Cardiometabolic risk through an integrative classification combining physical activity and sedentary behavior in European adolescents:HELENA study
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摘要
Purpose: This study aims to compare adolescents' cardiometabolic risk score through an integrative classification of physical activity(PA),which involves the combination of moderate-to-vigorous physical activity(MVPA) and sedentary behavior(SB).Methods: A cross-sectional study derived from the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study database(2006-2008) was conducted in adolescents(n = 548; boys, 47.3%; 14.7 ± 1.2 years) from 10 European cities. MVPA and SB were objectively measured using accelerometry. Adolescents were divided into 4 categories according to MVPA(meeting or not meeting the international recommendations) and the median of SB time(above or below sex-and age-specific median) as follows: High-SB & Inactive, Low-SB & Inactive,High-SB & Active, and Low-SB & Active. A clustered cardiometabolic risk score was computed using the homeostatic model assessment, systolic blood pressure, triglycerides, total cholesterol/high-density lipoprotein cholesterol, sum 4 skinfolds, and cardiorespiratory fitness(CRF).Analyses of covariance were performed to discern differences on cardiometabolic risk scores among PA categories and each health component.Results: The cardiometabolic risk score was lower in adolescents meeting the MVPA recommendation and with less time spent in SB in comparison to the high-SB & Inactive group(p < 0.05). However, no difference in cardiometabolic risk score was established between High-SB or Low-SB groups in inactive adolescents. It is important to note that CRF was the only variable that showed a significant modification(higher)when children were compared from the category of physically inactive with "active" but not from high-to low-SB.Conclusion: Being physically active is the most significant and protective outcome in adolescents to reduce cardiometabolic risk. Lower SB does not exhibit a significant and extra beneficial difference.
Purpose: This study aims to compare adolescents' cardiometabolic risk score through an integrative classification of physical activity(PA),which involves the combination of moderate-to-vigorous physical activity(MVPA) and sedentary behavior(SB).Methods: A cross-sectional study derived from the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study database(2006-2008) was conducted in adolescents(n = 548; boys, 47.3%; 14.7 ± 1.2 years) from 10 European cities. MVPA and SB were objectively measured using accelerometry. Adolescents were divided into 4 categories according to MVPA(meeting or not meeting the international recommendations) and the median of SB time(above or below sex-and age-specific median) as follows: High-SB & Inactive, Low-SB & Inactive,High-SB & Active, and Low-SB & Active. A clustered cardiometabolic risk score was computed using the homeostatic model assessment, systolic blood pressure, triglycerides, total cholesterol/high-density lipoprotein cholesterol, sum 4 skinfolds, and cardiorespiratory fitness(CRF).Analyses of covariance were performed to discern differences on cardiometabolic risk scores among PA categories and each health component.Results: The cardiometabolic risk score was lower in adolescents meeting the MVPA recommendation and with less time spent in SB in comparison to the high-SB & Inactive group(p < 0.05). However, no difference in cardiometabolic risk score was established between High-SB or Low-SB groups in inactive adolescents. It is important to note that CRF was the only variable that showed a significant modification(higher)when children were compared from the category of physically inactive with "active" but not from high-to low-SB.Conclusion: Being physically active is the most significant and protective outcome in adolescents to reduce cardiometabolic risk. Lower SB does not exhibit a significant and extra beneficial difference.
