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André Aschmann,1 Beat Knechtle,2 Marco Cribari,1 Christoph Alexander Rüst,1 Vincent Onywera,3 Thomas Rosemann,1 Romuald Lepers4 1Institute of General Practice and for Health Services Research, University of Zurich, Zurich, Switzerland; 2Gesundheitszentrum St Gallen, St Gallen, Switzerland; 3Department of Recreation Management and Exercise Science, Kenyatta University, Kenya; 4Institut National de la Santé et de la Recherche Médicale, Faculty of Sport Sciences, University of Burgundy, Dijon, France Background: Endurance running performance of African (AF) and non-African (NAF) athletes is investigated, with better performances seen for Africans. To date, no study has compared the age of peak performance between AF and NAF runners. The present research is an analysis of the age and running performance of top AF and NAF athletes, using the hypothesis that AF athletes were younger and faster than NAF athletes. Methods: Age and performance of male and female AF and NAF athletes in half-marathons and marathons held in Switzerland in 2000–2010 were investigated using single and multilevel hierarchical regression analyses. Results: For half-marathons, male NAF runners were older than male AF runners (P = 0.02; NAF, 31.1 years ± 6.4 years versus AF, 26.2 years ± 4.9 years), and their running time was longer (P = 0.02; NAF, 65.3 minutes ± 1.7 minutes versus AF, 64.1 minutes ± 0.9 minutes). In marathons, differences between NAF and AF male runners in age (NAF, 33.0 years ± 4.8 years versus AF, 28.6 years ± 3.8 years; P < 0.01) and running time (NAF, 139.5 minutes ± 5.6 minutes versus AF, 133.3 minutes ± 2.7 minutes; P < 0.01) were more pronounced. There was no difference in age (NAF, 31.0 years ± 7.0 years versus AF, 26.7 years ± 6.0 years; P > 0.05) or running time (NAF, 75.0 minutes ± 3.7 minutes versus AF, 75.6 minutes ± 5.3 minutes; P > 0.05) between NAF and AF female half-marathoners. For marathoners, NAF women were older than AF female runners (P = 0.03; NAF, 31.6 years ± 4.8 years versus AF, 27.8 years ± 5.3 years), but their running times were similar (NAF, 162.4 minutes ± 7.2 minutes versus AF, 163.0 minutes ± 7.0 minutes; P > 0.05). Conclusion: In Switzerland, the best AF male half-marathoners and marathoners were younger and faster than the NAF counterpart runners. In contrast to the results seen in men, AF and NAF female runners had similar performances. Future studies need to investigate performance and age of AF and NAF marathoners in the World Marathon Majors Series. Keywords: endurance, running, ethnicity, road race, gender difference

The food and macronutrient intake of elite Kenyan runners was compared to recommendations for endurance athletes. Estimated energy intake (EI: 2987 ± 293 kcal; mean ± standard deviation) was lower than energy expenditure (EE: 3605 ± 119 kcal; P < 0.001) and body mass (BM: 58.9 ± 2.7 kg vs. 58.3 ± 2.6 kg; P < 0.001) was reduced over the 7-d intense training period. Diet was high in carbohydrate (76.5%, 10.4 g/kg BM per day) and low in fat (13.4%). Protein intake (10.1%; 1.3 g/kg BM per day) matched recommendations for protein intake. Fluid intake was modest and mainly in the form of water (1113 ± 269 mL; 0.34 ± 0.16 mL/kcal) and tea (1243 ± 348 mL). Although the diet met most recommendations for endurance athletes for macronutrient intake, it remains to be determined if modifying energy balance and fluid intake will enhance the performance of elite Kenyan runners. [ABSTRACT FROM AUTHOR]

Summary: Background: It is unknown whether moderate‐to‐vigorous physical activity (MVPA) thresholds for obesity should be adapted depending on level of sedentary behaviour in children. Objective: The objective of the study is to determine the MVPA thresholds that best discriminate between obese and non‐obese children, by level of screen time and total sedentary time in 12 countries. Methods: This multinational, cross‐sectional study included 6522 children 9–11 years of age. MVPA and sedentary time were assessed using waist‐worn accelerometry, while screen time was self‐reported. Obesity was defined according to the World Health Organization reference data. Results: Receiver operating characteristic curve analyses showed that the best thresholds of MVPA to predict obesity ranged from 53.8 to 73.9 min d−1 in boys and from 41.7 to 58.7 min d−1 in girls, depending on the level of screen time. The MVPA cut‐offs to predict obesity ranged from 37.9 to 75.9 min d−1 in boys and from 32.5 to 62.7 min d−1 in girls, depending on the level of sedentary behaviour. The areas under the curve ranged from 0.57 to 0.73 (‘fail’ to ‘fair’ accuracy), and most sensitivity and specificity values were below 85%, similar to MVPA alone. Country‐specific analyses provided similar findings. Conclusions: The addition of sedentary behaviour levels to MVPA did not result in a better predictive ability to classify children as obese/non‐obese compared with MVPA alone. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the cardiovascular fitness of pediatric population in central Kampala, Uganda. A stratified random sampling was used to select 1929 pupils aged 6-9 years in Wakiso and Mukono districts. A pre-experimental design was used to collect data on the cardiovascular fitness endurance using a 9-minute distance run/walk test. Pupils in day schools had significantly higher mean score (1538.02±309.09) for the 9-minute distance run/walk than those in boarding schools (1486.27±305.22). There was significant gender difference in cardiovascular fitness endurance with boys recording higher mean score (1591±356.76) than girls (1440.64±236.72). Majority (71%) of pupils met acceptable cardiovascular fitness endurance according to percentile norms set by American Association of Health, Physical Education, Recreation and Dance (AAHPERD). About 18.8% and 10.1% had weak and critical cardiovascular endurance status, respectively, which necessitated intervention. Pupils in day schools had better cardiovascular fitness endurance than those in boarding schools; and boys had better cardiovascular endurance compared to girls. There is need for surveillance of physical activity patterns of Ugandan children which may affect their cardiovascular fitness endurance. [ABSTRACT FROM AUTHOR]

