cardiorespiratory fitness in children and adolescents Idoia - PowerPoint PPT Presentation

THE POWER OF PROGRAMMING 2014 International Conference on Developmental Origins of Adiposity and Long-Term Health March 13-15, Munich, Germany Exclusive breastfeeding duration and cardiorespiratory fitness in children and adolescents Idoia Labayen*, Jonatan R Ruiz*, Francisco B Ortega, Helle M Loit, Jaanus Harro, Inga Villa, Toomas Veidebaum, and Michael Sjöström University of the Basque Country, Spain Karolinska Institutet, Sweden, University of Granada, Granada, Spain National Institute for Health Development, Tallinn, Estonia Institute of Public Health, Tartu, Estonia *idoia.labayen@ehu.es; ruizj@ugr.es Note: for non-commercial purposes only

Exclusive breastfeeding duration and cardiorespiratory fitness in children and adolescents Benefits of breast feeding • Otitis meida • GI infections Institutions • Respiratory infections • Atopy • WHO • Atopic dermatitis • ESPGHAN • FISPGHAN • Asthma • ENeA • Type 1 diatebes • Early Nutrition Academy • Type 2 diabetes • US Agency for Healthcare Research and Quality • Cardiovascular diesease • Dutch State Institute for Nutrition and Health • High blood pressure • Cholesterol • Intelligence • Motor development • Etc. ESPGHAN Committee on Nutrition: Carlo Agostoni et al 2009

Childhood and adolescence Later in life Cardiorespiratory Health Musculoskeletal 3 Ruiz et al. BJSM 2009

Exclusive breastfeeding duration and cardiorespiratory fitness in children and adolescents Aim To examine the association of exclusive breastfeeding duration with fitness in children and adolescents and to test the role of body composition and sociodemographic factors in this relation Labayen et al. AJCN 2012

METHODS Participants 1025 children (9-10 years) and 971 adolescents (15-16 years) from Sweden and Estonia (EYHS) Exposures Breast feeding • Was your child fed completely on breast milk for any length of time—that is, without complementary formula feeds? (Categories provided for response were yes or no) • For how long was your child breastfed? (Categories provided for response were <1 month, 1–3 months, >3–6 months, and >6 months) Labayen et al. AJCN 2012

METHODS Participants 1025 children (9-10 years) and 971 adolescents (15-16 years) from Sweden and Estonia (EYHS) Exposures Breast feeding Main outcome Cardiorespiratory fitness Confounding factors Anthropometry, birth weight, smoking, physical activity, maternal education, and mother’s BMI Labayen et al. AJCN 2012

RESULTS Cardiorespiratory fitness and never vs. ever breastfed 2.00 Never breastfed P<0.001 P<0.001 P=0.001 P=0.011 1.95 Ever breastfed Fitness (L/min) 1.90 1.85 1.80 1.75 1.70 Model 1 Model 2 Model 3 Model 4 Model 1: adjusted for country, age, sex, and pubertal status Model 2: model 1 plus BMI Model 3: model 1 plus fat mass, and fat-free mass Model 4: model 1 plus birth weight and maternal BMI and educational level Labayen et al. AJCN 2012

RESULTS Cardiorespiratory fitness and duration of breast feeding Fitness (L/min) adjusted Model 1 1.96 P < 0.001 1.92 ** ** 1.88 1.84 * 1.80 1.76 Never <3months 3-6 months >6 months Model 1: adjusted for country, age, sex, and pubertal status Model 2: model 1 plus BMI Model 3: model 1 plus fat mass, and fat-free mass Model 4: model 1 plus birth weight and maternal BMI and educational level Labayen et al. AJCN 2012

RESULTS Cardiorespiratory fitness and duration of breast feeding by weight status 2.50 Normal weight 2.40 Overweight 2.30 Fitness (L/min) 2.20 P=0.002 2.10 2.00 1.90 P<0.001 1.80 1.70 1.60 Never <3months 3-6 months >6 months never < 3 months 3-6 months > 6 months Normal weight/overweight+obesity accoring to the International Obesity Task Force recommendations Confounders: country, sex, age, pubertal status, and body mass Labayen et al. AJCN 2012

RESULTS Cardiorespiratory fitness and duration of breast feeding by SES 2.20 Low SES High SES 2.10 Fitness (L/min) 2.00 P <0.001 1.90 P =0.004 1.80 1.70 1.60 never < 3 months 3-6 months > 6 months Low/ high-SES: less than university education and university education, respectively Confounders: country, sex, age, pubertal status, and body mass Labayen et al. AJCN 2012

RESULTS Cardiorespiratory fitness and duration of breast feeding by mother’s weight 2.20 Mother normal weight 2.10 Mother overweight P =0.003 Fitness (L/min) 2.00 1.90 P <0.001 1.80 1.70 1.60 Never <3months 3-6 months >6 months never < 3 months 3-6 months > 6 months Confounders: country, sex, age, pubertal status, and body mass Labayen et al. AJCN 2012

RESULTS Cardiorespiratory fitness and duration of breast feeding by BW 2.20 Low BW tertile Middle BW tertile 2.10 High BW tertile P =0.001 Fitness (L/min) 2.00 P =0.017 1.90 P =0.004 1.80 1.70 1.60 never < 3 months 3-6 months > 6 months Never <3months 3-6 months >6 months Confounders: country, sex, age, pubertal status, and body mass Labayen et al. AJCN 2012

Exclusive breastfeeding duration and cardiorespiratory fitness in children and adolescents Conclusions Longer exclusive breastfeeding has a beneficial effect on cardiorespiratory fitness in children and adolescents Because early infant-feeding patterns are potentially modifiable, a better understanding of the possible programming effect of exclusive breastfeeding on cardiorespiratory fitness is of public health interest Labayen et al. AJCN 2012

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REULTS Cardiorespiratory fitness and duration of breast feeding by FFM 2.50 Low FFM 2.40 High FFM 2.30 2.20 2.10 P=0.013 2.00 1.90 1.80 P<0.001 1.70 1.60 Never <3months 3-6 months >6 months never < 3 months 3-6 months > 6 months Low/high FFM: below or above the sex- and age group – specific median Labayen et al. AJCN 2012

Cardiorespiratory fitness METHODS Test protocol Age Weight Initial work Δ Work Gender (years) (kg) rate (W) rate (W) Girls & boys 9-10 < 30 20 20 Girls & boys 9-10 > 30 25 25 Girls 15-16 - 40 40 Boys 15-16 - 50 50 Variables • Watt: W1+ (W2  t/180) • VO 2 max (L/min): 12 x W + 5 x body weight (kg) 16

Anthropometry METHODS Weight Skinfold thickness Variables • BMI • % Overweight/Obese Height • % Body fat (Slaugher et al.) • FFM

Physical Activity (PA) METHODS Test protocol • 4 consecutive days • 10 hrs/day Variables • Total PA (counts/min) • Moderate + Vigorous PA >3 METs (min/day)

Cardiorespiratory fitness: marker of health 5 Relative Risk of Mortality 4 3 2 1 0 <5 6 7 8 9 10 11 12 >13 METS Very Low Low Medium High Very high Cardiorespiratory Fitness Adults 10,224 men and 3120 women 19 Blair et al. JAMA 1989