Gymnastik- och idrottshögskolan, GIH

AIM: To study cross-sectional relationships between step-up height and waist circumference (WC), a potential proxy for sarcopenic obesity, in Swedish children and parents.

METHODS: Participants were recruited from Swedish schools in disadvantaged areas in 2017. Height, body weight, WC and maximal step-up height were measured in 67 eight-year-old children and parents: 58 mothers, with a mean age of 38.5 and 32 fathers, with a mean age of 41.3. Sedentary time and physical activity were registered by an accelerometer. Associations between maximal step-up height and WC were analysed using Pearson's correlation and adjusted linear regression.

RESULTS: Abdominal obesity, WC ≥ 66 centimetres (cm) in children, ≥88 cm in women and ≥102 cm in men, was observed in 13% and 35% of girls and boys, and in 53% and 34% among mothers and fathers, respectively. Negative associations between maximal step-up height and WC were found for children (r = -0.37, p = 0.002) and adults (mothers r = -0.58, p < 0.001, fathers r = -0.48, p = 0.006). The associations remained after adjustments for height, body mass index (BMI) and physical activity in adults. Reduced muscle strength clustered within families (r = 0.54, p < 0.001).

CONCLUSION: Associations between reduced muscle strength and abdominal obesity were observed in children and parents. Sarcopenic obesity may need more attention in children. Our findings support family interventions.

Utvecklingen från mitten av 1960-talet och framåt har kännetecknats av ökad materiell levnadsstandard, stärkt rättskydd för barn, minskande somatisk ohälsa, och en kraftigt sjunkande barnadödlighet. Denna positiva utveckling i Sverige och andra höginkomstländer har inte lett till en minskning av psykiska symptom hos unga. Att barn rapporterar mer stress och psykiska symptom trots bättre levnadsförhållanden, ”välfärdsparadoxen”, har varit tydligt i Sverige. Utgångspunkten för denna översikthar varit att lyfta fram vilka livsstils- och omgivningsfaktorer som har visat sig kunna bromsa eller vända denna utveckling.

Folkhälsomyndighetens undersökning “Skolbarns hälsovanor”, och liknande rapporter från WHO, Unicef samt USA:s och Kanadas folkhälsomyndigheter har påtalat tydliga samband mellan psykiska symptom hos unga i skolåldern och fysisk inaktivitet. Låg fysisk aktivitet har i sin tur ofta ett samband med att tid på digitala medier tar utrymme från sömn och hälsofrämjande aktiviteter. Det finns även belägg för att program som stärker ungas förmåga att hantera känslor, sociala relationer och fatta ansvarsfulla beslutleder till bättre skolresultat, anpassning till vuxenlivet och bidrar till bättre psykisk hälsa. Ett omfattandekunskapsunderlag talar för att skolan har en central roll när det gäller att främja psykisk hälsa. Samma gäller vikten av tidiga insatser till unga med individuella svårigheter eller problem som beror på ogynnsamma eller socialt belastade uppväxtmiljöer.

Utifrån publicerade samband mellan psykiska symptom och livsstil eller livsomständigheter föreslår Svenska Läkarsällskapets arbetsgrupp fem konkreta interventioner där vi ser skolan som en viktig arena där man når alla unga i skolåldern.

5 konkreta interventioner för förbättrad psykisk hälsa bland barn och unga:

• Regelbunden strukturerad fysisk aktivitet – gärna i anslutning till skoltid.
• Hjälpa unga att nå en balans mellan tid ägnad åt digitala medier och hälsofrämjande aktiviteter.
• “Livskunskapsprogram” som hjälp till ungdomar att stärka självkänslan, hantera stress och skapa positiva förändringar.
• Främja psykisk hälsa i skolmiljön genom att anpassa kunskaps- och betygskrav till ungas utveckling och förutsättningar.
• Satsa på program för tidig upptäckt och stöd till unga med ökad risk för sämre psykisk hälsa.

