The contribution of physical fitness to individual and ethnic differences in risk markers for type 2 diabetes in children: The Child Heart and Health Study in England (CHASE)

Abstract

BackgroundThe relationship between physical fitness and risk markers for type 2 diabetes (T2D) in children and the contribution to ethnic differences in these risk markers have been little studied. We examined associations between physical fitness and early risk markers for T2D and cardiovascular disease in 9‐ to 10‐year‐old UK children.MethodsCross‐sectional study of 1445 9‐ to 10‐year‐old UK children of South Asian, black African‐Caribbean and white European origin. A fasting blood sample was used for measurement of insulin, glucose (from which homeostasis model assessment [HOMA]‐insulin resistance [IR] was derived), glycated hemoglobin (HbA1c), urate, C‐reactive protein (CRP), and lipids. Measurements of blood pressure (BP) and fat mass index (FMI) were made; physical activity was measured by accelerometry. Estimated VO2 max was derived from a submaximal fitness step test. Associations were estimated using multilevel linear regression.ResultsHigher VO2 max was associated with lower FMI, insulin, HOMA‐IR, HbA1c, glucose, urate, CRP, triglycerides, LDL‐cholesterol, BP and higher HDL‐cholesterol. Associations were reduced by adjustment for FMI, but those for insulin, HOMA‐IR, glucose, urate, CRP, triglycerides and BP remained statistically significant. Higher levels of insulin and HOMA‐IR in South Asian children were partially explained by lower levels of VO2max compared to white Europeans, accounting for 11% of the difference.ConclusionsPhysical fitness is associated with risk markers for T2D and CVD in children, which persist after adjustment for adiposity. Higher levels of IR in South Asians are partially explained by lower physical fitness levels compared to white Europeans. Improving physical fitness may provide scope for reducing risks of T2D.

Estimated cardiorespiratory fitness in childhood and cardiometabolic health in adulthood: 1970 British Cohort Study

“…We found that NETCRF at age 46 was associated with blood pressure and blood‐borne cardiometabolic risk factors at age 46 after adjustment for NETCRF at age 10. Studies of children of different ethnic groups suggest that it is plausible that genes explain at least some of the association between fitness and health in childhood . Studies of adults suggest that it is plausible that habitual physical activity explains at least some of the association between fitness and health in adulthood …”

“…Studies of children of different ethnic groups suggest that it is plausible that genes explain at least some of the association between fitness and health in childhood. 17 Studies of adults suggest that it is plausible that habitual physical activity explains at least some of the association between fitness and health in adulthood. 1 The present study is one of the largest studies with data across the life course to examine the associations between estimated cardiorespiratory fitness in childhood and cardiometabolic risk factors in adulthood.…”

Influence of autozygosity on common disease risk across the phenotypic spectrum

“…There are multiple risk factors for the diseases for which we found significant F ROH associations that differ between British South Asians and White British people (e.g., diet and lifestyle factors for T2D, 44 , 45 , 46 , 47 , 48 , 49 socioeconomic status and experience of racial discrimination for PTSD 50 , 51 ). However, there are several reasons we feel these are unlikely to confound our results here.…”

Challenges and Barriers to Providing Primary Care to Children of South Asian Origin: Pediatricians’ Perspectives

“…In its scientific statement on atherosclerotic cardiovascular diseases in SAs in the United States, 3 the American Heart Association recommends that physicians demonstrate "cultural competency in understanding the increased risk of atherosclerotic cardiovascular disease in SA patients and provide SA-specific recommendations on medications, diet, and lifestyle modifications." 3 As evidence shows that risk factors for these conditions have origins in childhood 23,27 and problematic diet and lifestyle practices in childhood can have life-long consequences, [12][13][14][15][16][17][18][19] pediatricians can play a very important role in this effort by counseling SA families effectively on prevention strategies starting in childhood. This study highlights several health challenges noted by pediatricians in SA children, especially problematic feeding practices and their consequences and significant barriers to addressing these challenges.…”

“…[12][13][14][15] Parent-led and pressurizing feeding or force-feeding have been associated with obesity and other problems. [16][17][18][19] Force-feeding, prolonged parent-led feeding, calorie-dense diets, [20][21][22] and lower levels of physical activity 23 have been reported in SA diaspora. Although only a few studies have explored these issues in the United States, they report similar practices.…”