumes data is missing not at random, clearly outperforming scoring systems commonly used in healthcare today. It is concluded that the size of the time window has a considerable impact on predictive performance when learning from heterogeneous sequences of sparse medical data for early prediction of sepsis.
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| 27. |
- Alam, Mahbub Ul, et al.
(författare)
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Terminology Expansion with Prototype Embeddings : Extracting Symptoms of Urinary Tract Infection from Clinical Text
- 2021
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Ingår i: Proceedings of the 14th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2021) - Volume 5: HEALTHINF. - Setúbal : SciTePress. - 9789897584909 ; , s. 47-57
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Konferensbidrag (refereegranskat)abstract
- Many natural language processing applications rely on the availability of domain-specific terminologies containing synonyms. To that end, semi-automatic methods for extracting additional synonyms of a given concept from corpora are useful, especially in low-resource domains and noisy genres such as clinical text, where nonstandard language use and misspellings are prevalent. In this study, prototype embeddings based on seed words were used to create representations for (i) specific urinary tract infection (UTI) symptoms and (ii) UTI symptoms in general. Four word embedding methods and two phrase detection methods were evaluated using clinical data from Karolinska University Hospital. It is shown that prototype embeddings can effectively capture semantic information related to UTI symptoms. Using prototype embeddings for specific UTI symptoms led to the extraction of more symptom terms compared to using prototype embeddings for UTI symptoms in general. Overall, 142 additional UTI symp tom terms were identified, yielding a more than 100% increment compared to the initial seed set. The mean average precision across all UTI symptoms was 0.51, and as high as 0.86 for one specific UTI symptom. This study provides an effective and cost-effective solution to terminology expansion with small amounts of labeled data.
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| 28. |
- Arias Tellez, Maria Jose, et al.
(författare)
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Association of Neck Circumference with Anthropometric Indicators and Body Composition Measured by DXA in Young Spanish Adults
- 2020
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Ingår i: Nutrients. - : MDPI. - 2072-6643. ; 12:2
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Tidskriftsartikel (refereegranskat)abstract
- Background: Due to a clinical and public health interest of neck circumference (NC), a better understanding of this simple anthropometric measurement, as a valid marker of body composition is necessary. Methods: A total of 119 young healthy adults participated in this study. NC was measured over the thyroid cartilage and perpendicular to the longitudinal axis of the neck. Body weight, height, waist circumference (WC), and hip circumference were measured. A Dual X-ray absorptiometry (DXA) scan was used to determine fat mass, lean mass, and visceral adipose tissue (VAT). Additionally, body mass index (BMI) and triponderal mass index (TMI), the waist to hip and waist to height ratios, and the fat mass and lean mass indexes (FMI and LMI, respectively) were calculated. Results: NC was positively associated in women (W) and men (M), with BMI (rW = 0.70 and rM = 0.84, respectively), TMI (rW = 0.63 and rM = 0.80, respectively), WC (rW = 0.75 and rM = 0.86, respectively), VAT (rW = 0.74 and rM = 0.82, respectively), Waist/hip (rW = 0.51 and rM = 0.67, respectively), Waist/height (rW = 0.68 and rM = 0.83, respectively) and FMI (rW = 0.61 and rM = 0.81, respectively). The association between NC and indicators of body composition was however weaker than that observed by BMI, TMI, WC and Waist/height in both women and men. It is of note that in women, NC was associated with FMI, VAT and LMI independently of BMI. In men, adding NC to anthropometric variables did not improve the prediction of body composition, while slight improvements were observed in women. Conclusions: Taken together, the present study provides no indication for NC as a useful proxy of body composition parameters in young adults, yet future studies should explore its usefulness as a measure to use in combination with BMI, especially in women.
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| 29. |
- Ballin, Marcel, et al.
(författare)
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Genetic and Environmental Factors and Cardiovascular Disease Risk in Adolescents
- 2023
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Ingår i: JAMA Network Open. - : American Medical Association (AMA). - 2574-3805. ; 6:11
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Tidskriftsartikel (refereegranskat)abstract
- Importance Cardiovascular risk factors in youth have been associated with future cardiovascular disease (CVD), but conventional observational studies are vulnerable to genetic and environmental confounding.Objective To examine the role of genetic and environmental factors shared by full siblings in the association of adolescent cardiovascular risk factors with future CVD.Design, Setting, and Participants This is a nationwide cohort study with full sibling comparisons. All men who underwent mandatory military conscription examinations in Sweden between 1972 and 1995 were followed up until December 31, 2016. Data analysis was performed from May 1 to November 10, 2022.Exposures Body mass index (BMI), cardiorespiratory fitness, blood pressure, handgrip strength, and a combined risk z score in late adolescence.Main Outcomes and Measures The primary outcome was fatal or nonfatal CVD, as recorded in the National Inpatient Register or the Cause of Death Register before 2017.Results A total of 1 138 833 men (mean [SD] age, 18.3 [0.8] years), of whom 463 995 were full brothers, were followed up for a median (IQR) of 32.1 (26.7-37.7) years, during which 48 606 experienced a CVD outcome (18 598 among full brothers). All risk factors were associated with CVD, but the effect of controlling for unobserved genetic and environmental factors shared by full siblings varied. In the sibling analysis, hazard ratios for CVD (top vs bottom decile) were 2.10 (95% CI, 1.90-2.32) for BMI, 0.77 (95% CI, 0.68-0.88) for cardiorespiratory fitness, 1.45 (95% CI, 1.32-1.60) for systolic blood pressure, 0.90 (95% CI, 0.82-0.99) for handgrip strength, and 2.19 (95% CI, 1.96-2.46) for the combined z score. The percentage attenuation in these hazard ratios in the sibling vs total cohort analysis ranged from 1.1% for handgrip strength to 40.0% for cardiorespiratory fitness. Consequently, in the sibling analysis, the difference in cumulative CVD incidence at age 60 years (top vs bottom decile) was 7.2% (95% CI, 5.9%-8.6%) for BMI and 1.8% (95% CI, 1.0%-2.5%) for cardiorespiratory fitness. Similarly, in the sibling analysis, hypothetically shifting everyone in the worst deciles of BMI to the middle decile would prevent 14.9% of CVD at age 60 years, whereas the corresponding number for cardiorespiratory fitness was 5.3%.Conclusions and Relevance In this Swedish national cohort study, cardiovascular risk factors in late adolescence, especially a high BMI, were important targets for CVD prevention, independently of unobserved genetic and environmental factors shared by full siblings. However, the role of adolescent cardiorespiratory fitness in CVD may have been overstated by conventional observational studies.