Overweight and obesity have been identified as increasing public health problems among adolescents in many developed and developing countries. This study aimed at measuring the determinants of overweight and obesity, namely body mass index (BMI), dietary intake and physical activity levels of students (15-19 years) at public (less affluent) versus private (more affluent) schools in Kisumu East District of Kenya (n=387). A 24-hour dietary recall and 7-day food frequency were conducted with each participant. Physical activity levels were measured using the physical activity questionnaire for adolescents (PAQ-A). A higher percent of overweight adolescents were found at private schools than public schools (17% vs. 14%). Overall, 15.5% of adolescents were overweight or obese (BMI>=25). Students at private schools had significantly higher intakes of all nutrients than those at public schools, except for cholesterol and fibre. Differences between private schools and public schools were particularly high for energy (2186 Kcal vs. 1845 Kcal), fat (66g vs. 50g), carbohydrate (302g vs. 345g), and polyunsaturated fats (16g vs. 10 g), respectively. Carbohydrates (p=0.003), fruit and vegetables (p=0.013), and fats (p=0.003) were negative predictors while meat and eggs (p=0.002) and protein (p=0.005) were positive predictors of BMI. Physical activity levels were lower at public schools than at private schools. The prevalence of overweight students was highest at private schools as were intake of calories, carbohydrate, and fat, suggestive of increased urbanisation of lifestyle and associated rise in NCDs. [ABSTRACT FROM AUTHOR]

Physical inactivity is a risk factor for childhood overweight and obesity, and is associated with habitual lifestyle behaviours that are in rapid transition in many countries. Data comparing the weight status and physical activity among children in countries at different stages of the physical activity transition are lacking. The objective of this study was to compare the weight status and physical activity levels among children in Canada, Mexico and Kenya as a model to assess the physical activity transition. School children (aged 9-13 years) from Canada (n=736), Mexico (n=193) and Kenya (n=179) participated in this study. Body mass index (BMI) was used to determine weight status (underweight, normal weight, overweight and obesity). Activity monitors were used to measure daily step counts. Findings showed that 25.6% of Canadian children were overweight or obese, compared to 35.7% and 5.6% of Mexican and Kenyan children, respectively. Results indicated that 41.2% of the Kenyan children were underweight compared to 10.9% and 6.4% of Mexican and Canadian children, respectively. Mexican and Kenyan children were more physically active than Canadian children, accumulating an average of 15,757±5565, 15,605±5963 and 10,730±3969 steps per day, respectively. This inter-country comparison shows that childhood overweight and obesity levels are lowest and physical activity levels are high in Kenya, a country at an early stage of the physical activity transition. Further research using more representative samples is recommended. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to compare dietary patterns in preadolescents in urban areas with different physical activity and socioeconomic profiles in Nairobi, Kenya., Design: Cross-sectional., Participants: Preadolescents aged 9-14 years (n = 149) living in low- or middle-income areas in Nairobi., Variables Measured: Sociodemographic characteristics were collected using a validated questionnaire. Weight and height were measured. Diet was assessed using a food frequency questionnaire and physical activity by accelerometer., Analysis: Dietary patterns (DP) were formed through principal component analysis. Associations of age, sex, parental education, wealth, body mass index, physical activity, and sedentary time with DPs were analyzed with linear regression., Results: Three DPs explained 36% of the total variance in food consumption: (1) snacks, fast food, and meat; (2) dairy products and plant protein; and (3) vegetables and refined grains. Higher wealth was associated with higher scores of the first DP (P < 0.05)., Conclusions and Implications: Consumption of foods often deemed unhealthy (eg, snacks and fast food) was more frequent among preadolescents whose families were wealthier. Interventions that seek ways to promote healthy lifestyles among families residing in urban areas of Kenya are warranted., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

