Patients diagnosed with type 2 diabetes can develop long-term complications. Therefore, it is essential to prevent previous stages of the disease, such as dysglycemia, hyperinsulinemia and insulin resistance, as well as cardiometabolic diseases.

Children and adolescents under 18 years of age are recommended to reduce sitting time (ST) and increase physical activity [2]. Movement behavior plays an important role in this. This is because abdominal fat and a high percentage of body fat in general can also increase the risk of insulin resistance in the young population. [3].

Minimize sitting time

Previous studies report that overweight or obese children benefit from moderate to vigorous physical activity (MVPA) and reduced sitting time, as this improved insulin sensitivity and reduced insulin secretion [4,5]. Similarly, moderate to vigorous physical activity had an effect on the homeostatic model assessment of insulin resistance (HOMA-IR) during adolescence [6].

However, there are still gaps in knowledge about the impact of physical inactivity as well as light physical activity (LPA) and MVPA on glycemia, insulin, and HOMA-IR in pediatric populations. Light physical activity in childhood has been shown to be more effective than moderate to vigorous activity in reducing inflammation, fat mass, and cholesterol levels during growth from infancy to young adulthood. [7,8,9].

Develop effective prevention programs

However, it remains uncertain whether movement behavior can influence dysglycemia and HOMA-IR during growth through the mediating pathway of fat mass, muscle mass, lipids, and inflammation, or due to a bias. reverse causality [7,8,9]. It is important to clarify possible associations between movement behavior and metabolic indices to develop effective programs for the prevention of metabolic diseases in childhood. [2,5,7,8].

Assessment of sitting time and physical activity

An observational study investigated how sitting time (ST), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) affect glucose, insulin, and HOMA-IR in children aged 11 to 24 years. The children were followed for 13 years into young adulthood. This is the world’s largest and longest follow-up study measuring movement behavior using accelerometers and levels of glucose, insulin and insulin resistance [1,10].

792 children were included from the Avon Longitudinal Study of Parents and Children, United Kingdom. For participants, there were at least two valid measurements of ST, LPA, and MVPA at age 11, 15, or 24 years, as well as complete glucose, insulin, and HOMA-IR measurements at ages 15, 17, and 24 years. [1].
Results of the observational study

The time that the children studied spent sitting at the beginning of the study was approximately six hours a day. During follow-up, this time increased to nine hours. Increased sitting time was associated with continuously higher fasting insulin levels. The probability of developing hyperinsulinemia was especially increased in overweight or obese children by 20% (odds ratio 1.20, 95% CI 1.00-1.44, p=0.047), while in children who exercised lightly during three to four hours a day, the probability was reduced by 20% (0.80, 0.66-0.96, p=0.017). Additionally, increased light physical activity was associated with lower insulin resistance [1,10].

Moderate to vigorous physical activity was initially associated with lower insulin levels. However, the reducing effect of MVPA on insulin levels decreased by 58% when the mediating role of fat mass was considered. Therefore, the association between MVPA and insulin levels was not significant. [1,10].

Previous results from the same cohort showed a connection between lack of exercise and obesity, dyslipidemia, inflammation and premature vascular damage. A vicious cycle was also observed between obesity and worsening insulin resistance [10].

Combat inactivity in childhood

The study shows that an increase in light physical activity and a simultaneous reduction in body fat mass and time spent sitting can reduce the risk of hyperinsulinemia and insulin resistance. An increase in sitting time was associated with worsening metabolic indices. This was especially true in overweight participants [1].

According to author Andrew Agbaje, a physician and associate professor of clinical epidemiology and child health at the University of Eastern Finland, this holds true from infancy to young adulthood. These parameters are therefore important intervention approaches to reduce the risk of dysglycemia, hyperinsulinemia and insulin resistance, and reverse the detrimental effects of lack of exercise in childhood. [1,10].

Inactivity in childhood is a monster that threatens young people around the world, according to Agbaje. “Lack of exercise should be recognized as one of the independent causes of excess insulin, fatty obesity, high lipid levels, inflammation and arterial stiffness in the 21st century. Three to four hours of light physical activity a day are crucial to combat inactivity in childhood,” continues Agbaje. The results extend current evidence from adolescence to young adulthood and close gaps in knowledge. This may be useful in updating guidelines regarding physical activity recommendations. [10].

Fountain:

  1. Agbaje, AO. (2024): The interactive effects of sedentary time, physical activity and fat mass on insulin resistance in the young population, The Journal of Clinical Endocrinology & Metabolism, 2024; dgae135, DOI: 10.1210/clinem/dgae135
  2. Bull, F.C., et al. (2020): 2020 World Health Organization guidelines on physical activity and sedentary behavior. Br J Sports Med. 2020 Dec;54(24):1451-1462. DOI: 10.1136/bjsports-2020-102955
  3. Agbaje, AO., et al. (2024): DXA-based fat mass at risk of worsening insulin resistance in adolescents: a 9-year temporal and mediation study. The Journal of Clinical Endocrinology & Metabolism. DOI 10.1210/clinem/dgae004
  4. Henderson, M., et al. (2016): Influence of adiposity, physical activity, fitness, and screen time on insulin dynamics over 2 years in children. JAMA Pediatr. 2016 Mar;170(3):227-35. DOI: 10.1001/jamapediatrics.2015.3909
  5. Harnois-Leblanc, S., et al (2022): Estimating the causal effects of physical activity and sedentary behaviors on the development of type 2 diabetes in at-risk children from infancy to late adolescence: an analysis of the QUALITY cohort. Lancet Child Adolesc Heal 2023;7(1):37-46. DOI: 10.1016/S2352-4642(22)00278-4
  6. Metcalf, B.S., et al. (2015): Physical activity attenuates the peak of insulin resistance in mid-adolescence, but by late adolescence the effect is lost: a longitudinal study with annual measurements from ages 9 to 16 (EarlyBird 66). Diabetology. 2015 Dec;58(12):2699-708. DOI: 10.1007/s00125-015-3714-5
  7. Agbaje, AO. (2023): Longitudinal mediating effect of fat mass and lipids on sedentary time, light physical activity and MVPA with inflammation in youth. J Clin Endocrinol Metab. 2023;108(12):3250-3259. DOI: 10.1210/clinem/dgad354
  8. Agbaje, AO., et al. (20..): Effects of sedentary time and accelerometer-based physical activity on fat mass measured by DEXA in 6059 children. Nat Commun.2023;14(1):8232. DOI: 10.1038/s41467-023-43316-w
  9. Agbaje, AO. (2023): Associations of sedentary time and physical activity since childhood with lipids: a 13-year mediation and temporal study. J Clin Endocrinol Metab. DOI: 10.1210/clinem/dgad688
  10. EurekAlert!, Press Release, April 9, 2024
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