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| 30. |
- Cadenas-Sanchez, Cristina, et al.
(författare)
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Differences in Brain Volume between Metabolically Healthy and Unhealthy Overweight and Obese Children : The Role of Fitness
- 2020
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Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 9:4
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to examine whether metabolically healthy overweight/obese children have greater global and regional gray matter volumes than their metabolically unhealthy peers. We further examined the association between gray matter volume and academic achievement, along with the role of cardiorespiratory fitness in these associations. A total of 97 overweight/obese children (10.0 +/- 1.2 years) participated. We classified children as metabolically healthy/unhealthy based on metabolic syndrome cut-offs. Global and regional brain volumes were assessed by magnetic resonance imaging. Academic achievement was assessed using the Woodcock-Munoz standardized test. Cardiorespiratory fitness was assessed by the 20 m shuttle run test. Metabolically healthy overweight/obese (MHO) children had greater regional gray matter volume compared to those who were metabolically unhealthy (MUO) (all p <= 0.001). A similar trend was observed for global gray matter volume (p = 0.06). Global gray matter volume was positively related to academic achievement (beta = 0.237, p = 0.036). However, all the associations were attenuated or disappeared after adjusting for cardiorespiratory fitness (p > 0.05). The findings of the present study support that metabolically healthy overweight/obese children have greater gray matter volume compared to those that are metabolically unhealthy, which is in turn related to better academic achievement. However, cardiorespiratory fitness seems to explain, at least partially, these findings.
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| 31. |
- Cadenas-Sanchez, Cristina, et al.
(författare)
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Fitness, physical activity and academic achievement in overweight/obese children
- 2020
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Ingår i: Journal of Sports Sciences. - : TAYLOR & FRANCIS LTD. - 0264-0414 .- 1466-447X. ; 38:7, s. 731-740
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to examine the associations of fitness and physical activity with academic achievement in children with overweight/obesity. A total of 106 (10.0 +/- 1.1y, 61 boys) children participated. The fitness components were assessed by field and laboratory-based tests. Physical activity was measured via accelerometry. The academic achievement was assessed by a standardised test and school-grades. Field-based cardiorespiratory fitness was associated with language skills (ss-standardised- ranging from 0.281 to 0.365, p amp;lt; 0.01). The field-based muscular strength was associated with grade point average, natural and social sciences, and foreign language (ss = 0.280-0.326, all p amp;lt;= 0.01). Speed-agility was associated with some language-related skills (ss = 0.325-0.393, all p amp;lt;= 0.01). The laboratory-based muscular strength also showed an association with mathematics skills (ss = 0.251-0.306, all p amp;lt;= 0.01). Physical activity did not show significant association with academic achievement (p amp;gt; 0.01). Overall, the significant associations observed for muscular strength and speed/agility were attenuated and disappeared in many cases after additional adjustments for body mass index and cardiorespiratory fitness, indicating that these associations are inter-dependent. Our study contributes by indicating that other fitness components apart from cardiorespiratory fitness, such as muscular strength and speed-agility, are positively associated with academic achievement. However, these associations appear to be dependent on body mass index and cardiorespiratory fitness.
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| 32. |
- Chen, C., et al.
(författare)
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Increasing Childrens physical Activity by Policy (CAP) in preschools within the Stockholm region : study protocol for a pragmatic cluster-randomized controlled trial
- 2022
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Ingår i: Trials. - : BMC. - 1745-6215. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Systematic reviews suggest that preschool environmental/organizational changes may be effective in increasing physical activity (PA) levels of preschool children, but evidence is scarce regarding feasible, effective, and equitable interventions that can be scaled up. Specifically, it is essential to understand whether introducing a multicomponent organizational change in terms of policy in the preschool context may be beneficial for childrens PA levels and concomitant health outcomes. To bridge this knowledge gap, our main aim is to examine the feasibility and effectiveness of a policy package in increasing PA levels in preschool children, using a large-scale pragmatic cluster-randomized controlled trial. Methods: This proposed study is a pragmatic cluster-randomized controlled trial with two conditions (intervention and control with a 1:1 ratio) with preschools as clusters and the unit of randomization. We aim to recruit approximately 4000 3-5-year-old children from 90 preschools and retain more than 2800 children from 85 preschools to provide adequate statistical power for the analyses. The intervention to implement is a co-created, multicomponent policy package running for 6 months in preschools randomized to intervention. Change in accelerometer measured PA levels in children between intervention and control from pre- and post-intervention will be the primary outcome of the study, while secondary outcomes include health outcomes such as musculoskeletal fitness, psychosocial functioning, and absence due to illness in children among others. Implementation will be studied carefully using both quantitative (dose, fidelity) and qualitative (interview) methodologies. The change in primary and secondary outcomes, from pre- to post-intervention, will be analyzed with linear mixed-effect models (to allow both fixed and random effects) nested on a preschool level. Discussion: This is a large-scale co-creation project involving the City of Stockholm, childcare stakeholders, preschool staff, and the research group with the potential to influence more than 30,000 preschool children within the Stockholm area. The study will add reliable evidence for the implementation of PA policies at the organizational level of preschools and clarify its potential effect on objectively measured PA and health markers in children.