The prevalence of non-communicable diseases is increasing in lower-middle-income countries as these countries transition to unhealthy lifestyles. The transition is mostly predominant in urban areas. We assessed the association between wealth and obesity in two sub-counties in Nairobi City County, Kenya, in the context of family and poverty. This cross-sectional study was conducted among of 9-14 years old pre-adolescents and their guardians living in low- (Embakasi) and middle-income (Langata) sub-counties. The sociodemographic characteristics were collected using a validated questionnaire. Weight, height, mid-upper arm circumference, and waist circumference were measured using standard approved protocols. Socioeconomic characteristics of the residential sites were accessed using Wealth Index, created by using Principal Component Analysis. Statistical analyses were done by analysis of variance (continuous variables, comparison of areas) and with logistic and linear regression models.A total of 149 households, response rate of 93%, participated, 72 from Embakasi and 77 from Langata. Most of the participants residing in Embakasi belonged to the lower income and education groups whereas participants residing in Langata belonged to the higher income and education groups. About 30% of the pre-adolescent participants in Langata were overweight, compared to 6% in Embakasi (p<0.001). In contrast, the prevalence of adults (mostly mothers) with overweight and obesity was high (65%) in both study areas. Wealth (β = 0.01; SE 0.0; p = 0.003) and income (β = 0.29; SE 0.11; p = 0.009) predicted higher BMI z-score in pre-adolescents. In, pre-adolescent overweight was already highly prevalent in the middle-income area, while the proportion of women with overweight/obesity was high in the low-income area. These results suggest that a lifestyle promoting obesity is high regardless of socioeconomic status and wealth in Kenya. This provides a strong justification for promoting healthy lifestyles across all socio-economic classes., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ochola et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Like many countries in sub-Saharan Africa, Kenya has experienced rapid urbanization in recent years. Despite the distinct socioeconomic and environmental differences, few studies have examined the adherence to movement guidelines in urban and rural areas. This cross-sectional study aimed at examining compliance to the 24-hour movement guidelines and their correlates among children from urban and rural Kenya., Method: Children (n = 539) aged 11.1 ± 0.8 years (52% female) were recruited from 8 urban and 8 rural private and public schools in Kenya. Physical activity (PA) and sleep duration were estimated using 24-h raw data from wrist-worn accelerometers. Screen time (ST) and potential correlates were self- reported. Multi-level logistic regression was applied to identify correlates of adherence to combined and individual movement guidelines., Results: Compliance with the combined movement guidelines was low overall (7%), and higher among rural (10%) than urban (5%) children. Seventy-six percent of rural children met the individual PA guidelines compared to 60% urban children while more rural children also met sleep guidelines (27% vs 14%). The odds of meeting the combined movement guidelines reduced with age (OR = 0.55, 95% CI = 0.35-0.87, p = 0.01), was greater among those who could swim (OR = 3.27, 95% CI = 1.09-9.83, p = 0.04), and among those who did not engage in ST before school (OR = 4.40, 95% CI = 1.81-10.68, p<0.01). The odds of meeting PA guidelines increased with the number of weekly physical education sessions provided at school (OR = 2.1, 95% CI = 1.36-3.21, p<0.01) and was greater among children who spent their lunch break walking (OR = 2.52, 95% CI = 1.15-5.55, p = 0.02) or running relative to those who spent it sitting (OR = 2.33, 95% CI = 1.27-4.27, p = 0.01)., Conclusions: Prevalence of meeting movement guidelines among Kenyan children is low and of greatest concern in urban areas. Several correlates were identified, particularly influential were features of the school day, School is thus a significant setting to promote a healthy balance between sleep, sedentary time, and PA., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Swindell et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Physical activity (PA) surveillance, policy, and research efforts need to be periodically appraised to gain insight into national and global capacities for PA promotion. The aim of this paper was to assess the status and trends in PA surveillance, policy, and research in 164 countries., Methods: We used data from the Global Observatory for Physical Activity (GoPA!) 2015 and 2020 surveys. Comprehensive searches were performed for each country to determine the level of development of their PA surveillance, policy, and research, and the findings were verified by the GoPA! Country Contacts. Trends were analyzed based on the data available for both survey years., Results: The global 5-year progress in all 3 indicators was modest, with most countries either improving or staying at the same level. PA surveillance, policy, and research improved or remained at a high level in 48.1%, 40.6%, and 42.1% of the countries, respectively. PA surveillance, policy, and research scores decreased or remained at a low level in 8.3%, 15.8%, and 28.6% of the countries, respectively. The highest capacity for PA promotion was found in Europe, the lowest in Africa and low- and lower-middle-income countries. Although a large percentage of the world's population benefit from at least some PA policy, surveillance, and research efforts in their countries, 49.6 million people are without PA surveillance, 629.4 million people are without PA policy, and 108.7 million live in countries without any PA research output. A total of 6.3 billion people or 88.2% of the world's population live in countries where PA promotion capacity should be significantly improved., Conclusion: Despite PA is essential for health, there are large inequalities between countries and world regions in their capacity to promote PA. Coordinated efforts are needed to reduce the inequalities and improve the global capacity for PA promotion.