Purpose: This study aims to compare adolescents' cardiometabolic risk score through an integrative classification of physical activity(PA),which involves the combination of moderate-to-vigorous physical activity(MVPA) and sedentary behavior(SB).Methods: A cross-sectional study derived from the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study database(2006-2008) was conducted in adolescents(n = 548; boys, 47.3%; 14.7 ± 1.2 years) from 10 European cities. MVPA and SB were objectively measured using accelerometry. Adolescents were divided into 4 categories according to MVPA(meeting or not meeting the international recommendations) and the median of SB time(above or below sex-and age-specific median) as follows: High-SB & Inactive, Low-SB & Inactive,High-SB & Active, and Low-SB & Active. A clustered cardiometabolic risk score was computed using the homeostatic model assessment, systolic blood pressure, triglycerides, total cholesterol/high-density lipoprotein cholesterol, sum 4 skinfolds, and cardiorespiratory fitness(CRF).Analyses of covariance were performed to discern differences on cardiometabolic risk scores among PA categories and each health component.Results: The cardiometabolic risk score was lower in adolescents meeting the MVPA recommendation and with less time spent in SB in comparison to the high-SB & Inactive group(p < 0.05). However, no difference in cardiometabolic risk score was established between High-SB or Low-SB groups in inactive adolescents. It is important to note that CRF was the only variable that showed a significant modification(higher)when children were compared from the category of physically inactive with "active" but not from high-to low-SB.Conclusion: Being physically active is the most significant and protective outcome in adolescents to reduce cardiometabolic risk. Lower SB does not exhibit a significant and extra beneficial difference.
引文
1. Moliner-Urdiales D, Ruiz JR, Ortega FB, Rey-Lopez JP, Vicente-Rodriguez G, Espana-Romero V, et al. Association of objectively assessed physical activity with total and central body fat in Spanish adolescents;the HELENA Study. Int J Obes(Lond)2009;33:1126-35.
2. Jimenez-Pavon D, Fernandez-Vazquez A, Alexy U, Pedrero R, CuencaGarcia M, Polito A, et al. Association of objectively measured physical activity with body components in European adolescents. BMC Public Health 2013;13:667. doi:10.1186/1471-2458-13-667.
3. Ruiz JR, Huybrechts I, Cuenca-Garcia M, Artero EG, Labayen I, Meirhaeghe A, et al. Cardiorespiratory fitness and ideal cardiovascular health in European adolescents.Heart 2015;101:766-73.
4. Santos R, Mota J, Okely AD, Pratt M, Moreira C, Coelho-E-Silva MJ,et al. The independent associations of sedentary behaviour and physical activity on cardiorespiratory fitness. Br J Sports Med 2014;48:1508-12.
5. Armstrong N. Young people are fit and active-fact or fiction? J Sport Heal Sci 2012;1:131-40.
6. Jimenez-Pavon D, Ruiz JR, Ortega FB, Martinez-Gomez D, Moreno S,Urzanqui A, et al. Physical activity and markers of insulin resistance in adolescents:role of cardiorespiratory fitness levels-the HELENA study.Pediatr Diabetes 2013;14:249-58.
7. Herman KM, Chaput JP, Sabiston CM, Mathieu ME, Tremblay A, Paradis G. Combined physical activity/sedentary behavior associations with indices of adiposity in 8-to 10-year-old children. J Phys Act Heal2015;12:20-9.
8. Marques A, Santos R, Ekelund U, Sardinha LB. Association between physical activity, sedentary time, and healthy fitness in youth. Med Sci Sports Exerc 2015;47:575-80.
9. Rendo-Urteaga T, de Moraes ACF, Collese TS, Manios Y, Hagstromer M,Sjostrom M, et al. The combined effect of physical activity and sedentary behaviors on a clustered cardio-metabolic risk score:the Helena study. Int J Cardiol 2015;186:186-95.
10. Tarp J, Brond JC, Andersen LB, Moller NC, Froberg K, Grontved A.Physical activity, sedentary behavior, and long-term cardiovascular risk in young people:a review and discussion of methodology in prospective studies. J Sport Health Sci 2016;5:145-50.
11. Ruiz JR, Ortega FB, Martinez-Gomez D, Labayen I, Moreno LA, De Bourdeaudhuij I, et al. Objectively measured physical activity and sedentary time in European adolescents:the HELENA study. Am J Epidemiol2011;174:173-84.
12. Tremblay MS, Aubert S, Barnes JD, Saunders TJ, Carson V, LatimerCheung AE, et al. Sedentary Behavior Research Network(SBRN)-Terminology Consensus Project process and outcome. Int J Behav Nutr Phys Act 2017;14:75. doi:10.1186/s12966-017-0525-8.
13. Saunders TJ, Chaput JP, Tremblay MS. Sedentary behaviour as an emerging risk factor for cardiometabolic diseases in children and youth. Can J Diabetes 2014;38:53-61.