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| 33. |
- Chen, Chu, et al.
(författare)
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Preschool environment and preschool teachers physical activity and their association with childrens activity levels at preschool
- 2020
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Ingår i: PLOS ONE. - : PUBLIC LIBRARY SCIENCE. - 1932-6203. ; 15:10
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Tidskriftsartikel (refereegranskat)abstract
- Objective The aim of this study was to investigate the association between preschool playground size, formalized physical activity (PA) policies, time spent outdoors and preschool teachers levels of PA and childrens objectively assessed levels of PA and sedentary time (ST) during preschool hours. Methods In total, 369 children and 84 preschool teachers from 27 preschools in Sodermalm municipally, Stockholm Sweden wore an Actigraph GT3X+ accelerometer during 7 consecutive days. Preschool environmental and structural characteristics were measured via the Environment and Policy Evaluation Self-Report ( EPAO-SR) instrument and time in- and outdoors was recorded by preschool teachers during the PA measurements. Weight and height of children were measured via validated scales and parents filled out a questionnaire on demographical and descriptive variables. Linear mixed models, nested on preschool level, were used to assess the association between predictors and outcomes. Results The mean child age was 4.7 years (SD 0.8) and 45% were girls. We found that children were more active in preschools with a formalized PA policy, compared to preschools without such a policy, but not less sedentary. The association between policy and activity seemed to be more pronounced when accounting for other environmental factors. Similar associations were found in children spent most time outdoors (uppermost quartile) compared with children spent least time outdoors (Lowermost quartile). Preschool teachers light PA (LPA) (beta = 0.25, P = 0.004) and steps (beta = 0.52, P<0.001) were associated with childrens LPA and steps while the preschool playground size showed no association with PA in children, when accounting for other environmental factors. Conclusion The current study showed that preschool structural characteristics such as formalized PA policies and more time spent outdoors were positively associated with childrens PA. These findings suggest that formalized PA policies and time outdoors may be of importance for promoting childrens PA during preschool hours.
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| 34. |
- De-la-O, A., et al.
(författare)
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Association of Energy and Macronutrients Intake with S-Klotho Plasma Levels in Middle-Aged Sedentary Adults: A Cross-Sectional Study
- 2022
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Ingår i: The Journal of Nutrition, Health & Aging. - : SPRINGER FRANCE. - 1279-7707 .- 1760-4788. ; 26, s. 360-367
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Tidskriftsartikel (refereegranskat)abstract
- Background The ageing process can be influenced by energy intake and different macronutrients within the diet. The soluble form of the a-Klotho gene (called S-Klotho) is widely considered as a powerful anti-ageing biomarker. Objective To analyze the association of energy, dietary energy density and macronutrient intake with S-Klotho plasma levels in middle-aged sedentary adults. Methods A total of 72 (52.8% women) middle-aged sedentary adults (53.7 +/- 5.2 years old) participated in the study. Energy and macronutrients intake (i.e. fat, carbohydrate and protein) were assessed using three non-consecutive 24-h recalls. S-Klotho plasma levels were measured in the Ethylenediaminetetraacetic acid (EDTA) plasma using a solid-phase sandwich enzyme-linked immunosorbent assay. Results No association was observed between energy, dietary energy density or macronutrient intake and S-Klotho plasma levels in men (all P >= 0.1). We found an inverse association between energy, protein and carbohydrate intake with S-Klotho plasma levels in women (all P <= 0.043), which disappeared after controlling for age, lean mass index and sedentary time. An inverse association was observed between dietary energy density and S-Klotho plasma levels in women after controlling for covariates (all P <= 0.05). Conclusion In summary, the present study showed an inverse association of dietary energy density with S-Klotho plasma levels in middle-aged women. In addition, our data suggest that the associations between energy and macronutrient intake could be highly dependent on lean mass and sedentary time.
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| 35. |
- Delisle Nystrom, Christine, et al.
(författare)
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Physical Activity and Cardiovascular Risk Factors in Children from 4 to 9 Years of Age
- 2023
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Ingår i: SPORTS MEDICINE-OPEN. - : SPRINGER. - 2199-1170. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Physical activity guidelines for children encourage moderate-to-vigorous intensity activities (MVPA); however, some studies have found that only vigorous intensity activities (VPA) might promote health benefits in young children. Thus, the aim of this study is to investigate cross-sectional and 5-year longitudinal associations of VPA and MVPA with cardiovascular disease (CVD) risk factors in childhood using compositional data analysis.Results This study utilized data from the SPINACH study (n = 411). Physical activity was measured with accelerometers at 4- and 9-years of age. CVD risk factors were measured at 9-years of age, and included blood pressure (BP), lipid metabolism, and glucose metabolism biomarkers, as well as a continuous metabolic syndrome risk score (MetS). Cross-sectional and longitudinal linear regression models were built using compositional data analysis standards. Cross-sectionally, reallocating time to VPA from lower-intensity behaviours at 9-years was associated with lower waist circumference (B = - 3.219, P = 0.002), diastolic BP (B = - 1.836, P = 0.036), triglycerides (B = - 0.214, P < 0.001), glucose (B = - 0.189, P = 0.033), insulin (B = - 2.997, P < 0.001), and HOMA-IR (B = - 0.778, P < 0.001). Similarly, reallocating time to VPA at 4-years was associated with lower MetS (B = - 0.831, P = 0.049), waist circumference (B = - 4.211, P = 0.015), systolic BP (B = - 5.572, P = 0.015), diastolic BP (B = - 2.931, P = 0.044), triglycerides (B = - 0.229, P = 0.034), glucose (B = - 0.325, P = 0.032), insulin (B = - 5.114, P = 0.001), and HOMA-IR (B = - 0.673, P = 0.001) at 9-years. Reallocations of time to MVPA at 4- or 9-years were not associated with CVD risk factors at 9-years.Conclusions VPA was associated with CVD risk factors in children both cross-sectionally (9-years) and longitudinally (at 4- and 9-years). MVPA seemed not to be a stimulus of enough intensity to trigger these potential cardiometabolic benefits in healthy children. Thus, these findings suggest the importance of higher intensity activities, i.e., VPA already in early childhood for cardiometabolic health.