Background: In Sub-Saharan African countries, rapid urbanization and increasing socio-economic status are associated with a transition to decreased physical activity (PA). A more sedentary lifestyle is linked to increased body fat leading to increments in leptin levels. Since rodent and human studies in high-income countries have shown that starvation-induced hypoleptinemia triggers high PA, efforts are warranted to pursue the hypothesis that low leptin levels in lean children of low- and middle-income countries (LMIC) are also associated with high PA., Methods: In this cross-sectional study, we assessed seven-day PA with triaxial accelerometry (ActiGraph GT3X) among 223 primary school children (9 to 12 years of age) in rural Tanzania. Moderate-to-vigorous PA (MVPA) and total accelerometer counts per day were outcome variables. Leptin was determined using enzyme linked immunosorbent assay tests from dried blood spots. Anthropometric assessments were conducted and food insecurity and socio-demographic data were gathered using semi-structured interviews., Results: In this sample of school children in rural Tanzania, leptin concentrations (median: 0.91 ng/mL, P25: 0.55, P75: 1.69), body mass index z-scores (median: -1.35, P25: -1.93, P75: -0.82), and height-for-age-z-scores (median: -1.16, P25: -1.96, P75: -0.61) were low. In contrast, PA levels were high with a median MVPA time of 119 min/day. Linear regression confirmed that leptin levels were negatively associated with MVPA (beta: -18.1; 95%CI: -29.7; -6.5; p = 0.002) and total accelerometer counts (beta: -90,256; 95%CI: -154,146; -26,365; p = 0.006). Children residing in areas with better infrastructure had lower MVPA levels (p < 0.001) and tended to have higher leptin levels (p = 0.062) than children residing in areas only reachable via dirt roads., Conclusion: Our cross-sectional field study is the first that supports the hypothesis of low leptin levels as a potential endocrine trigger of high PA in lean children of a LMIC. We observed early signs of a PA transition towards a less active lifestyle in a subgroup residing in areas with better infrastructure that concomitantly tended to have higher leptin concentrations. Considering that area-dependent PA differences were more pronounced among girls than boys, whereas differences in leptin levels were less pronounced, not only biological, but also external factors explain PA transition., (© 2022. The Author(s).)

This study aimed to examine the association between breastfeeding and childhood obesity. A multinational cross-sectional study of 4,740 children aged 9-11 years was conducted from 12 countries. Infant breastfeeding was recalled by parents or legal guardians. Height, weight, waist circumference, and body fat were obtained using standardized methods. The overall prevalence of obesity, central obesity, and high body fat were 12.3%, 9.9%, and 8.1%, respectively. After adjustment for maternal age at delivery, body mass index (BMI), highest maternal education, history of gestational diabetes, gestational age, and child's age, sex, birth weight, unhealthy diet pattern scores, moderate-to-vigorous physical activity, sleeping, and sedentary time, exclusive breastfeeding was associated with lower odds of obesity (odds ratio [OR] 0.76, 95% confidence interval, CI [0.57, 1.00]) and high body fat (OR 0.60, 95% CI [0.43, 0.84]) compared with exclusive formula feeding. The multivariable-adjusted ORs based on different breastfeeding durations (none, 1-6, 6-12, and > 12 months) were 1.00, 0.74, 0.70, and 0.60 for obesity (P trend = .020) and 1.00, 0.64, 047, and 0.64 for high body fat (P trend = .012), respectively. These associations were no longer significant after adjustment for maternal BMI. Breastfeeding may be a protective factor for obesity and high body fat in 9- to 11-year-old children from 12 countries., (© 2020 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Introduction: Previous studies have linked short sleep duration, poor sleep quality, and late sleep timing with lower health-related quality of life (HRQoL) in children. However, almost all studies relied solely on self-reported sleep information, and most studies were conducted in high-income countries. To address these gaps, we studied both device-measured and self-reported sleep characteristics in relation to HRQoL in a sample of children from 12 countries that vary widely in terms of economic and human development., Methods: The study sample included 6,626 children aged 9-11 years from Australia, Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, the United Kingdom, and the United States. Waist-worn actigraphy was used to measure total sleep time, bedtime, wake-up time, and sleep efficiency on both weekdays and weekends. Children also reported ratings of sleep quantity and quality. HRQoL was measured by the KIDSCREEN-10 survey. Multilevel regression models were used to determine the relationships between sleep characteristics and HRQoL., Results: Results showed considerable variation in sleep characteristics, particularly duration and timing, across study sites. Overall, we found no association between device-measured total sleep time, sleep timing or sleep efficiency, and HRQoL. In contrast, self-reported ratings of poor sleep quantity and quality were associated with HRQoL., Conclusions: Self-reported, rather than device-based, measures of sleep are related to HRQoL in children. The discrepancy related to sleep assessment methods highlights the importance of considering both device-measured and self-reported measures of sleep in understanding its health effects., (Copyright © 2019 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

The aim of the present study was to examine trends in participation, performance, age and nationality during a ~ 50-years period in the largest dataset ever studied in the "New York City Marathon". We analysed 1,174,331 finishers (women, n = 349,145, age 39.7 ± 8.7 years; men, n = 825,186, 41.7 ± 9.2 years). The overall participation increased across calendar years for all nationalities, and this increase was more pronounced in women, which resulted in a decreasing men-to-women ratio. Men were faster and older than women. Ethiopians and Kenyans were the fastest and youngest in women and men, respectively. Japanese were the slowest and Germans were the oldest in both sexes. Race time increased across years. Coaches and fitness trainers should be aware of these trends and should emphasize the development of training programs for older and slower runners.

