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Obesity (Silver Spring). Author manuscript; available in PMC 2017 June 01. Published in final edited form as: Obesity (Silver Spring). 2016 June ; 24(6): 1328–1335. doi:10.1002/oby.21489.
Role of physical activity and sleep duration in growth and body composition of preschool-aged children Nancy F. Butte1, Maurice R. Puyau1, Theresa A. Wilson1, Yan Liu1, William W. Wong1, Anne L. Adolph1, and Issa F. Zakeri2 1USDA/ARS
Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030
Author Manuscript
2Department
of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA 19120
Abstract Objective—The impact of physical activity patterns and sleep duration on growth and body composition of preschool-aged children remains unresolved. Aims were 1) to delineate crosssectional associations between physical activity components, sleep, total energy expenditure (TEE) and body size and composition; and 2) to determine whether physical activity components, sleep and TEE predict 1-y changes in body size and composition in healthy preschool-aged children. Methods—Anthropometry, body composition, accelerometry and TEE by doubly labeled water were measured at baseline; anthropometry and body composition were repeated 1-y later (n=111).
Author Manuscript
Results—Cross-sectionally, positive associations between sedentary activity (SED) and weight and fat-free mass (FFM) (p=0.009-0.047), and negative association between moderate-vigorous physical activity (MVPA) and percent fat mass (FM) (p=0.015) were observed. TEE and activity energy expenditure (AEE) were positively associated with weight, body mass index (BMI), FFM, and FM (p=0.0001-0.046). Prospectively, TEE, AEE, physical activity level (PAL), MVPA, but not SED, were positively associated with changes in BMI (p=0.0001-0.051) and FFM (p=0.0001-0.037), but not percent FM. Sleep duration inversely predicted changes in FM (p=0.005) and percent FM (p=0.006). Conclusions—Prospectively, MVPA, TEE, AEE and PAL promote normal growth and accretion of FFM, whereas sleep inversely predicts changes in adiposity in preschool-aged children. Keywords
Author Manuscript
sedentary activity; moderate-vigorous physical activity; accelerometer; doubly labeled water; DXA
Contact information: Nancy F. Butte, Ph.D., Children’s Nutrition Research Center, Baylor College of Medicine, 1100 Bates Street, Houston, TX 77030, Telephone: 713-798-7179, FAX: 713-798-7187, ; Email: [email protected] Disclosures: The authors declare no conflicts of interest. Author contributions: NFB and IFZ designed the research; WWW oversaw the DLW analysis; ALA, TAW and MRP conducted the research; IFZ and YL performed the statistical analysis; and NFB and IFZ are responsible for the final content. All authors read and approved the final manuscript.
Butte et al.
Page 2
Author Manuscript
Introduction Early childhood is a period of complex and integrated physical, cognitive and psychosocial development. In the preschool years, children grow rapidly, becoming taller and leaner. Because of asynchronous linear and ponderal growth, body mass index (BMI) declines after infancy to a nadir around 6 years of age, followed by a period of rapidly rising BMI, often referred to as adiposity rebound (1). Early adiposity rebound has been identified as one of the critical risks for the development of obesity (2). It may occur as early as 3 years of age in children with obesity. The role that physical activity plays in normal growth and physical maturation represented by changes in body composition remains unresolved (3, 4). Moderate-vigorous physical activity (MVPA) has been shown to be inversely related to adiposity in preschool-aged children (5), however, it does not appear to drive the timing of the adiposity rebound (6).
Author Manuscript
A systematic review of 48 studies examined associations between objectively measured physical activity and adiposity in children and adolescents (7). Consistent evidence of negative associations between physical activity and adiposity was seen in 79% of these predominantly cross-sectional studies. Of the few studies (5/48) that focused on preschoolaged children, three reported an inverse relationship between physical activity and adiposity. A more recent review demonstrated that the inverse association between MVPA and measures of adiposity was independent of sedentary time (8). Prospective data are conflicting but one systematic review concluded that objectively measured physical activity may not be a determinant of fat gain (9).
Author Manuscript
A systematic review of 17 studies in preschool-aged children in part corroborated the inverse association between physical activity and obesity status; however, the association depended on the outcome measure of adiposity (5). In 60% (3/5) of the studies using percent fat mass, an inverse relationship with physical activity was found compared with 18% (2/11) of the studies that used BMI. The few longitudinal studies in preschoolers substantiate a negative association between physical activity and later adiposity (10-12); however, more research using quantitative, objective devices is needed to understand the role of sedentary activity (SED) and MVPA on the growth and body composition of preschool-age children.
