A 2 year physical activity and dietary intervention attenuates the increase in insulin resistance in a general population of children: the PANIC study.

Autor: Lakka TA; Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio Campus, P.O. Box 1627, FI-70211, Kuopio, Finland. timo.lakka@uef.fi.; Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland. timo.lakka@uef.fi.; Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, Finland. timo.lakka@uef.fi., Lintu N; Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio Campus, P.O. Box 1627, FI-70211, Kuopio, Finland., Väistö J; Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio Campus, P.O. Box 1627, FI-70211, Kuopio, Finland., Viitasalo A; Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio Campus, P.O. Box 1627, FI-70211, Kuopio, Finland.; Institute of Dentistry, University of Eastern Finland, Kuopio, Finland., Sallinen T; Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio Campus, P.O. Box 1627, FI-70211, Kuopio, Finland.; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland., Haapala EA; Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio Campus, P.O. Box 1627, FI-70211, Kuopio, Finland.; Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland., Tompuri TT; Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio Campus, P.O. Box 1627, FI-70211, Kuopio, Finland.; Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland., Soininen S; Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio Campus, P.O. Box 1627, FI-70211, Kuopio, Finland.; Social and Health Center, City of Varkaus, Finland., Karjalainen P; Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio Campus, P.O. Box 1627, FI-70211, Kuopio, Finland., Schnurr TM; Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark., Mikkonen S; Department of Applied Physics, University of Eastern Finland, Kuopio, Finland., Atalay M; Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio Campus, P.O. Box 1627, FI-70211, Kuopio, Finland., Kilpeläinen TO; Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark., Laitinen T; Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland., Laaksonen DE; Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland., Savonen K; Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland.; Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, Finland., Brage S; MRC Epidemiology Unit, University of Cambridge, Cambridge, UK., Schwab U; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.; Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland., Jääskeläinen J; Department of Pediatrics, Institute of Clinical Medicine, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland., Lindi V; University of Eastern Finland Library Kuopio, Kuopio, Finland., Eloranta AM; Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio Campus, P.O. Box 1627, FI-70211, Kuopio, Finland.; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
Jazyk: angličtina
Zdroj: Diabetologia [Diabetologia] 2020 Nov; Vol. 63 (11), pp. 2270-2281. Date of Electronic Publication: 2020 Aug 20.
DOI: 10.1007/s00125-020-05250-0
Abstrakt: Aims/hypothesis: We studied for the first time the long-term effects of a combined physical activity and dietary intervention on insulin resistance and fasting plasma glucose in a general population of predominantly normal-weight children.
Methods: We carried out a 2 year non-randomised controlled trial in a population sample of 504 children aged 6-9 years at baseline. The children were allocated to a combined physical activity and dietary intervention group (306 children at baseline, 261 children at 2-year follow-up) or a control group (198 children, 177 children) without blinding. We measured fasting insulin and fasting glucose, calculated HOMA-IR, assessed physical activity and sedentary time by combined heart rate and body movement monitoring, assessed dietary factors by a 4 day food record, used the Finnish Children Healthy Eating Index (FCHEI) as a measure of overall diet quality, and measured body fat percentage (BF%) and lean body mass by dual-energy x-ray absorptiometry. The intervention effects on insulin, glucose and HOMA-IR were analysed using the intention-to-treat principle and linear mixed-effects models after adjustment for sex, age at baseline, and pubertal status at baseline and 2 year follow-up. The measures of physical activity, sedentary time, diet and body composition at baseline and 2 year follow-up were entered one-by-one as covariates into the models to study whether changes in these variables might partly explain the observed intervention effects.
Results: Compared with the control group, fasting insulin increased 4.65 pmol/l less (absolute change +8.96 vs +13.61 pmol/l) and HOMA-IR increased 0.18 units less (+0.31 vs +0.49 units) over 2 years in the combined physical activity and dietary intervention group. The intervention effects on fasting insulin (regression coefficient β for intervention effect -0.33 [95% CI -0.62, -0.04], p = 0.026) and HOMA-IR (β for intervention effect -0.084 [95% CI -0.156, -0.012], p = 0.023) were statistically significant after adjustment for sex, age at baseline, and pubertal status at baseline and 2 year follow-up. The intervention had no effect on fasting glucose, BF% or lean body mass. Changes in total physical activity energy expenditure, light physical activity, moderate-to-vigorous physical activity, total sedentary time, the reported consumption of high-fat (≥60%) vegetable oil-based spreads, and FCHEI, but not a change in BF% or lean body mass, partly explained the intervention effects on fasting insulin and HOMA-IR.
Conclusions/interpretation: The combined physical activity and dietary intervention attenuated the increase in insulin resistance over 2 years in a general population of predominantly normal-weight children. This beneficial effect was partly mediated by changes in physical activity, sedentary time and diet but not changes in body composition.
Trial Registration: ClinicalTrials.gov NCT01803776 Graphical abstract.
Databáze: MEDLINE
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