Background: To determine if children's moderate to vigorous physical activity (MVPA) and sedentary time varied across levels of household income in countries at different levels of Human Development Index (HDI), consistent with the theory of epidemiological transition., Methods: Data from 6548 children (55% girls) aged 9-11 years from 12 countries at different HDI levels are used in this analysis to assess MVPA and sedentary time (measured using ActiGraph accelerometers) across levels of household income. Least-square means are estimated separately for boys and girls at the estimated 10th, 50th, and 90th percentiles of HDI for the sample., Results: For boys, time in MVPA is negatively associated with income at the 10th and 50th percentiles of HDI (both P < .002). For girls, time in MVPA is negatively associated with income at the 10th and 50th percentiles of HDI (all P < .01) and positively related with income at the 90th percentile (P = .04). Sedentary time is positively associated with income at the 10th percentile of HDI for boys (P = .03), but not for girls., Conclusions: Results support the possibility of an epidemiological transition in physical activity, with lower levels of MVPA observed at opposite levels of income depending on the HDI percentile. This phenomenon was not observed for sedentary time.

Objective: To evaluate the single and joint associations of objectively measured moderate-to-vigorous physical activity (MVPA) and sedentary time on week and weekend days with obesity in children from 12 countries across all inhabited continents., Methods: A multinational, 12-country cross-sectional study of 5779 children aged 9-11 years was conducted. Time spent in MVPA and sedentary behaviors was assessed by waist-worn accelerometry. Logistic regression was used to examine the independent and joint associations of MVPA and sedentary time on weekdays and weekend with the odds of obesity., Results: After adjustment for all confounding factors, the odds ratios (ORs) of childhood obesity were the highest among children with a low level of MVPA on both weekdays and weekend (OR 4.67), high among children with a high level of MVPA on weekdays and a low level of MVPA on weekend (OR 1.99) and high among children with a low level of MVPA on weekdays and a high levels of MVPA on weekend (OR 2.20), compared to those with a high level of MVPA on both weekdays and weekend. Similarly, the ORs of childhood obesity were significantly higher among children with a high level of sedentary time on both weekdays and weekend (OR 1.87) compared with those with low levels of sedentary time on both weekdays and weekend., Conclusions: Lower levels of MVPA or higher levels of sedentary time on either weekdays or weekend were associated with increased odds of obesity in 9-11 year old children in 12 countries.

Background: Existing research has documented inconsistent findings for the associations among breakfast frequency, physical activity (PA), and sedentary time in children. The primary aim of this study was to examine the associations among breakfast frequency and objectively-measured PA and sedentary time in a sample of children from 12 countries representing a wide range of human development, economic development and inequality. The secondary aim was to examine interactions of these associations between study sites., Methods: This multinational, cross-sectional study included 6228 children aged 9-11 years from the 12 International Study of Childhood Obesity, Lifestyle and the Environment sites. Multilevel statistical models were used to examine associations between self-reported habitual breakfast frequency defined using three categories (breakfast consumed 0 to 2 days/week [rare], 3 to 5 days/week [occasional] or 6 to 7 days/week [frequent]) or two categories (breakfast consumed less than daily or daily) and accelerometry-derived PA and sedentary time during the morning (wake time to 1200 h) and afternoon (1200 h to bed time) with study site included as an interaction term. Model covariates included age, sex, highest parental education, body mass index z-score, and accelerometer waking wear time., Results: Participants averaged 60 (s.d. 25) min/day in moderate-to-vigorous PA (MVPA), 315 (s.d. 53) min/day in light PA and 513 (s.d. 69) min/day sedentary. Controlling for covariates, breakfast frequency was not significantly associated with total daily or afternoon PA and sedentary time. For the morning, frequent breakfast consumption was associated with a higher proportion of time in MVPA (0.3%), higher proportion of time in light PA (1.0%) and lower min/day and proportion of time sedentary (3.4 min/day and 1.3%) than rare breakfast consumption (all p ≤ 0.05). No significant associations were found when comparing occasional with rare or frequent breakfast consumption, or daily with less than daily breakfast consumption. Very few significant interactions with study site were found., Conclusions: In this multinational sample of children, frequent breakfast consumption was associated with higher MVPA and light PA time and lower sedentary time in the morning when compared with rare breakfast consumption, although the small magnitude of the associations may lack clinical relevance., Trial Registration: The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) is registered at (Identifier NCT01722500 ).

Purpose: This study investigated the relationship between outdoor time and physical activity (PA), sedentary time (SED), and body mass index z scores among children from 12 lower-middle-income, upper-middle-income, and high-income countries., Methods: In total, 6478 children (54.4% girls) aged 9-11 years participated. Outdoor time was self-reported, PA and SED were assessed with ActiGraph GT3X+ accelerometers, and height and weight were measured. Data on parental education, neighborhood collective efficacy, and accessibility to neighborhood recreation facilities were collected from parent questionnaires. Country latitude and climate statistics were collected through national weather data sources. Gender-stratified multilevel models with parental education, climate, and neighborhood variables as covariates were used to examine the relationship between outdoor time, accelerometry measures, and body mass index z scores., Results: Each additional hour per day spent outdoors was associated with higher moderate- to vigorous-intensity PA (boys: +2.8 min/d; girls: +1.4 min/d), higher light-intensity PA (boys: +2.0 min/d; girls: +2.3 min/d), and lower SED (boys: -6.3 min/d; girls: -5.1 min/d). Effect sizes were generally weaker in lower-middle-income countries. Outdoor time was not associated with body mass index z scores., Conclusions: Outdoor time was associated with higher PA and lower SED independent of climate, parental education, and neighborhood variables, but effect sizes were small. However, more research is needed in low- and middle-income countries.