14. Pedersen BK, Saltin B. Exercise as medicine-evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sport2015;25:1-72.
15. Tremblay MS, Carson V, Chaput JP, Connor Gorber S, Dinh T, Duggan M, et al. Canadian 24-hour movement guidelines for children and youth:an integration of physical activity, sedentary behaviour, and sleep. Appl Physiol Nutr Metab 2016;41(Suppl. 3):S311-27.
16. Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol 2012;2:1143-211.
17. Koster A, Caserotti P, Patel KV, Matthews CE, Berrigan D, van Domelen DR, et al. Association of sedentary time with mortality independent of moderate to vigorous physical activity. PLoS One 2012;7:e37696.doi:10.1371/journal.pone.0037696.
18. Bakrania K, Edwardson CL, Bodicoat DH, Esliger DW, Gill JMR, Kazi A,et al. Associations of mutually exclusive categories of physical activityand sedentary time with markers of cardiometabolic health in English adults:a cross-sectional analysis of the Health Survey for England. BMC Public Health 2016;16:25. doi:10.1186/s12889-016-2694-9.
19. Loprinzi PD, Cardinal BJ, Lee H, Tudor-Locke C. Markers of adiposity among children and adolescents:implications of the isotemporal substitution paradigm with sedentary behavior and physical activity patterns. J Diabetes Metab Disord 2015;14:46. doi:10.1186/s40200-015-0175-9.
20. Spittaels H, Van Cauwenberghe E, Verbestel V, De Meester F, Van Dyck D, Verloigne M, et al. Objectively measured sedentary time and physical activity time across the lifespan:a cross-sectional study in four age groups.Int J Behav Nutr Phys Act 2012;9:149. doi:10.1186/1479-5868-9-149.
21. Cristi-Montero C. An integrative methodology for classifying physical activity level in apparently healthy populations for use in public health.Rev Panam Salud Publica 2017;41:e 161. doi:10.26633/RPSP.2017.161.
22. Roman-Vinas B, Chaput JP, Katzmarzyk PT, Fogelholm M, Lambert EV, Maher C, et al. Proportion of children meeting recommendations for 24-hour movement guidelines and associations with adiposity in a12-country study. Int J Behav Nutr Phys Act 2016;13:123. doi:10.1186/s12966-016-0449-8.
23. Martinez-Gomez D, Ortega FB, Ruiz JR, Vicente-Rodriguez G, Veiga OL,Widhalm K, et al. Excessive sedentary time and low cardiorespiratory fitness in European adolescents:the HELENA study. Arch Dis Child2011;96:240-6.
24. Andersen LB, Harro M, Sardinha LB, Froberg K, Ekelund U, Brage S,et al. Physical activity and clustered cardiovascular risk in children:a cross-sectional study(The European Youth Heart Study). The Lancet2006;368:299-304.
25. Azevedo LB, Ling J, Soos I, Robalino S, Ells L. The effectiveness of sedentary behaviour interventions for reducing body mass index in children and adolescents:systematic review and meta-analysis. Obes Rev2016;17:623-35.
26. World Health Organization(WHO). Global recommendations on physical activity for health. Geneva:WHO; 2010. p. 60. doi:10.1080/11026480410034349.
27. Riner WF, Sellhorst SH. Physical activity and exercise in children with chronic health conditions.J Sport Health Sci 2013;2:12-20.
28. Vicente-Rodriguez G, Libersa C, Mesana MI, Beghin L, Iliescu C, Moreno Aznar LA, et al. Healthy lifestyle by nutrition in adolescence(HELENA). A new EU funded project. Therapie 2007;62:259-70.
29. Moreno LA, De Henauw S, Gonzalez-Gross M, Kersting M, Molnar D,Gottrand F, et al. Design and implementation of the healthy lifestyle in Europe by nutrition in adolescence cross-sectional study. Int J Obes2008;32(Suppl. 5):S4-11.
