A 2 year physical activity and dietary intervention attenuates the increase in insulin resistance in a general population of children: the PANIC study
Creators: name: Lakka, Timo A.
name: Lintu, Niina
name: Väistö, Juuso
name: Viitasalo, Anna
name: Sallinen, Taisa
name: Haapala, Eero A.
name: Tompuri, Tuomo T.
name: Soininen, Sonja
name: Karjalainen, Panu
name: Schnurr, Theresia M.
name: Mikkonen, Santtu
name: Atalay, Mustafa
name: Kilpeläinen, Tuomas O.
name: Laitinen, Tomi
name: Laaksonen, David E.
name: Savonen, Kai
name: Brage, Soren
name: Schwab, Ursula
name: Jääskeläinen, Jarmo
name: Lindi, Virpi
name: Eloranta, Aino-Maija
Publisher: name: Apollo - University of Cambridge Repository
Year: 2020
Subjects: Article
Body fat
Children
Diet
Glucose
HOMA-IR
Insulin
Intervention
Lean body mass
Physical activity
Sedentary time

description: Funder: The NIHR Biomedical Research Centre in Cambridge
description: Funder: Finnish Innovation Fund Sitra
description: Funder: Foundation for Paediatric Research
description: Funder: Ministry of Social Affairs and Health of Finland
description: Funder: Yrjö Jahnsson Foundation
description: Funder: Research Committee of the Kuopio University Hospital Catchment Area (State Research Funding)
description: Funder: The city of Kuopio
description: Funder: The UK Medical Research Council
description: Funder: Finnish Cultural Foundation
description: Funder: Ministry of Education and Culture of Finland
description: Funder: Juho Vainio Foundation
description: Funder: Paavo Nurmi Foundation
description: Funder: Diabetes Research Foundation in Finland
description: Funder: Finnish Foundation for Cardiovascular Research
description: Funder: Social Insurance Institution of Finland
description: 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 Graphical abstract