Author Manuscript
Evidence also is emerging that sleep, as diet and physical activity, may play a critical role in the metabolic and hormonal milieu affecting growth and development of children (13). Short sleep duration has been identified frequently as a risk factor for childhood obesity in crosssectional (14) and longitudinal (15-18) studies; however, most of these epidemiological studies relied on parent-reported sleep. Objectively measured sleep duration using accelerometry may clarify the nature of the sleep-obesity associations reported in children. The aims of this study were two-fold: 1) to delineate cross-sectional associations between physical activity components, sleep, total energy expenditure (TEE) and body size and composition; and 2) to determine whether physical activity components, sleep and TEE predict 1-y changes in body size and composition in healthy preschool-aged children.
Obesity (Silver Spring). Author manuscript; available in PMC 2017 June 01.
Butte et al.
Page 3
Author Manuscript
Methods Study Design and Participants A longitudinal design was used to evaluate the effect of physical activity on growth and body composition of preschool-aged children, defined as ages 3 to 5 years at baseline, living in the Greater Houston Area in 2010-2012. The study design called for measurements at baseline and at 1-year follow-up. Children were eligible if the child had no major illnesses. Exclusion criteria included any medical illness or medication affecting growth or limiting participation in physical activities or sports. Children on prescription drugs or with chronic diseases including metabolic or endocrine disorders, asthma treated with steroids, and sleep apnea were excluded from the study. The Institutional Review Board for Human Subject Research for Baylor College of Medicine and Affiliated Hospitals approved the protocol. All parents/primary caretakers gave written informed consent to participate in this study.
Author Manuscript Author Manuscript
The children were recruited and enrolled into the study with a balance of boys and girls, and 3, 4 and 5 y/o using fliers at local clinics and preschool centers in Houston. A total of 204 families responded to our recruitment efforts and 127 children ((age 4.6±0.9 y), sex (51% M) and race/ethnicity (26/29/37/8% white/black/Hispanic/mixed race-ethnicity)) were consented to the study after full parental disclosure of the study design and procedures. Children and parents were admitted to the Children’s Nutrition Research Center (CNRC) metabolic research unit. At baseline, parents completed questionnaires assessing sociodemographics, child care, and child physical activity participation. Anthropometric and body composition measurements were completed on the child; and accelerometry and heart rate monitoring for activity monitoring and the doubly labeled water (DLW) method for free-living TEE to be conducted at home were initiated. A total of 119 children ((age 4.6±0.9 y), sex (49% M) and race/ethnicity (29/30/33/8% white/black/Hispanic/mixed raceethnicity)) completed the baseline study. Subsequently, 111 children returned after 1 year for repeated anthropometric and body composition measurements only (Table 1). The children who did not complete the study did not differ from those who did, in terms of age, sex and race/ethnicity (t-test and chi-square). Parent-reported Physical Activity Physical Activity Questionnaire for Children (19) modified for preschool-aged children was completed by the parent to assess the participation in 20 activities in the previous 7 days. Seven activities not applicable to preschool-aged children and questions referring to physical education and recess were deleted from the questionnaire.
Author Manuscript
Child Body Size and Composition Body weight to the nearest 0.1 kg was measured with a digital balance and height to the nearest 1 mm was measured with a stadiometer in duplicate and repeated if the two measurements differed by >0.2 kg or 0.5 cm, respectively (20). BMI was calculated as weight/height2 (kg/m2). Overweight was defined as ≥85th percentile but 80% participation) reported by the parents were playing on swings and slides etc. at the playground, tag or chase, and dancing. Next, bicycling, running, walking and active video games were cited (>40% participation). Sports including baseball/softball, basketball, gymnastics, soccer and swimming were reported for a minority of children (20-30% participation).
Author Manuscript
Mean child BMI z-score and percent FM at baseline were 0.18 ± 1.06 and 27.4 ± 6.7%, respectively (Table 2). While there were no significant differences in BMI z-score by race/ ethnicity, the black children had lower percent FM than the white and Hispanic children (p=0.004). Boys had lower FM (p=0.009), percent FM (p=0.001) and higher FFM (p=0.001) compared with the girls. The percent of the children who were overweight and obese was 8.1% and 9.9%, respectively. Changes in anthropometric indices and body composition over one year did not differ by age, sex or race/ethnicity, except for height velocity which decreased with age (p
Obesity (Silver Spring). Author manuscript; available in PMC 2017 June 01. Published in final edited form as: Obesity (Silver Spring). 2016 June ; 24(6): 1328–1335. doi:10.1002/oby.21489.
