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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 ).

Background: Young adulthood is a critical period for excessive weight gain. The extent to which young adults' sedentary time (ST) and moderate-to-vigorous physical activity (MVPA) relate to adiposity and weight gain remains unclear., Objective: The purpose of this study was to examine the relation of ST and MVPA with adiposity and change in adiposity in healthy, nonobese young adults over a 2-y period., Design: Participants were 71 adults aged 20-35 y. Measurements included ST and MVPA by accelerometry and reported energy intake at baseline, and anthropometry (%FM) and fat mass (FM) by dual-energy X-ray absorptiometry at baseline, year 1, and year 2. Associations of baseline ST and MVPA with adiposity were examined with the use of repeated-measures linear regression models, controlling for age, sex, and reported energy intake. The Benjamini-Hochberg procedure was used to adjust for multiple comparisons., Results: Participants [mean ± SD body mass index (BMI; kg/m2): 22.6 ± 2.4] engaged in 8.5 ± 1.5 h ST/d and 0.4 ± 0.3 h MVPA/d. At baseline, adults who engaged in ST for ≥8 h/d had higher FM, %FM, and lower MVPA, whereas those who engaged in MVPA for ≥30 min/d had lower FM and %FM. In fully adjusted models, ST was significantly associated with baseline body weight, hip circumference, BMI, FM, and %FM and with year-1 body weight, waist and hip circumference, FM, and %FM, but not with any year-2 adiposity indicators. MVPA was not significantly associated with any adiposity indicators at baseline, year 1, or year 2 in fully adjusted models. Over 2 y, participants significantly increased waist circumference, BMI, FM, and %FM (all P-values <0.05), but there were no associations among baseline ST and MVPA with change in adiposity., Conclusions: Among nonobese young adults, high ST and low MVPA were related to elevated adiposity but did not predict change in adiposity over time. This trial was registered at clinicaltrials.gov as NCT00945633.

Objective: The aim was to assess associations between lifestyle behaviors and obesity in a multinational study of children from 12 countries representing a wide range of human development., Methods: The sample included 6,025 children 9-11 years of age. Behavioral risk factors included nocturnal sleep duration, moderate to vigorous physical activity (MVPA), television viewing (TV time), and healthy and unhealthy diet pattern scores. Multilevel analyses were used to obtain odds ratios for obesity expressed per standard deviation of each behavioral risk factor., Results: The odds ratios (95% confidence intervals) for obesity from multilevel, multivariable models were 0.79 (0.71-0.90) for nocturnal sleep duration, 0.52 (0.45-0.60) for MVPA, 1.15 (1.05-1.27) for TV time, 1.08 (0.96-1.20) for healthy diet score, and 0.93 (0.83-1.04) for unhealthy diet score in boys and 0.71 (0.63-0.80) for nocturnal sleep duration, 0.43 (0.35-0.53) for MVPA, 1.07 (0.96-1.19) for TV time, 1.05 (0.93-1.19) for healthy diet score, and 0.96 (0.82-1.11) for unhealthy diet score in girls., Conclusions: Behavioral risk factors are important correlates of obesity in children, particularly low MVPA, short sleep duration, and high TV viewing., (© 2015 The Obesity Society.)

Introduction: The metabolic syndrome is the clustering of several cardiometabolic risk factors that can lead to the development of coronary heart disease and type 2 diabetes. We evaluated whether a change in aerobic fitness resulting from a lifestyle intervention could significantly change the odds of metabolic syndrome prevalence., Methods: Participants (n = 810) were recruited into PREMIER, a multicenter, randomized, controlled clinical trial with outcome assessments at 6 and 18 months. The primary eligibility criterion was a diagnosis of prehypertension or stage 1 hypertension. PREMIER randomized participants to 2 lifestyle interventions, both of which included increased physical activity, or an advice-only control group. Participants completed a submaximal treadmill exercise test; we used reduction in heart rate as the measure of improved aerobic fitness. We used logistic regression to determine intervention effects on metabolic syndrome prevalence. Our models controlled for dietary pattern change., Results: The lifestyle interventions had no significant effect on metabolic syndrome prevalence at 6 months or 18 months. When combining intervention and control groups, at 6 and 18 months, a 1-beat-per-minute reduction in heart rate was associated with a 4% reduction in prevalence of metabolic syndrome (P < .001). When we tested for weight change as a mediator, the association was no longer significant., Conclusion: Increased aerobic fitness may reduce prevalence of metabolic syndrome. This association appears to be mediated through concomitant weight change.