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| 36. |
- Delisle Nystrom, Christine, et al.
(författare)
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The Tanita SC-240 to Assess Body Composition in Pre-School Children: An Evaluation against the Three Component Model
- 2016
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Ingår i: Nutrients. - : MDPI AG. - 2072-6643. ; 8:6, s. 371-
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Tidskriftsartikel (refereegranskat)abstract
- Quick, easy-to-use, and valid body composition measurement options for young children are needed. Therefore, we evaluated the ability of the bioelectrical impedance (BIA) device, Tanita SC-240, to measure fat mass (FM), fat free mass (FFM) and body fatness (BF%) in 40 healthy, Swedish 5.5 years old children against the three component model (3C model). Average BF%, FM, and FFM for BIA were: 19.4% +/- 3.9%, 4.1 +/- 1.9 kg, and 16.4 +/- 2.4 kg and were all significantly different (p amp;lt; 0.001) from corresponding values for the 3C model (25.1% +/- 5.5%, 5.3 +/- 2.5 kg, and 15.2 +/- 2.0 kg). Bland and Altman plots had wide limits of agreement for all body composition variables. Significant correlations ranging from 0.81 to 0.96 (p amp;lt; 0.001) were found for BF%, FM, and FFM between BIA and the 3C model. When dividing the children into tertiles for BF%, 60% of children were classified correctly by means of BIA. In conclusion, the Tanita SC-240 underestimated BF% in comparison to the 3C model and had wide limits of agreement. Further work is needed in order to find accurate and easy-to-use methods for assessing body composition in pre-school children.
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| 37. |
- Ek, Anna, et al.
(författare)
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Effectiveness of a 3-Month Mobile Phone-Based Behavior Change Program on Active Transportation and Physical Activity in Adults : Randomized Controlled Trial.
- 2020
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Ingår i: JMIR mhealth and uhealth. - : JMIR Publications. - 2291-5222. ; 8:6, s. 1-15
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Active transportation (AT; ie, walking and cycling as a mode for transportation) has been associated with decreased morbidity and mortality; however, low-cost and scalable intervention programs are lacking.OBJECTIVE: The goal of the research was to determine the effectiveness of a 3-month behavior change program delivered via a mobile phone app to promote AT (TravelVu Plus) on time spent in moderate-to-vigorous physical activity (MVPA).METHODS: For this 2-arm parallel randomized controlled trial, we recruited a population-based sample of 254 adults from Stockholm County who were aged 20 to 65 years and had access to a smartphone. On completion of 1-week baseline measures, the 254 participants were randomized to either the control or intervention group (1:1 ratio). Both groups had access to the standard TravelVu app (Trivector AB) for monitoring their AT for 6 months. The intervention group also received a 3-month behavior change program to promote AT (TravelVu Plus app). Assessors of outcomes were blinded to group allocation. Outcomes were objectively measured MVPA at 3 (primary) and 6 months. Secondary outcomes were AT, attitudes toward AT, and health-related quality of life at 3 and 6 months.RESULTS: No effect on MVPA was observed after 3 months (P=.29); however, at 6 months the intervention group had a greater improvement in MVPA than the controls (6.05 minutes per day [95% CI 0.36 to 11.74; P=.04]). A Bayesian analyses showed that there was a 98% probability that the intervention had any effect at 6 months, and a 63% probability that this effect was >5 minute MVPA per day.CONCLUSIONS: No effect on MVPA immediately after the intervention period (at 3 months) was observed; however, there was a delayed effect on MVPA (6 minutes per day) at 6 months, which corresponds to approximately 30% of the weekly MVPA recommendation. Our findings suggest that a behavior change program promoting AT delivered via an app may have a relevant effect on PA.TRIAL REGISTRATION: ClinicalTrials.gov NCT03086837; https://clinicaltrials.gov/ct2/show/NCT03086837.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12889-018-5658-4.
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| 38. |
- Esteban-Cornejo, Irene, et al.
(författare)
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Early life programming of attention capacity in adolescents : The HELENA study
- 2018
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Ingår i: Maternal and Child Nutrition. - : Wiley. - 1740-8695 .- 1740-8709. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- The study aims to examine the individual and combined association of early life factors (birth weight, birth length, and any and exclusive breastfeeding) with attention capacity in adolescents. The study included 421 European adolescents (243 girls), aged 12.5-17.5 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence Study. Body weight and length at birth of adolescents were collected from parental records. The duration of any and exclusive breastfeeding were self-reported. The d2 Test of Attention was administered to assess attention capacity. The main results showed that birth weight, birth length, breastfeeding, and exclusive breastfeeding were related to attention capacity in boys (β ranging from 0.144 to 0.196; all p < .05) after adjustment for age, centre, gestational age, maternal education, family affluence scale, and body mass index. Among boys, differences in attention capacity were found according to tertiles of birth weight and birth length (p < .05), as well as borderline significant differences across groups of any and exclusive breastfeeding (p = 0.055 and p = 0.108, respectively) after adjusting for potential confounders. In addition, boys with 3 early life risk factors (low birth weight, low birth length, and <3 months of breastfeeding) had significantly lower scores in attention capacity compared with boys with 0 risk factors (percentile score - 15.88; p = 0.009). In conclusion, early life factors, both separately and combined, may influence attention capacity in male European adolescents. Importantly, the combination of the 3 early life risk factors, low birth weight, low birth length, and <3 months of breastfeeding, even in normal ranges, may provide the highest reduction in attention capacity.
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| 39. |
- Esteban-Cornejo, Irene, et al.