För att kunna genomföra dessa insatser krävs ett nära samarbete mellan alla som verkar för ungas hälsa; professioner inom hälso- och sjukvård, elevhälsa, socialtjänst men även föräldra- och elevorganisationer. När det gäller samhällsfunktioner som hälso- och sjukvård, skola och socialtjänst behöver man undanröja organisatoriska hinder för samverkan. Olika huvudmän för samhällsfunktioner har skilda ansvarsområden och ibland olika syn på sitt uppdrag. Vi vill även understryka vikten av fler kontaktytor mellan akademisk forskning som utvärderar hälsofrämjande program och verksamheter som ska tillämpa dessa.

BACKGROUND: The effect of overweight on metabolic risk factors and the role of physical activity (PA) in pre-pubertal children is unclear.

OBJECTIVE: To study differences in metabolic risk factors between groups of normal weight and overweight children and how these risk factors are associated with objectively measured PA and cardio-respiratory fitness (CRF).

DESIGN: A cross-sectional study was conducted with 68 children aged 8?11 years. Children were categorized into normal weight (n = 39) and overweight/obese (n = 24/5). PA and CRF were measured objectively. An oral glucose tolerance test (OGTT) was performed and triglycerides (TG) and HDL-cholesterol (HDL-C) were measured. A metabolic risk score (MRS) was calculated from the standardized values of insulin, glucose, TG, inverted HDL-C and blood pressure.

RESULTS: There was a significant (P < 0.05) difference between normal weight and overweight children in clustered metabolic risk, insulin (AUC), fasting insulin and systolic blood pressure. PA and CRF did not differ significantly between groups. In linear regression analysis combining the two groups, PA was negatively associated with insulin (AUC) (? = ?0.25, 95% CI = ?0.50, ?0.002) and CRF was negatively associated with fasting insulin (? = ?0.41, 95% CI = ?0.67, ?0.15).

CONCLUSIONS: Metabolic risk factors are elevated in overweight pre-pubertal children compared with normal weight controls. This is not explained by lower PA or CRF in the overweight group although PA and CRF were associated with lower insulin levels in pooled analyses. This highlights the importance of preventing overweight in children from an early age in order to prevent the metabolic syndrome and its associated diseases.

AIM: To evaluate the effect of a universal, school-based family support programme on body mass index (BMI) of children aged 5-7 years, using pooled data from three trials.

METHODS: The programme has three to four components and is delivered during the first school year. It aims to promote healthy dietary and physical activity behaviours, and secondarily prevent unhealthy weight gain. Three cluster-randomised controlled trials were conducted between 2010 and 2018 in low and mixed socioeconomic status areas in Sweden. Weight and height were measured. Multiple mixed linear regression analysis was performed on the pooled data.

RESULTS: In total, 961 children were included (50% girls, mean age 6.3 years). The post-intervention effect on BMI z-score in all children was small, but in those with obesity at baseline, we observed a significant, clinically relevant, decrease in BMI z-score (-0.21). This was most pronounced in children with a non-Nordic born parent (-0.24). Five to six months after the intervention, decreases were no longer statistically significant.

CONCLUSION: The intervention resulted in changes in BMI comparable to obesity treatment programmes focusing on behaviour change. However, the effect attenuated with time suggesting the programme should be sustained and evaluated for a longer time.

Physical activity (PA) can prevent cardiovascular diseases. Because of increased risks of impairments affecting motor activity, PA in children born preterm may differ from that in children born at term. In this prospective cohort study, we compared objectively measured PA in 71 children born extremely preterm (<27 weeks gestational age), to their 87 peers born at term, at 6.5 years of age. PA measured with accelerometer on the non-dominant wrist for 7 consecutive days was compared between index and control children and analyzed for associations to prenatal growth, major neonatal brain injury, bronchopulmonary dysplasia and neonatal septicemia, using ANOVA. Boys born extremely preterm spent on average 22 min less time per day in moderate to vigorous physical activity (MVPA) than control boys (95% CI: -8, -37). There was no difference in girls. Amongst children born extremely preterm, major neonatal brain injury was associated with 56 min less time in MVPA per day (95%CI: -88, -26). Subgroups of children born extremely preterm exhibit lower levels of physical activity which may be a contributory factor in the development of cardiovascular diseases as adults.