title: Low physical activity level and short sleep duration are associated with an increased cardio-metabolic risk profile: a longitudinal study in 8-11 year old Danish children.
abstract: BACKGROUND
  As cardio-metabolic risk tracks from childhood to adulthood, a better understanding of the relationship between movement behaviors (physical activity, sedentary behavior and sleep) and cardio-metabolic risk in childhood may aid in preventing metabolic syndrome (MetS) in adulthood.
  
  
  OBJECTIVE
  To examine independent and combined cross-sectional and longitudinal associations between movement behaviors and the MetS score in 8-11 year old Danish children.
  
  
  METHODS
  Physical activity, sedentary time and sleep duration (seven days and eight nights) were assessed by accelerometer and fat mass index (fat mass/height2) was assessed using Dual-energy X-ray absorptiometry. The MetS-score was based on z-scores of waist circumference, mean arterial blood pressure, homeostatic model assessment of insulin resistance, triglycerides and high density lipoprotein cholesterol. All measurements were taken at three time points separated by 100 days. Average of the three measurements was used as habitual behavior in the cross-sectional analysis and changes from first to third measurement was used in the longitudinal analysis.
  
  
  RESULTS
  723 children were included. In the cross-sectional analysis, physical activity was negatively associated with the MetS-score (P<0.03). In the longitudinal analysis, low physical activity and high sedentary time were associated with an increased MetS-score (all P<0.005); however, after mutual adjustments for movement behaviors, physical activity and sleep duration, but not sedentary time, were associated with the MetS-score (all P<0.03). Further adjusting for fat mass index while removing waist circumference from the MetS-score rendered the associations no longer statistically significant (all P>0.17). Children in the most favorable tertiles of changes in moderate-to-vigorous physical activity, sleep duration and sedentary time during the 200-day follow-up period had an improved MetS-score relative to children in the opposite tertiles (P = 0.005).
  