(författare)
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Fitness, cortical thickness and surface area in overweight/obese children: The mediating role of body composition and relationship with intelligence
- 2019
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Ingår i: NeuroImage. - : ACADEMIC PRESS INC ELSEVIER SCIENCE. - 1053-8119 .- 1095-9572. ; 186, s. 771-781
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Tidskriftsartikel (refereegranskat)abstract
- Cortical thickness and surface area are thought to be genetically unrelated and shaped by independent neurobiological events suggesting that they should be considered separately in morphometric analyses. Although the developmental trajectories of cortical thickness and surface area may differ across brain regions and ages, there is no consensus regarding the relationships of physical fitness with cortical thickness and surface area as well as for its subsequent influence on intelligence. Thus, this study examines: (i) the associations of physical fitness components (i.e., cardiorespiratory fitness, speed-agility and muscular fitness) with overall and regional cortical thickness and surface area; (ii) whether body composition indicators (i.e., body mass index, fat-free mass index and fat mass index) mediate these associations; and (iii) the association of physical fitness and cortical thickness with intelligence in overweight/obese children. A total of 101 overweight/obese children aged 8-11 years were recruited in Granada, Spain. The physical fitness components were assessed following the ALPHA health-related fitness test battery. T1-weighted images were acquired with a 3.0 Tesla Siemens Magnetom Tim Trio system. We used FreeSurfer software version 5.3.0 to assess cortical thickness (mm) and surface area (mm(2)). The main results showed that cardiorespiratory fitness and speed-agility were related to overall cortical thickness (beta = 0.321 and beta = 0.302, respectively; both P amp;lt; 0.05), and in turn, cortical thickness was associated with higher intelligence (beta = 0.198, P amp;lt; 0.05). Muscular fitness was not related to overall cortical thickness. None of the three physical fitness components were related to surface area (p amp;gt; 0.05). The associations of cardiorespiratory fitness and speed-agility with overall cortical thickness were mediated by fat mass index (56.86% amp; 62.28%, respectively). In conclusion, cardiorespiratory fitness and speed-agility, but not muscular fitness, are associated with overall cortical thickness, and in turn, thicker brain cortex is associated with higher intelligence in overweight/obese children. Yet, none of the three physical fitness components were related to surface area. Importantly, adiposity may hinder the benefits of cardiorespiratory fitness and speed-agility on cortical thickness. Understanding individual differences in brain morphology may have important implications for educators and policy makers who aim to determine policies and interventions to maximize academic learning and occupational success later in life.
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| 40. |
- Flor-Alemany, Marta, et al.
(författare)
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Associations of Mediterranean diet with psychological ill-being and well-being throughout the pregnancy course : The GESTAFIT project
- 2022
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Ingår i: Quality of Life Research. - : Springer. - 0962-9343 .- 1573-2649. ; 31, s. 2705-2716
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The relation between diet and maternal mental health during pregnancy might be relevant to prevent adverse materno-foetal outcomes. This study examined the association of Mediterranean diet (MD) adherence and MD components with mental health during pregnancy. Methods This secondary analysis of the GESTAFIT trial included longitudinal data from 152 pregnant women. Dietary habits were assessed with a food frequency questionnaire, and MD adherence was derived from it using the Mediterranean Food pattern. Psychological ill-being (i.e., negative affect, anxiety, and depression) and well-being (i.e., emotional intelligence, resilience, positive affect) were assessed with the Spanish version of well-established self-reported questionnaires. Cross-sectional (16th gestational week [g.w.]) and longitudinal associations (34th g.w.) between MD and mental health were studied using linear regression models. Results A greater MD adherence was inversely associated with negative affect and anxiety; and positively associated with emotional regulation, resilience and positive affect at the 16th and 34th g.w. (|beta| ranging from 0.179 to 0.325, all p < 0.05). Additionally, a higher intake of whole grain cereals, fruits, vegetables, fish, olive oil and nuts, and a lower intake of red meat and subproducts and sweets were associated with lower negative affect, anxiety, depression and higher emotional regulation, resilience and positive affect throughout gestation (|beta| ranging from 0.168 to 0.415, all p < 0.05). Conclusion A higher intake of whole grain cereals, fruits, vegetables, fish, olive oil and nuts, together with a lower intake of red meat and sweets, resulted in a higher MD adherence, which was associated with a better mental health during pregnancy.
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| 41. |
- Flor-Alemany, Marta, et al.
(författare)
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Impact of Exercise Intervention Combined with Optimal Mediterranean Diet Adherence during Pregnancy on Postpartum Body Composition: A Quasi-Experimental Study-The GESTAFIT Project
- 2023
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Ingår i: Nutrients. - : MDPI. - 2072-6643. ; 15:20
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed to investigate whether the effects of an exercise program during pregnancy on postpartum body composition are moderated by following a healthy dietary pattern (i.e., Mediterranean diet (MD)). Eighty-three pregnant women (control n = 40, exercise n = 43) were included in the present quasi-experimental study. The exercise intervention consisted of a 60 min, 3 day/week throughout pregnancy from gestational week 17, supervised concurrent (aerobic + resistance) exercise program. A food frequency questionnaire and the MD Score (min-max: 0-50) were employed to assess dietary habits and the MD adherence during pregnancy, respectively. Postpartum body composition was measured with dual-energy X-ray absorptiometry, 6 weeks postpartum. The body mass index and the gynecoid fat mass at postpartum were lower in the exercise compared to the control group (p = 0.018 and p = 0.047, respectively). There was an interaction showing that the MD adherence during pregnancy positively moderated the effects of the exercise intervention on postpartum lean mass (p = 0.024), fat mass percentage (p = 0.092), android fat mass (p = 0.076), and android-to-gynecoid fat mass (p = 0.019). The Johnson-Neyman technique revealed that the effects of exercise were enhanced at a MD score of similar to 31 for lean mass, similar to 25 for fat mass, similar to 23 for android fat mass and similar to 29 for android-to-gynecoid fat mass. Our results suggest that a concurrent-exercise training plus an optimal MD adherence during pregnancy might be a useful strategy to promote a healthier body composition at the postpartum period.