Purpose: To examine the influence of an environmental intervention to prevent excess weight gain in African-American children., Design: Single-group repeated measures., Setting: The intervention was delivered to a school composed of African-American children., Participants: Approximately 45% (N = 77) of enrolled second through sixth grade students., Intervention: The 18-month intervention was designed to alter the school environment to prevent excess weight gain by making healthier eating choices and physical activity opportunities more available., Measures: Body mass index percentile was the primary outcome variable. Body mass index z score was also calculated, and percent body fat, using bioelectrical impedance, was also measured. Total caloric intake (kilocalories) and percent kilocalories from fat, carbohydrate, and protein were measured by digital photography. Minutes of physical activity and sedentary behavior were selfreported., Analysis: Mixed-models analysis was used with covarying baseline values., Results: Boys maintained, whereas girls increased, percent body fat over 18 months (p = .027). All children decreased percent of kilocalories consumed from total and saturated fat and increased carbohydrate intake and self-reported physical activity during the intervention (p < .025). Body mass index z score, sedentary behavior, and total caloric intake were unchanged., Conclusion: The program may have resulted in maintenance of percent body fat in boys. The percent body fat in girls steadily increased, despite similar behavioral changes as boys. School-based interventions targeting African-American children should investigate strategies that can be effective across gender.

Background: To improve methods for long-term weight management, the Weight Loss Maintenance (WLM) trial, a four-center randomized trial, was conducted to compare alternative strategies for maintaining weight loss over a 30-month period. This paper describes methods and results for the initial 6-month weight-loss program (Phase I)., Methods: Eligible adults were aged > or =25, overweight or obese (BMI=25-45 kg/m2), and on medications for hypertension and/or dyslipidemia. Anthropomorphic, demographic, and psychosocial measures were collected at baseline and 6 months. Participants (n=1685) attended 20 weekly group sessions to encourage calorie restriction, moderate-intensity physical activity, and the DASH (dietary approaches to stop hypertension) dietary pattern. Weight-loss predictors with missing data were replaced by multiple imputation., Results: Participants were 44% African American and 67% women; 79% were obese (BMI> or =30), 87% were taking anti-hypertensive medications, and 38% were taking antidyslipidemia medications. Participants attended an average of 72% of 20 group sessions. They self-reported 117 minutes of moderate-intensity physical activity per week, kept 3.7 daily food records per week, and consumed 2.9 servings of fruits and vegetables per day. The Phase-I follow-up rate was 92%. Mean (SD) weight change was -5.8 kg (4.4), and 69% lost at least 4 kg. All race-gender subgroups lost substantial weight: African-American men (-5.4 kg +/- 7.7); African-American women (-4.1 kg +/- 2.9); non-African-American men (-8.5 kg +/- 12.9); and non-African-American women (-5.8 kg +/- 6.1). Behavioral measures (e.g., diet records and physical activity) accounted for most of the weight-loss variation, although the association between behavioral measures and weight loss differed by race and gender groups., Conclusions: The WLM behavioral intervention successfully achieved clinically significant short-term weight loss in a diverse population of high-risk patients.

The Metabolic Syndrome encompasses a set of laboratory and physical findings, including central adiposity, insulin resistance, hypertension, high triglycerides, and low HDL-cholesterol and several abnormalities in clotting and inflammatory markers. Using the definition provided by the Adult Treatment Panel III of the National Cholesterol Education Program, 24% of adult Americans have the Metabolic Syndrome. Central location of fat and release of fatty acids and cytokines from enlarged fat cells located in the intra-abdominal fat tissue provide the major agents that incite this syndrome. From a practical point of view, identifying dietary and lifestyle factors, including low levels of physical activity, are important in designing a diet and exercise program that can help individuals with the Metabolic Syndrome to reduce the associated detrimental health consequences.