Background: Whether outdoor time is linked to dietary patterns of children has yet to be empirically tested. The objective of this study was to examine the association between outdoor time and dietary patterns of children from 12 countries around the world., Methods: This multinational, cross-sectional study included 6229 children 9-11 years of age. Children self-reported the time that they spent outside before school, after school and on weekends. A composite score was calculated to reflect overall daily outdoor time. Dietary patterns were assessed using a food frequency questionnaire, and two components were used for analysis: healthy and unhealthy dietary pattern scores., Results: On average, children spent 2.5 h outside per day. After adjusting for age, sex, parental education, moderate-to-vigorous physical activity, screen time and body mass index z-score, greater time spent outdoors was associated with healthier dietary pattern scores. No association was found between outdoor time and unhealthy dietary pattern scores. Similar associations between outdoor time and dietary patterns were observed for boys and girls and across study sites., Conclusions: Greater time spent outside was associated with a healthier dietary pattern in this international sample of children. Future research should aim to elucidate the mechanisms behind this association.

Objective: To examine the relationships between objectively measured sleep patterns (sleep duration, sleep efficiency and bedtime) and sugar-sweetened beverage (SSB) consumption (regular soft drinks, energy drinks, sports drinks and fruit juice) among children from all inhabited continents of the world., Design: Multinational, cross-sectional study., Setting: The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE)., Subjects: Children (n 5873) 9-11 years of age., Results: Sleep duration was 12 min per night shorter in children who reported consuming regular soft drinks 'at least once a day' compared with those who reported consuming 'never' or 'less than once a week'. Children were more likely to sleep the recommended 9-11 h/night if they reported lower regular soft drink consumption or higher sports drinks consumption. Children who reported consuming energy drinks 'once a week or more' reported a 25-min earlier bedtime than those who reported never consuming energy drinks. Children who reported consuming sports drinks '2-4 d a week or more' also reported a 25-min earlier bedtime compared with those who reported never consuming sports drinks. The associations between sleep efficiency and SSB consumption were not significant. Similar associations between sleep patterns and SSB consumption were observed across all twelve study sites., Conclusions: Shorter sleep duration was associated with higher intake of regular soft drinks, while earlier bedtimes were associated with lower intake of regular soft drinks and higher intake of energy drinks and sports drinks in this international study of children. Future work is needed to establish causality and to investigate underlying mechanisms.

Purpose: This study aimed to examine the associations between participation frequency in physical education (PE) classes and objective measures of physical activity (PA) and sedentary behavior (SB) in children from 12 countries at different levels of development., Methods: This multinational, cross-sectional study included 5874 children 9-11 yr old from sites in Australia, Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, the United Kingdom, and the United States. PA and SB were monitored for seven consecutive days using a waist-worn accelerometer. PA and SB data were presented for weekdays (times in and out of school) and weekend days. Participation frequency in PE classes was determined by questionnaire. Multilevel modeling analyses stratified by sex were used., Results: Overall, 24.8% of children self-reported participation in PE classes ≥3 times per week (25.3% in high-income countries [HIC] and 24.3% in low- and middle-income countries [LMIC]). After adjusting for age, sex, parental education, and body mass index z-score, results showed that children from low- and middle-income countries who took PE classes one to two times per week were more likely to present better indicators of PA and shorter time in SB in and out of school. In HIC, boys that participated in PE classes were more likely to meet the moderate-to-vigorous PA recommendations and to present better indicators of PA (in school) and shorter time in SB in and out of school. For girls in HIC, attending PE classes increased the likelihood of spending more time in moderate-to-vigorous PA, especially if they attended ≥3 times per week., Conclusion: Attending PE classes is associated with a higher level of PA and a lower level of SB in and out of school during weekdays in children from countries at various levels of development.

The purpose of this study was to describe children's daily compliance with moderate-to-vigorous physical activity (MVPA) recommendations across a week in different parts of the world, and to identify individual- and school-level correlates that may explain differences in daily MVPA compliance. The sample included 6553 children aged 9-11 years from 12 countries, and multilevel statistical analyses were used, including both child- and school-level variables. Most children did not comply with the MVPA guidelines on a daily basis: Chinese children complied the least, whereas Finnish, Australian, Colombian, UK, and Kenyan children complied the most. Boys (rate ratio [RR] = 1.47) and children with higher unhealthy diet scores (RR = 1.08) complied more, but overweight/obese children (RR = 0.81), earlier maturing children (RR = 0.93), and those who spent more time in screen activities (RR = 0.98) and sleeping (RR = 0.96) had the lowest compliance. At the school level, children with access to playground or sport equipment (RR = 0.88, for both) tended to comply less, whereas those with access to a gymnasium outside the school hours complied more with the MVPA guidelines (RR = 1.14). Significant between-country differences in children's daily MVPA compliance were observed, reflecting not only site characteristics, but also the importance of individual traits and local school contexts.