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| 42. |
- Forsum, Elisabet, et al.
(författare)
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The Two-Component Model for Calculating Total Body Fat from Body Density: An Evaluation in Healthy Women before, during and after Pregnancy
- 2014
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Ingår i: Nutrients. - : MDPI. - 2072-6643. ; 6:12, s. 5888-5899
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Tidskriftsartikel (refereegranskat)abstract
- A possibility to assess body composition during pregnancy is often important. Estimating body density (D-B) and use the two-component model (2CM) to calculate total body fat (TBF) represents an option. However, this approach has been insufficiently evaluated during pregnancy. We evaluated the 2CM, and estimated fat-free mass (FFM) density and variability in 17 healthy women before pregnancy, in gestational weeks 14 and 32, and 2 weeks postpartum based on D-B (underwater weighing), total body water (deuterium dilution) and body weight, assessed on these four occasions. TBF, calculated using the 2CM and published FFM density (TBF2CM), was compared to reference estimates obtained using the three-component model (TBF3CM). TBF2CM minus TBF3CM (mean +/- 2SD) was -1.63 +/- 5.67 (p = 0.031), -1.39 +/- 7.75 (p = 0.16), -0.38 +/- 4.44 (p = 0.49) and -1.39 +/- 5.22 (p = 0.043) % before pregnancy, in gestational weeks 14 and 32 and 2 weeks postpartum, respectively. The effect of pregnancy on the variability of FFM density was larger in gestational week 14 than in gestational week 32. The 2CM, based on D-B and published FFM density, assessed body composition as accurately in gestational week 32 as in non-pregnant adults. Corresponding values in gestational week 14 were slightly less accurate than those obtained before pregnancy.
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| 43. |
- Galvez-Fernandez, Patricia, et al.
(författare)
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Convergent Validation of a Self-Reported Commuting to and from School Diary in Spanish Adolescents
- 2023
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to examine the convergent validity of self-reported diary times for commuting to and from school with device-measured positional data (Global Positioning System; GPS) in Spanish adolescents. Methods: Cross-sectional data were obtained from four Spanish public secondary schools in 2021, comprising 47 adolescents and 141 home-school and school-home trips. Participants self-reported the time they left and arrived at home and school through a commuting diary. They wore a GPS device recording the objective time during three trips (i.e., one home-school trip and two school-home trips). Agreement between commuting diary and GPS data regarding home-school trips and school-home trips was evaluated using Bland-Altman plots. Results: Total commuting time differed by 1 min (95% limits of agreement were 16.1 min and -18.1 min) between subjective and objective measures (adolescents reported 0.8 more minutes in home-school trips and 1 more minute in school-home trips compared to objective data). Passive commuters reported 0.7 more minutes and active commuters reported 1.2 more minutes in the total commuting time compared to objective data. Conclusions: Self-reported commuting diaries may be a useful tool to obtain commuting times of adolescents in epidemiological research or when tools to measure objective times are not feasible.
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| 44. |
- Hebib, Lana, et al.
(författare)
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Life’s Essential 8 is inversely associated with high-sensitivity C-reactive protein
- 2024
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Ingår i: Scientific Reports. - : Springer Nature. - 2045-2322. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- Life’s Essential 8 (LE8) is a score that includes modifiable risk factors for cardiovascular disease. Four health behaviors (diet, physical activity, nicotine exposure and sleep health) and four health factors (non-HDL cholesterol, blood glucose, blood pressure and body mass index) are included. These modifiable risk factors promote inflammation, and inflammation is one of the biological mechanisms of cardiovascular disease development. Thus, we examined the relationship between cardiovascular health measured by LE8 and low-grade inflammation measured by high-sensitivity C-reactive protein (hs-CRP) in the cross-sectional population-based Swedish CArdioPulmonary bioImage Study (SCAPIS). The study consisted of 28,010 participants between 50 and 64 years (51.5% women, mean age 57.5 years). All individual LE8 components were assigned a score between 0 (unhealthy) and 100 (healthy) points, and a global score was calculated. The association between LE8 scores and high-risk hs-CRP (defined as > 3.0 mg/L) was analyzed using adjusted logistic regression with spline analyses. There was a strong, dose response and inverse association between LE8 scores and levels of hs-CRP. Thus, those with a low LE8 score (= 50.0 points) had 5.8 higher (95% confidence interval [CI] 5.2–6.4) odds ratio (OR) of having high hs-CRP as compared to those with a high LE8 score (= 80.0 points). In conclusion, our findings show strong inverse associations between LE8 scores and levels of hs-CRP.
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| 45. |
- Henriksson, Pontus, et al.
(författare)
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Assessment and prediction of thoracic gas volume in pregnant women: an evaluation in relation to body composition assessment using air displacement plethysmography
- 2013
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Ingår i: British Journal of Nutrition. - : Cambridge University Press (CUP). - 0007-1145 .- 1475-2662. ; 109:1, s. 111-117
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Tidskriftsartikel (refereegranskat)abstract
- Assessment of body fat (BF) in pregnant women is important when investigating the relationship between maternal nutrition and offspring health. Convenient and accurate body composition methods applicable during pregnancy are therefore needed. Air displacement plethysmography, as applied in Bod Pod, represents such a method since it can assess body volume (BV) which, in combination with body weight, can be used to calculate body density and body composition. However, BV must be corrected for the thoracic gas volume (TGV) of the subject. In non-pregnant women, TGV may be predicted using equations, based on height and age. It is unknown, however, whether these equations are valid during pregnancy. Thus, we measured the TGV of women in gestational week 32 (n 27) by means of plethysmography and predicted their TGV using equations established for non-pregnant women. Body weight and BV of the women was measured using Bod Pod. Predicted TGV was significantly (P = 0.033) higher than measured TGV by 6% on average. Calculations in hypothetical women showed that this overestimation tended to be more pronounced in women with small TGV than in women with large TGV. The overestimation of TGV resulted in a small but significant (P = 0.043) overestimation of BF, equivalent to only 0.5% BF, on average. A Bland-Altman analysis showed that the limits of agreement were narrow (from -1.9 to 2.9% BF). Thus, although predicted TGV was biased and too high, the effect on BF was marginal and probably unimportant in many situations.