Context: Weight loss, sodium reduction, increased physical activity, and limited alcohol intake are established recommendations that reduce blood pressure (BP). The Dietary Approaches to Stop Hypertension (DASH) diet also lowers BP. To date, no trial has evaluated the effects of simultaneously implementing these lifestyle recommendations., Objective: To determine the effect on BP of 2 multicomponent, behavioral interventions., Design, Setting, and Participants: Randomized trial with enrollment at 4 clinical centers (January 2000-June 2001) among 810 adults (mean [SD] age, 50 [8.9] years; 62% women; 34% African American) with above-optimal BP, including stage 1 hypertension (120-159 mm Hg systolic and 80-95 mm Hg diastolic), and who were not taking antihypertensive medications., Intervention: Participants were randomized to one of 3 intervention groups: (1) "established," a behavioral intervention that implemented established recommendations (n = 268); (2) "established plus DASH,"which also implemented the DASH diet (n = 269); and (3) an "advice only" comparison group (n = 273)., Main Outcome Measures: Blood pressure measurement and hypertension status at 6 months., Results: Both behavioral interventions significantly reduced weight, improved fitness, and lowered sodium intake. The established plus DASH intervention also increased fruit, vegetable, and dairy intake. Across the groups, gradients in BP and hypertensive status were evident. After subtracting change in advice only, the mean net reduction in systolic BP was 3.7 mm Hg (P<.001) in the established group and 4.3 mm Hg (P<.001) in the established plus DASH group; the systolic BP difference between the established and established plus DASH groups was 0.6 mm Hg (P =.43). Compared with the baseline hypertension prevalence of 38%, the prevalence at 6 months was 26% in the advice only group, 17% in the established group (P =.01 compared with the advice only group), and 12% in the established plus DASH group (P<.001 compared with the advice only group; P =.12 compared with the established group). The prevalence of optimal BP (<120 mm Hg systolic and <80 mm Hg diastolic) was 19% in the advice only group, 30% in the established group (P =.005 compared with the advice only group), and 35% in the established plus DASH group (P<.001 compared with the advice only group; P =.24 compared with the established group)., Conclusion: Individuals with above-optimal BP, including stage 1 hypertension, can make multiple lifestyle changes that lower BP and reduce their cardiovascular disease risk.

Objective: Across the Diabetes Prevention Program (DPP) follow-up, cumulative diabetes incidence remained lower in the lifestyle compared with the placebo and metformin randomized groups and could not be explained by weight. Collection of self-reported physical activity (PA) (yearly) with cross-sectional objective PA (in follow-up) allowed for examination of PA and its long-term impact on diabetes prevention.Research Design and Methods: Yearly self-reported PA and diabetes assessment and oral glucose tolerance test results (fasting glucose semiannually) were collected for 3,232 participants with one accelerometry assessment 11-13 years after randomization (n = 1,793). Mixed models determined PA differences across treatment groups. The association between PA and diabetes incidence was examined using Cox proportional hazards models.Results: There was a 6% decrease (Cox proportional hazard ratio 0.94 [95% CI 0.92, 0.96]; P < 0.001) in diabetes incidence per 6 MET-h/week increase in time-dependent PA for the entire cohort over an average of 12 years (controlled for age, sex, baseline PA, and weight). The effect of PA was greater (12% decrease) among participants less active at baseline (<7.5 MET-h/week) (n = 1,338) (0.88 [0.83, 0.93]; P < 0.0001), with stronger findings for lifestyle participants. Lifestyle had higher cumulative PA compared with metformin or placebo (P < 0.0001) and higher accelerometry total minutes per day measured during follow-up (P = 0.001 and 0.047). All associations remained significant with the addition of weight in the models.Conclusions: PA was inversely related to incident diabetes in the entire cohort across the study, with cross-sectional accelerometry results supporting these findings. This highlights the importance of PA within lifestyle intervention efforts designed to prevent diabetes and urges health care providers to consider both PA and weight when counseling high-risk patients. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to compare steps/day detected by the YAMAX SW-200 pedometer versus the Actigraph GT3X accelerometer in free-living adults. Methods: Daily YAMAX and GT3X steps were collected from a sample of 23 overweight and obese participants (78% female; age = 52.6 ± 8.4 yr.; BMI = 31.0 ± 3.7 m·kg-2). Because a pedometer is more likely to be used in a community-based intervention program, it was used as the standard for comparison. Percent difference (PD) and absolute percent difference (APD) were calculated to examine between-instrument agreement. In addition, days were categorized based on PD: a) under-counting (> -10 PD), b) acceptable counting (-10 to 10 PD), and c) over-counting (> 10 PD). Results: The YAMAX and GT3X detected 8,025 ± 3,967 and 7131 ± 3066 steps/day, respectively, and the outputs were highly correlated (r = .87). Average PD was -3.1% ± 30.7% and average APD was 23.9% ± 19.4%. Relative to the YAMAX, 53% of the days detected by the GT3X were classified as under-counting, 25% acceptable counting, and 23% over-counting. Conclusion: Although the output of these 2 instruments is highly correlated, caution is advised when directly comparing or using their output interchangeably. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess the associations of meeting physical activity (PA), sleep, and dietary guidelines with cardiometabolic risk factors and adiposity in adolescents. The sample included adolescents aged 10–16 years. Accelerometry was used to measure PA and sleep over 7 days, 24 h/d. The PA guideline was defined as ≥60 min/d of moderate-to-vigorous PA. The sleep guideline was 9–11 hours (10–13 years) or 8–10 hours (14–16 years) per night. The dietary guideline was based on the Healthy Eating Index calculated from dietary recalls. Cardiometabolic risk factors and adiposity were assessed in an in-patient setting. Linear regression was used to examine the association between meeting each guideline and cardiometabolic risk factors/adiposity, adjusted for confounders and meeting other guidelines. Of the 342 participants, 251 (73%) provided complete measurements. Adolescents were 12.5 ± 1.9 years (African American [37%] and white [57%], girls [54%], and overweight or obesity [48%]). Half met the sleep guideline (52%), few met the PA guideline (11%), and the top quintile was preselected as meeting the diet guideline (20%). Most met one (47%) or no guidelines (35%), and few met multiple guidelines (18%). Meeting the PA guideline was associated with lower cardiometabolic risk factors and adiposity (p <.05 for all). Compared with meeting no guidelines, those who met multiple guidelines had lower cardiometabolic risk factors and adiposity (p <.05 for all). Few met the PA or multiple guidelines, and those not meeting guidelines were associated with adverse cardiometabolic factors and adiposity. Multidisciplinary strategies for improving multiple behaviors are needed to improve adolescent health. [ABSTRACT FROM AUTHOR]