  
  CONCLUSIONS
  The present findings indicate that physical activity, sedentary time and sleep duration should all be targeted to improve cardio-metabolic risk markers in childhood; this is possibly mediated by adiposity.
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Mads F
authors.initials: MF
authors.lastname: Hjorth
authors.affiliation: Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Chaput
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Camilla T
authors.initials: CT
authors.lastname: Damsgaard
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Stine-Mathilde
authors.initials: SM
authors.lastname: Dalskov
authors.affiliation: National Food Institute, Division of Nutrition, Technical University of Denmark, Søborg, Denmark.
authors.forename: Rikke
authors.initials: R
authors.lastname: Andersen
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Arne
authors.initials: A
authors.lastname: Astrup
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Kim F
authors.initials: KF
authors.lastname: Michaelsen
authors.affiliation: National Food Institute, Division of Nutrition, Technical University of Denmark, Søborg, Denmark.
authors.forename: Inge
authors.initials: I
authors.lastname: Tetens
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Ritz
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Sjödin
mesh_terms: D002648:Child; D003430:Cross-Sectional Studies; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000209:etiology / Q000503:physiopathology*; D009043:Motor Activity; D012307:Risk Factors; D012890:Sleep
references.citation: Can J Public Health. 2011 Sep-Oct;102(5):369-74
references.pmid: 22032104
references.citation: Lancet. 2006 Jul 22;368(9532):299-304
references.pmid: 16860699
references.citation: BMJ. 2000 May 6;320(7244):1240-3
references.pmid: 10797032
references.citation: J Appl Physiol (1985). 2008 Jul;105(1):342-51
references.pmid: 18369096
references.citation: Med Sci Sports Exerc. 2011 Jul;43(7):1360-8
references.pmid: 21131873
references.citation: Sleep. 2013 Jul 1;36(7):1085-1090
references.pmid: 23814346
references.citation: Scand J Med Sci Sports. 2008 Apr;18(2):171-8
references.pmid: 17555542
references.citation: Obes Rev. 2011 May;12(5):e12-20
references.pmid: 20576006
references.citation: Scand J Med Sci Sports. 2011 Dec;21(6):e341-50
references.pmid: 21518010
references.citation: BMJ. 2007 Jul 28;335(7612):194
references.pmid: 17591624
references.citation: Br J Nutr. 2013 Jul 14;110(1):186-95
references.pmid: 23181984
references.citation: Diabetes Care. 2012 Jun;35(6):1272-8
references.pmid: 22492585
references.citation: Pediatrics. 2004 Aug;114(2 Suppl 4th Report):555-76
references.pmid: 15286277
references.citation: Br J Nutr. 2013 Oct;110(7):1304-12
references.pmid: 23591057
references.citation: Sleep. 2000 Dec 15;23(8):1043-51
references.pmid: 11145319
references.citation: J Pediatr. 2011 Apr;158(4):617-23
references.pmid: 21146189
references.citation: J Physiol Biochem. 2005 Jun;61(2):381-8
references.pmid: 16180336
references.citation: J Hum Nutr Diet. 2014 Jan;27 Suppl 1:43-53
references.pmid: 22594587
references.citation: Scand J Public Health. 2012 Dec;40(8):693-703
references.pmid: 23108477
references.citation: JAMA. 2012 Feb 15;307(7):704-12
references.pmid: 22337681
references.citation: Pediatrics. 2011 Feb;127(2):e345-52
references.pmid: 21262888
references.citation: PLoS Med. 2006 Dec;3(12):e488
references.pmid: 17194189
references.citation: BMC Public Health. 2013 Mar 07;13:200
references.pmid: 23497190
references.citation: Diabetes Care. 2011 Nov;34(11):2442-7
references.pmid: 21933909
references.citation: Circulation. 2008 Sep 2;118(10):1034-40
references.pmid: 18711015
references.citation: Int J Vitam Nutr Res. 2009 Jan;79(1):14-23
references.pmid: 19838999
references.citation: Appl Physiol Nutr Metab. 2011 Feb;36(1):59-64; 65-71
references.pmid: 21326378
references.citation: Sleep. 2012 Oct 01;35(10):1353-8
references.pmid: 23024433
references.citation: Hypertension. 2011 Jul;58(1):16-21
references.pmid: 21555678
references.citation: Diabetes Care. 2008 Mar;31(3):569-75
references.pmid: 18070991
references.citation: BMC Public Health. 2013 Sep 08;13:808
references.pmid: 24010811
references.citation: J Youth Adolesc. 1980 Jun;9(3):271-80
references.pmid: 24318082
references.citation: J Pediatr. 2007 Apr;150(4):364-9
references.pmid: 17382111
references.citation: Bull World Health Organ. 2007 Sep;85(9):660-7
references.pmid: 18026621
references.citation: Int J Obes (Lond). 2010 Dec;34 Suppl 2:S4-17
references.pmid: 21151146
references.citation: Am J Clin Nutr. 2009 Nov;90(5):1185-92
references.pmid: 19776141
references.citation: Med Sci Sports Exerc. 2013 Jun;45(6):1097-104
references.pmid: 23274612
references.citation: Appl Physiol Nutr Metab. 2013 May;38(5):477-83
references.pmid: 23668753
references.citation: Sleep. 2011 Jul 01;34(7):891-8
references.pmid: 21731139
references.citation: Br J Sports Med. 2014 Oct;48(20):1502-7
references.pmid: 23584828
references.citation: Sleep. 1994 Apr;17(3):201-7
references.pmid: 7939118
references.citation: J Sports Med Phys Fitness. 2011 Dec;51(4):664-9
references.pmid: 22212270
references.citation: Pediatr Diabetes. 2003 Sep;4(3):119-25
references.pmid: 14655269
references.citation: Int J Obes (Lond). 2014 Jul;38(7):959-65
references.pmid: 24304596
references.citation: Obesity (Silver Spring). 2013 Feb;21(2):382-5
references.pmid: 23404925
references.citation: Eur J Clin Nutr. 2000 May;54(5):395-404
references.pmid: 10822286
references.citation: Cardiovasc Diabetol. 2008 Jun 05;7:17
references.pmid: 18534019
references.citation: Am J Clin Nutr. 2003 May;77(5):1146-55
references.pmid: 12716665
references.citation: Can J Cardiol. 2008 Jul;24(7):575-83
references.pmid: 18612501
references.citation: J Pediatr. 2008 Feb;152(2):201-6
references.pmid: 18206689