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| 46. |
- Henriksson, Pontus, et al.
(författare)
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Associations of body composition and physical fitness with gestational diabetes and cardiovascular health in pregnancy : Results from the HealthyMoms trial
- 2021
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Ingår i: Nutrition & Diabetes. - : SPRINGERNATURE. - 2044-4052. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to examine associations of body composition (fat mass index, % fat mass, fat-free mass index, body mass index) and physical fitness (cardiorespiratory fitness and handgrip strength) with gestational diabetes and cardiovascular health in early pregnancy. This cross-sectional study utilized baseline data (n = 303) collected in early pregnancy from the HealthyMoms trial. Body composition was measured using air-displacement plethysmography, cardiorespiratory fitness was assessed by means of the 6-min walk test and handgrip strength using a dynamometer. Logistic regression was used to estimate odds ratios (ORs) for gestational diabetes as well as high (defined as 1 SD above the mean) blood pressure, homeostatic model assessment for insulin resistance (HOMA-IR), and metabolic syndrome score (MetS score) per 1 SD increase in body composition and fitness variables. Fat mass index, % fat mass and body mass index were all strongly associated with gestational diabetes (ORs: 1.72-2.14, P <= 0.003), HOMA-IR (ORs: 3.01-3.80, P < 0.001), blood pressure (ORs: 1.81-2.05, P < 0.001) and MetS score (ORs: 3.29-3.71, P < 0.001). Associations with fat-free mass index were considerably weaker (ORs: 1.26-1.82, P = 0.001-0.15) and were strongly attenuated after adjustments for fat mass index (ORs: 0.88-1.54, P = 0.039-0.68). Finally, greater cardiorespiratory fitness was associated with lower risk of high HOMA-IR and MetS score (ORs: 0.57-0.63, P <= 0.004) although these associations were attenuated when accounting for fat mass index (ORs: 1.08-1.11, P >= 0.61). In conclusion, accurately measured fat mass index or % fat mass were strongly associated with gestational diabetes risk and markers of cardiovascular health although associations were not stronger than the corresponding ones for body mass index. Fat-free mass index had only weak associations with gestational diabetes and cardiovascular health which support that the focus during clinical care would be on excess fat mass and not fat-free mass.
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| 47. |
- Henriksson, Pontus, et al.
(författare)
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Associations of Fat Mass and Fat-Free Mass with Physical Fitness in 4-Year-Old Children: Results from the MINISTOP Trial
- 2016
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Ingår i: Nutrients. - : MDPI AG. - 2072-6643. ; 8:8, s. 473-
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Tidskriftsartikel (refereegranskat)abstract
- Physical fitness is a powerful marker of health in youth. Studies in adolescents and adults suggest that higher fat mass is related to worse physical fitness. However, there is limited knowledge whether fat mass and fat-free mass are associated with physical fitness already in preschoolers. Baseline data from the MINISTOP (Mobile-based INtervention Intended to STop Obesity in Preschoolers) trial was utilized for this cross-sectional analysis. Body composition was assessed using air-displacement plethysmography. Fat mass index [fat mass (kg)/height(2) (m)] and fat-free mass index [fat-free mass (kg)/height(2) (m)] were used to provide height-adjusted measures of body composition. Physical fitness was measured using the PREFIT (FITness testing in PREschool children) battery, which assesses cardiorespiratory fitness, upper-body and lower-body muscular strength as well as motor fitness. In total, this study included 303 children (168 boys and 135 girls), who were on average 4.48 +/- 0.15 years old. Higher fat mass index was associated with worse cardiorespiratory fitness (standardized beta = -0.17, p = 0.002), lower-body muscular strength (beta = -0.17, p = 0.003) and motor fitness (beta = -0.21, p amp;lt; 0.001) in regression analyses adjusted for age, sex and mutually adjusted for fat-mass index and fat-free mass index. Conversely, higher fat-free mass index was associated with better cardiorespiratory fitness (beta = 0.18, p = 0.002), upper-body muscular strength (beta = 0.39, p amp;lt; 0.001), lower-body muscular strength (beta = 0.22, p amp;lt; 0.001) and motor fitness (beta = 0.17, p = 0.004). Thus, fat mass and fat-free mass in preschoolers appear to have joint but opposite associations with physical fitness, an important marker for current and future health.