Background: Excess weight is a strong predictor of incident breast cancer (BC) and survivorship. A limited number of studies comparing strategies for promoting successful weight loss in women with remitted BC exist. Purpose: CASTLE was a pilot study comparing the effectiveness/feasibility of in-person and telephonic behavioral-based lifestyle weight loss interventions in BC survivors. Method: Fifty-two overweight/obese women (BMI = 25-45 kg/m) with remitted BC (stages I-IIIa) who recently completed cancer treatment were assigned to either an in-person group ( n = 24) or an individual telephone-based condition ( n = 11). Both interventions focused on increasing physical activity and reducing caloric intake. The phase I intervention lasted 6 months. The in-person condition received 16 group-based sessions, and the telephone condition received intervention calls approximately weekly. Phase II lasted 6 months (e.g., months 6-12), and all participants received monthly intervention calls via telephone. Results: Participants were predominately Caucasian (80 %) with a mean age of 52.8 (8.0) years and BMI of 31.9 (5.4) kg/m. Mixed models ANOVAs showed significant within group weight loss after 6 months for both the in-person (−3.3 kg ± 4.4, p = 0.002) and the telephonic (−4.0 kg ± 6.0, p = 0.01) conditions with no between group differences. During phase II, the in-person group demonstrated significant weight regain (1.3 kg ± 1.7, p = 0.009). Conclusion: Our pilot study findings demonstrated that telephone-based behavioral weight loss programs are effective and feasible in BC survivors and that telephonic programs may have advantages in promoting weight loss maintenance. [ABSTRACT FROM AUTHOR]

The article presents a study regarding the effects of calorie restriction (CR), a dietary treatment, on the bone mass of overweight youths. It mentions that the researchers evaluated 46 people divided into four groups who use various dietary interventions such as healthy diet, calorie restriction, combination of CR and aerobic exercise and low-calorie diet for six months. According to the authors, there is no bone loss and other harmful effects to bone health if CR is done moderately with or without exercise.

Purpose: This study aimed to examine the effects of substituting sedentary time with sleep or physical activity on adiposity in a longitudinal sample of adolescents. Methods: Adolescents (10–16 yr) were recruited for a prospective observational cohort. Parents and adolescents reported demographic characteristics and pubertal development. Accelerometry was used to measure sleep, physical activity, and sedentary time. Adiposity was quantified with imaging techniques. Isotemporal substitution modeling was conducted to examine the effect of substituting 10 min of sedentary time with sleep or differing intensities of physical activity. Results were stratified by sex and race and adjusted for covariates. Results: A total of 217 adolescents provided complete measures at both baseline and 2 yr later (58.1% White, 51.8% girls; 12.9 ± 1.9 yr at baseline). Sleep was negatively related to adiposity 2 yr later when considering other movement behaviors, but substituting baseline sedentary time with sleep was not related to future adiposity (P > 0.05). In boys and non-White adolescents, substituting sedentary time with vigorous-intensity physical activity was related to lower adiposity 2 yr later (P < 0.05). Substituting sedentary time for moderate- to vigorous-intensity physical activity was not associated with future adiposity. Conclusions: Substituting sedentary time with vigorous-intensity physical activity was related to lower adiposity in later adolescence in certain groups. Opportunities to promote an adequate balance of sleep, sedentary time, and physical activity in all adolescents are encouraged for optimal development. [ABSTRACT FROM AUTHOR]