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

Abstract

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

Longitudinal and cross‐sectional associations of adherence to 24‐hour movement guidelines with cardiometabolic risk

“…The children were allocated to the intervention group (N = 293, 60.4%) and the control group (N = 192, 39.6%) after the baseline measurements. 28 The combined PA and dietary intervention consisted of six intervention visits during the 2 years follow-up. The children and their parents received individualized advice regarding PA and diet from a specialist in exercise medicine and a clinical nutritionist.…”

Cost-effectiveness of physical activity intervention in children – results based on the Physical Activity and Nutrition in Children (PANIC) study

“…The 2-year PA intervention included six family-based and tailored PA counselling visits organised during office hours for each family [26]. The children and their parents received individual advice from an exercise medicine specialist on how to increase PA and decrease sedentary time of the children in everyday conditions.…”

Impact of moderate exercise on fatty acid oxidation in pancreatic β-cells and skeletal muscle

“…Indeed, exercise has been largely demonstrated to improve the peripheral insulin sensitivity in T2D patients and to have a beneficial effect on insulin resistance [14,[77][78][79]. In addition, exercise increases the expression of GLUT 4 in skeletal muscles and thus enhances insulin-and muscle contraction-stimulated glucose uptake into the muscle cells [76,94]. Furthermore, it was recently reviewed that intramyocellular lipids (IMCL) content in skeletal muscle is increased and fat oxidative capacity decreased in obese people and T2D [12].…”

“…Additionally, recently it was mentioned that a prolonged exercise for several hours from a low to moderate intensity enhances FA utilization at the expense of glucose as fuel. This is associated with a decrease in glucose availability [ 76 ]. Thus, a correlation between respiratory capacity and MFO exists.…”