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| 48. |
- Henriksson, Pontus
(författare)
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Body composition of parents and their infants : methodological, anthropometric, metabolic and genetic studies
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Body composition in infancy may be of importance for later health. In particular, infant body composition may be relevant regarding obesity risk in childhood. Recent advances in body composition methodology using air displacement plethysmography (ADP) have provided possibilities to accurately measure body composition of infants in a quick and non-invasive manner. The aims of this thesis were to study associations of parental body composition using ADP, glucose homeostasis during pregnancy and infant genetics with infant body composition also using ADP. When using ADP in adults, a correction for the thoracic gas volume (TGV) is needed and TGV can be predicted using equations developed in nonpregnant adults. Thus another aim was to study the validity of using such equations during pregnancy.Parent couples were invited to this study at a routine visit to a maternity clinic in Linköping between September 2008 and October 2010. When the mother was in gestational week 32, parental body composition using ADP and maternal glucose homeostasis variables were assessed. Size and body composition of healthy, singleton and full term (≥ 37 gestational weeks) infants were measured at 1 and 12 weeks of age and a total of 211 infants were included in the studies. Weight and length at 1 year of age were reported by parents. Saliva samples were collected from the infants to obtain DNA for genotyping of the fat mass and obesity associated (FTO) gene.Body composition results calculated using measured and predicted TGV were compared in 27 women. Results showed that predicted TGV yields a very marginal overestimation (0.5 %) of fat mass (FM). Further, each kg increase in maternal and paternal fat-free mass (FFM) was associated with 15.6 g (P=0.001) and 9.1 g (P=0.007), respectively, more FFM in their 1-week old infants. FM of fathers was not related to infant FM. However, maternal FM was positively associated with FM of daughters (5.8 g/kg, P=0.007), but not of sons (P=0.79) at 1 week of age. Similarly, each standard deviation increase in maternal HOMA-IR (homeostatic model assessment-insulin resistance) was related to 52.7 more g of FM (P<0.001) in 1-weekold daughters, but no such relationship was found for sons (P=0.79). The number of risk alleles at the FTO locus rs9939609 was not associated with infant body mass index (BMI) or infant FM at 1 or 12 weeks of age. However, the number of risk alleles was positively associated (P≤0.033) with infant length at 1 and 12 weeks of age, and the results suggested that this association was stronger in boys than in girls.The results presented in this thesis show that: i) The use of predicted TGV when applying ADP in gestational week 32 overestimated % FM only slightly. ii) Associations between parental and infant body composition are present early in life. Thus, parental FFM was positively related to FFM in 1-week-old infants. Furthermore, maternal FM and insulin resistance (HOMA-IR) were positively related to FM of 1-week-old daughters, but no such relationships were observed for sons. iii) The FTO genotype is not associated with infant body fatness at 1 or 12 weeks of age. However, the results suggested that the number of FTO risk alleles is positively associated with infant length, especially in boys.In conclusion, parental and genetic factors were associated with infant size and body composition and these relationships may be of importance for future body composition and health.
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| 49. |
- Henriksson, Pontus, et al.
(författare)
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Body composition, physical fitness and cardiovascular risk factors in 9-year-old children
- 2022
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Ingår i: Scientific Reports. - : Nature Portfolio. - 2045-2322. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- The independent associations of body composition and physical fitness components with cardiovascular disease (CVD) risk factors in childhood are not fully understood. Thus, this cross-sectional study examined the independent associations of body composition and physical fitness with CVD risk factors in Swedish 9-year-old children (n = 411). Unadjusted linear regression analyses showed that body mass index (BMI), % fat mass and fat mass index were all positively associated with systolic and diastolic blood pressure, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and Metabolic Syndrome (MetS) score (all β ≥ 0.229, P ≤ 0.001). These associations were virtually unaffected by adjustments for basic covariates (child’s age and sex, maternal educational level and maternal BMI), fat-free mass and physical fitness. Fat-free mass index had generally weak associations with CVD risk factors and no associations were statistically significant after adjustments (all P > 0.27). Greater cardiorespiratory fitness and motor fitness were associated with lower HOMA-IR and MetS score in unadjusted models (all β ≤ − 0.158, P ≤ 0.039) but not after adjustments for basic covariates and body composition. These findings indicate that cardiovascular health promotion in childhood may focus on the maintenance of a healthy fat mass.
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- Henriksson, Pontus, et al.
(författare)
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Body mass index and gestational weight gain in migrant women by birth regions compared with Swedish-born women : A registry linkage study of 0.5 million pregnancies
- 2020
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 15:10
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Women migrating to high-income countries may have increased risks of adverse pregnancy outcomes as compared with native-born women. However, little is known whether migrant women are more likely to have unhealthy body mass index (BMI) or gestational weight gain (GWG), which is of importance considering the well-established links between unhealthy BMI and GWG with adverse pregnancy outcomes. Hence, the aim of the study was to examine the prevalence and estimate odds ratios (ORs) of underweight and obesity in the first trimester as well as inadequate and excessive GWG across birth regions in migrant (first-generation) and Swedish-born women in a population-based sample of pregnant women in Sweden.METHODS: This population-based study included 535 609 pregnancies from the Swedish Pregnancy Register between the years 2010-2018. This register has a coverage of approximately 90% and includes data on body weight, height, birth country and educational attainment. BMI in the first trimester of pregnancy was classified as underweight, normal weight, overweight and obesity whereas GWG was classified as inadequate, adequate and excessive according to the recommendations from the National Academy of Medicine, USA. BMI and GWG were examined according to 7 birth regions and the 100 individual birth countries. Adjusted ORs of underweight, obesity as well as inadequate or excessive GWG by birth regions were estimated using multinomial logistic regression.RESULTS: There were large disparities in unhealthy BMI and GWG across birth regions. For instance, women born in North Africa and Middle East and Sub-Saharan Africa had 1.40 (95% CI 1.35-1.44) and 2.13 (95% CI 2.03-2.23) higher odds of obesity compared with women born in Sweden. However, women born in Sub-Saharan Africa had also considerably higher odds of underweight (OR, 2.93 [95% CI 2.70-3.18]) and inadequate GWG (OR, 1.97 [95% CI 1.87-2.07]). The limitations of the study include the lack of a validated measure of acculturation and that the study only had data on first-generation migration.CONCLUSIONS: The large differences across the 7 regions and 100 countries highlights the importance of considering birth region and country-specific risks of unhealthy BMI and GWG in first-generation migrant women. Furthermore, inadequate GWG was common among pregnant first-generation migrant women, especially in women born in Sub-Saharan Africa, which demonstrates the need to promote adequate GWG, not only the avoidance of excessive GWG. Thus, our findings also indicate that additional support and interventions may be needed for first-generation migrant women from certain birth regions and countries in order to tackle the observed disparities in unhealthy BMI and GWG. Although further studies are needed, our results are useful for identifying groups of women at increased risk of unhealthy BMI and weight gain during pregnancy.
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