Role of physical activity and sleep duration in growth and body composition of preschool-aged children Nancy F. Butte1, Maurice R. Puyau1, Theresa A. Wilson1, Yan Liu1, William W. Wong1, Anne L. Adolph1, and Issa F. Zakeri2 1USDA/ARS
Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030
Author Manuscript
2Department
of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA 19120
Abstract Objective—The impact of physical activity patterns and sleep duration on growth and body composition of preschool-aged children remains unresolved. Aims were 1) to delineate crosssectional associations between physical activity components, sleep, total energy expenditure (TEE) and body size and composition; and 2) to determine whether physical activity components, sleep and TEE predict 1-y changes in body size and composition in healthy preschool-aged children. Methods—Anthropometry, body composition, accelerometry and TEE by doubly labeled water were measured at baseline; anthropometry and body composition were repeated 1-y later (n=111).
Author Manuscript
Results—Cross-sectionally, positive associations between sedentary activity (SED) and weight and fat-free mass (FFM) (p=0.009-0.047), and negative association between moderate-vigorous physical activity (MVPA) and percent fat mass (FM) (p=0.015) were observed. TEE and activity energy expenditure (AEE) were positively associated with weight, body mass index (BMI), FFM, and FM (p=0.0001-0.046). Prospectively, TEE, AEE, physical activity level (PAL), MVPA, but not SED, were positively associated with changes in BMI (p=0.0001-0.051) and FFM (p=0.0001-0.037), but not percent FM. Sleep duration inversely predicted changes in FM (p=0.005) and percent FM (p=0.006). Conclusions—Prospectively, MVPA, TEE, AEE and PAL promote normal growth and accretion of FFM, whereas sleep inversely predicts changes in adiposity in preschool-aged children. Keywords
Author Manuscript
sedentary activity; moderate-vigorous physical activity; accelerometer; doubly labeled water; DXA
Contact information: Nancy F. Butte, Ph.D., Children’s Nutrition Research Center, Baylor College of Medicine, 1100 Bates Street, Houston, TX 77030, Telephone: 713-798-7179, FAX: 713-798-7187, ; Email: [email protected] Disclosures: The authors declare no conflicts of interest. Author contributions: NFB and IFZ designed the research; WWW oversaw the DLW analysis; ALA, TAW and MRP conducted the research; IFZ and YL performed the statistical analysis; and NFB and IFZ are responsible for the final content. All authors read and approved the final manuscript.
Butte et al.
Page 2
Author Manuscript
Introduction Early childhood is a period of complex and integrated physical, cognitive and psychosocial development. In the preschool years, children grow rapidly, becoming taller and leaner. Because of asynchronous linear and ponderal growth, body mass index (BMI) declines after infancy to a nadir around 6 years of age, followed by a period of rapidly rising BMI, often referred to as adiposity rebound (1). Early adiposity rebound has been identified as one of the critical risks for the development of obesity (2). It may occur as early as 3 years of age in children with obesity. The role that physical activity plays in normal growth and physical maturation represented by changes in body composition remains unresolved (3, 4). Moderate-vigorous physical activity (MVPA) has been shown to be inversely related to adiposity in preschool-aged children (5), however, it does not appear to drive the timing of the adiposity rebound (6).
Author Manuscript
A systematic review of 48 studies examined associations between objectively measured physical activity and adiposity in children and adolescents (7). Consistent evidence of negative associations between physical activity and adiposity was seen in 79% of these predominantly cross-sectional studies. Of the few studies (5/48) that focused on preschoolaged children, three reported an inverse relationship between physical activity and adiposity. A more recent review demonstrated that the inverse association between MVPA and measures of adiposity was independent of sedentary time (8). Prospective data are conflicting but one systematic review concluded that objectively measured physical activity may not be a determinant of fat gain (9).
Author Manuscript
A systematic review of 17 studies in preschool-aged children in part corroborated the inverse association between physical activity and obesity status; however, the association depended on the outcome measure of adiposity (5). In 60% (3/5) of the studies using percent fat mass, an inverse relationship with physical activity was found compared with 18% (2/11) of the studies that used BMI. The few longitudinal studies in preschoolers substantiate a negative association between physical activity and later adiposity (10-12); however, more research using quantitative, objective devices is needed to understand the role of sedentary activity (SED) and MVPA on the growth and body composition of preschool-age children.