We investigated whether associations of neighborhood social environment attributes and physical activity differed among 12 countries and levels of economic development using World Bank classification (low/lower-middle-, upper-middle- and high- income countries) among 9-11 year old children (N=6161) from the International Study of Childhood Obesity, Lifestyle, and the Environment (ISCOLE). Collective efficacy and perceived crime were obtained via parental/guardian report. Moderate-to-vigorous physical activity (MVPA) was assessed with waist-worn Actigraph accelerometers. Neighborhood environment by country interactions were tested using multi-level statistical models, adjusted for covariates. Effect estimates were reported by country and pooled estimates calculated across World Bank classifications for economic development using meta-analyses and forest plots. Associations between social environment attributes and MVPA varied among countries and levels of economic development. Associations were more consistent and in the hypothesized directions among countries with higher levels economic development, but less so among countries with lower levels of economic development., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: To examine the joint association of birth weight and physical activity/sedentary time with childhood obesity in 12 countries., Methods: A cross-sectional study of 5,088 children aged 9 to 11 years was conducted. Birth weight was recalled by parents or guardians. Moderate-to-vigorous physical activity (MVPA) and sedentary behavior were objectively measured using accelerometry., Results: The association of birth weight with the odds of obesity, central obesity, and high body fat was significant among children with either low MVPA or high sedentary time but not among children with either high MVPA or low sedentary time. In comparison with children with normal birth weight and high MVPA, children with high birth weight and low MVPA showed 4.48- to 5.18-fold higher odds of obesity, central obesity, and high body fat; children with normal birth weight and low MVPA showed 3.00- to 3.30-fold higher odds of obesity, central obesity, and high body fat, and children with high birth weight and high MVPA showed 1.16- to 1.68-fold higher odds of obesity, central obesity, and high body fat., Conclusions: High MVPA is more important than high birth weight as a correlate of obesity in children., (© 2017 The Obesity Society.)

Background: Although 'unhealthy' diet is a well-known risk factor for non-communicable diseases, its relationship with socio-economic status (SES) has not been fully investigated. Moreover, the available research has largely been conducted in countries at high levels of human development. This is the first study to examine relationships among dietary patterns and SES of children from countries spanning a wide range of human development., Methods: This was a multinational cross-sectional study among 9-11 year-old children (n = 6808) from urban/peri-urban sites across 12 countries. Self-reported food frequency questionnaires were used to determine the children's dietary patterns. Principal Components Analysis was employed to create two component scores representing 'unhealthy' and 'healthy' dietary patterns. Multilevel models accounting for clustering at the school and site level were used to examine the relationships among dietary patterns and SES., Results: The mean age of participants in this study (53.7% girls) was 10.4 years. Largest proportions of total variance in dietary patterns occurred at the individual, site, and school levels (individual, school, site: 62.8%; 10.8%; 26.4% for unhealthy diet pattern (UDP) and 88.9%; 3.7%; 7.4%) for healthy diet pattern (HDP) respectively. There were significant negative 'unhealthy' diet-SES gradients in 7 countries and positive 'healthy' diet-SES gradients in 5. Within country diet-SES gradients did not significantly differ by HDI. Compared to participants in the highest SES groups, unhealthy diet pattern scores were significantly higher among those in the lowest within-country SES groups in 8 countries: odds ratios for Australia (2.69; 95% CI: 1.33-5.42), Canada (4.09; 95% CI: 2.02-8.27), Finland (2.82; 95% CI: 1.27-6.22), USA (4.31; 95% CI: 2.20-8.45), Portugal (2.09; 95% CI: 1.06-4.11), South Africa (2.77; 95% CI: 1.22-6.28), India (1.88; 95% CI: 1.12-3.15) and Kenya (3.35; 95% CI: 1.91-5.87)., Conclusions: This study provides evidence of diet-SES gradients across all levels of human development and that lower within-country SES is strongly related to unhealthy dietary patterns. Consistency in within-country diet-SES gradients suggest that interventions and public health strategies aimed at improving dietary patterns among children may be similarly employed globally. However, future studies should seek to replicate these findings in more representative samples extended to more rural representation.

The age for the fastest marathoners is well investigated, but not the age and nationality of the fastest. We investigated the age of peak marathon performance for the annual top 100 women and men competing in four races of the "World Marathon Majors" (Boston, Berlin, Chicago and New York) and the "Stockholm Marathon" between 2000 and 2014 using mixed-effects regression analyses and one-way ANOVA. Race times of Ethiopian men decreased to 2:14 h:min, but remained unchanged for Kenyan (2:14 h:min), Moroccan (2:15 h:min) and South African (2:18 h:min) men. Race times in Ethiopian (2:34 h:min), Kenyan (2:29 h:min) and South African (2:49 h:min) women showed no changes. Age increased in Ethiopian and South African men to 29.0 ± 5.0 and 32.0 ± 1.0 years, respectively. Age for Kenyan (29.9 ± 2.0 years) and Moroccan (34.9 ± 3.9 years) men remained unchanged. Age remained unchanged for Ethiopian (26.5 ± 2.0 years), Kenyan (30.0 ± 0.8 years) and South African (36.3 ± 7.0 years) women. In summary, Ethiopian men improved marathon race times, but not Ethiopian women. Age increased in Ethiopian men, but not in Ethiopian women. For practical applications, female and male marathoners from Ethiopia were the youngest and the fastest.