Author Manuscript
Evidence also is emerging that sleep, as diet and physical activity, may play a critical role in the metabolic and hormonal milieu affecting growth and development of children (13). Short sleep duration has been identified frequently as a risk factor for childhood obesity in crosssectional (14) and longitudinal (15-18) studies; however, most of these epidemiological studies relied on parent-reported sleep. Objectively measured sleep duration using accelerometry may clarify the nature of the sleep-obesity associations reported in children. The aims of this study were two-fold: 1) to delineate cross-sectional associations between physical activity components, sleep, total energy expenditure (TEE) and body size and composition; and 2) to determine whether physical activity components, sleep and TEE predict 1-y changes in body size and composition in healthy preschool-aged children.
Obesity (Silver Spring). Author manuscript; available in PMC 2017 June 01.
Butte et al.
Page 3
Author Manuscript
Methods Study Design and Participants A longitudinal design was used to evaluate the effect of physical activity on growth and body composition of preschool-aged children, defined as ages 3 to 5 years at baseline, living in the Greater Houston Area in 2010-2012. The study design called for measurements at baseline and at 1-year follow-up. Children were eligible if the child had no major illnesses. Exclusion criteria included any medical illness or medication affecting growth or limiting participation in physical activities or sports. Children on prescription drugs or with chronic diseases including metabolic or endocrine disorders, asthma treated with steroids, and sleep apnea were excluded from the study. The Institutional Review Board for Human Subject Research for Baylor College of Medicine and Affiliated Hospitals approved the protocol. All parents/primary caretakers gave written informed consent to participate in this study.
Author Manuscript Author Manuscript
The children were recruited and enrolled into the study with a balance of boys and girls, and 3, 4 and 5 y/o using fliers at local clinics and preschool centers in Houston. A total of 204 families responded to our recruitment efforts and 127 children ((age 4.6±0.9 y), sex (51% M) and race/ethnicity (26/29/37/8% white/black/Hispanic/mixed race-ethnicity)) were consented to the study after full parental disclosure of the study design and procedures. Children and parents were admitted to the Children’s Nutrition Research Center (CNRC) metabolic research unit. At baseline, parents completed questionnaires assessing sociodemographics, child care, and child physical activity participation. Anthropometric and body composition measurements were completed on the child; and accelerometry and heart rate monitoring for activity monitoring and the doubly labeled water (DLW) method for free-living TEE to be conducted at home were initiated. A total of 119 children ((age 4.6±0.9 y), sex (49% M) and race/ethnicity (29/30/33/8% white/black/Hispanic/mixed raceethnicity)) completed the baseline study. Subsequently, 111 children returned after 1 year for repeated anthropometric and body composition measurements only (Table 1). The children who did not complete the study did not differ from those who did, in terms of age, sex and race/ethnicity (t-test and chi-square). Parent-reported Physical Activity Physical Activity Questionnaire for Children (19) modified for preschool-aged children was completed by the parent to assess the participation in 20 activities in the previous 7 days. Seven activities not applicable to preschool-aged children and questions referring to physical education and recess were deleted from the questionnaire.
Author Manuscript
Child Body Size and Composition Body weight to the nearest 0.1 kg was measured with a digital balance and height to the nearest 1 mm was measured with a stadiometer in duplicate and repeated if the two measurements differed by >0.2 kg or 0.5 cm, respectively (20). BMI was calculated as weight/height2 (kg/m2). Overweight was defined as ≥85th percentile but 80% participation) reported by the parents were playing on swings and slides etc. at the playground, tag or chase, and dancing. Next, bicycling, running, walking and active video games were cited (>40% participation). Sports including baseball/softball, basketball, gymnastics, soccer and swimming were reported for a minority of children (20-30% participation).
Author Manuscript
Mean child BMI z-score and percent FM at baseline were 0.18 ± 1.06 and 27.4 ± 6.7%, respectively (Table 2). While there were no significant differences in BMI z-score by race/ ethnicity, the black children had lower percent FM than the white and Hispanic children (p=0.004). Boys had lower FM (p=0.009), percent FM (p=0.001) and higher FFM (p=0.001) compared with the girls. The percent of the children who were overweight and obese was 8.1% and 9.9%, respectively. Changes in anthropometric indices and body composition over one year did not differ by age, sex or race/ethnicity, except for height velocity which decreased with age (p