The purpose of this study was to determine the association between regular (sugar containing) and diet (artificially sweetened) soft drink consumption and obesity in children from 12 countries ranging in levels of economic and human development. The sample included 6162 children aged 9-11 years. Information on soft drink consumption was obtained using a food frequency questionnaire. Percentage body fat (%BF) was estimated by bio-electrical impedance analysis, body mass index (BMI) z -scores were computed using World Health Organization reference data, and obesity was defined as a BMI > +2 standard deviations (SD). Multi-level models were used to investigate trends in BMI z -scores, %BF and obesity across categories of soft drink consumption. Age, sex, study site, parental education and physical activity were included as covariates. There was a significant linear trend in BMI z -scores across categories of consumption of regular soft drinks in boys ( p = 0.049), but not in girls; there were no significant trends in %BF or obesity observed in either boys or girls. There was no significant linear trend across categories of diet soft drink consumption in boys, but there was a graded, positive association in girls for BMI z -score ( p = 0.0002) and %BF ( p = 0.0001). Further research is required to explore these associations using longitudinal research designs., Competing Interests: ISCOLE was funded by The Coca-Cola Company. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. M.F. has received a research grant from Fazer Finland. V.M. is a member of the Scientific Advisory Board of Actigraph. The authors reported no other potential conflicts of interest.

Background: The Canadian 24-h movement guidelines were developed with the hope of improving health and future health outcomes in children and youth. The purpose of this study was to evaluate adherence to the 3 recommendations most strongly associated with health outcomes in new 24-h movement guidelines and their relationship with adiposity (obesity and body mass index z-score) across countries participating in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE)., Methods: Cross-sectional results were based on 6128 children aged 9-11 years from the 12 countries of ISCOLE. Sleep duration and moderate-to-vigorous physical activity (MVPA) were assessed using accelerometry. Screen time was measured through self-report. Body weight and height were measured. Body mass index (BMI, kg · m -2 ) was calculated, and BMI z-scores were computed using age- and sex-specific reference data from the World Health Organization. Obesity was defined as a BMI z-score > +2 SD. Meeting the overall 24-h movement guidelines was defined as: 9 to 11 h/night of sleep, ≤2 h/day of screen time, and at least 60 min/day of MVPA. Age, sex, highest parental education and unhealthy diet pattern score were included as covariates in statistical models. Associations between meeting vs. not meeting each single recommendation (and combinations) with obesity were assessed with odds ratios calculated using generalized linear mixed models. A linear mixed model was used to examine the differences in BMI z-scores between children meeting vs. not meeting the different combinations of recommendations., Results: The global prevalence of children meeting the overall recommendations (all three behaviors) was 7%, with children from Australia and Canada showing the highest adherence (15%). Children meeting the three recommendations had lower odds ratios for obesity compared to those meeting none of the recommendations (OR = 0.28, 95% CI 0.18-0.45). Compared to not meeting the 24-h movement recommendations either independently or combined, meeting them was significantly associated with a lower BMI z-score. Whenever the MVPA recommendation was included in the analysis the odds ratios for obesity were lower., Conclusions: For ISCOLE participants meeting these 3 healthy movement recommendations the odds ratios of being obese or having high BMI z-scores were lower. However, only a small percentage of children met all recommendations. Future efforts should aim to find promising ways to increase daily physical activity, reduce screen time, and ensure an adequate night's sleep in children., Trial Registration: The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) was registered at ClinicalTrials.gov (Identifier NCT01722500) (October 29, 2012).

Aims/hypothesis: The aim of this study was to examine the association between maternal gestational diabetes mellitus (GDM) and childhood obesity at age 9-11 years in 12 countries around the world., Methods: A multinational cross-sectional study of 4740 children aged 9-11 years was conducted. Maternal GDM was diagnosed according to the ADA or WHO criteria. Height and waist circumference were measured using standardised methods. Weight and body fat were measured using a portable Tanita SC-240 Body Composition Analyzer. Multilevel modelling was used to account for the nested nature of the data., Results: The prevalence of reported maternal GDM was 4.3%. The overall prevalence of childhood obesity, central obesity and high body fat were 12.3%, 9.9% and 8.1%, respectively. The multivariable-adjusted (maternal age at delivery, education, infant feeding mode, gestational age, number of younger siblings, child unhealthy diet pattern scores, moderate-to-vigorous physical activity, sleeping time, sedentary time, sex and birthweight) odds ratios among children of GDM mothers compared with children of non-GDM mothers were 1.53 (95% CI 1.03, 2.27) for obesity, 1.73 (95% CI 1.14, 2.62) for central obesity and 1.42 (95% CI 0.90, 2.26) for high body fat. The positive association was still statistically significant for central obesity after additional adjustment for current maternal BMI but was no longer significant for obesity and high body fat., Conclusions/interpretation: Maternal GDM was associated with increased odds of childhood obesity at 9-11 years old but this association was not fully independent of maternal BMI., Competing Interests: Duality of interest MF has received a research grant from Fazer Finland and has received an honorarium for speaking for Merck. AK has been a member of the Advisory Boards of Dupont and McCain Foods. RK has received a research grant from Abbott Nutrition Research and Development. VM is a member of the Scientific Advisory Board of Actigraph and has received an honorarium for speaking for The Coca-Cola Company. TO has received an honorarium for speaking for The Coca-Cola Company. The authors report no other potential conflicts of interest.