30. Nagy E, Vicente-Rodriguez G, Manios Y, Beghin L, Iliescu C, Censi L,et al. Harmonization process and reliability assessment of anthropometric measurements in a multicenter study in adolescents. Int J Obes(Lond)2008;32(Suppl. 5):S58-65.
31. Gonzalez-Gross M, Breidenassel C, Gomez-Martinez S, Ferrari M,Beghin L, Spinneker A, et al. Sampling and processing of fresh blood samples within a European multicenter nutritional study:evaluation of biomarker stability during transport and storage. Int J Obes(Lond)2008;32(Suppl. 5):S66-75.
32. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment:insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412-9.
33. Ortega FB, Artero EG, Ruiz JR, Vicente Rodriguez G, Bergman P,Hagstromer M, et al. Reliability of health-related physical fitness tests in European adolescents. The HELENA Study. Int J Obes(Lond)2008;32:49-57.
34. Leger LA, Mercier D, Gadoury C, Lambert J. The multistage 20 metre shuttle run test for aerobic fitness. J Sports Sci 1988;6:93-101.
35. Andersen LB, Lauersen JB, Brnd JC,Anderssen SA,Sardinha LB,Steene-Johannessen J, et al. A new approach to define and diagnose cardiometabolic disorder in children. J Diabetes Res 2015;2015:539835.doi:10.1155/2015/539835.
36. Freedson P, Pober D, Janz KF. Calibration of accelerometer output for children. Med Sci Sports Exerc 2005;37(Suppl. 11):S523-30.
37. Ward DS, Evenson KR, Vaughn A, Rodgers AB, Troiano RP. Accelerometer use in physical activity:best practices and research recommendations.Med Sci Sport Exerc 2005;37(Suppl. 11):S582-8.
38. Carson V, Hunter S, Kuzik N, Gray CE, Poitras VJ, Chaput JP, et al. Systematic review of sedentary behaviour and health indicators in schoolaged children and youth:an update. Appl Physiol Nutr Metab 2016;41(Suppl. 3):S240-65.
39. Ekelund U, Luan J, Sherar LB, Esliger DW, Griew P, Cooper A, et al.Moderate to vigorous physical activity and sedentary time and cardiometabolic risk factors in children and adolescents. JAMA 2012;307:704-12.
40. Ferrari GL, Oliveira LC, Araujo TL, Matsudo V, Barreira TV, TudorLocke C,et al. Moderate-to-vigorous physical activity and sedentary behavior:Independent associations with body composition variables in Brazilian children. Pediatr Exerc Sci 2015;27:380-9.
41. Peterson MD, Al Snih S, Stoddard J, McClain J, Lee IM. Adiposity and insufficient MVPA predict cardiometabolic abnormalities in adults. Med Sci Sports Exerc 2014;46:1133-9.
42. Cliff DP, Hesketh KD, Vella SA, Hinkley T, Tsiros MD, Ridgers ND,et al. Objectively measured sedentary behaviour and health and development in children and adolescents:systematic review and meta-analysis.Obes Rev 2016;17:330-44.
43. Boddy LM, Murphy MH, Cunningham C, Breslin G, Foweather L, Gobbi R, et al. Physical activity, cardiorespiratory fitness, and clustered cardiometabolic risk in 10-to 12-year-old school children:the REACH Y6study. Am J Hum Biol 2014;26:446-51.
44. Garcia-Hermoso A, Cerrillo-Urbina AJ, Herrera-Valenzuela T, CristiMontero C, Saavedra JM, Martinez-Vizcaino V. Is high-intensity interval training more effective on improving cardiometabolic risk and aerobic capacity than other forms of exercise in overweight and obese youth? A meta-analysis. Obes Rev 2016; 17:531-40.
45. Rey-Lopez JP, Bel-Serrat S, Santaliestra-Pasias A, de Moraes AC, Vicente-Rodriguez G, Ruiz JR, et al. Sedentary behaviour and clustered metabolic risk in adolescents:the HELENA study. Nutr Metab Cardiovasc Dis2013;23:1017-24.
46. Kulinski JP, Khera A, Ayers CR, Das SR, de Lemos JA, Blair SN, et al.Association between cardiorespiratory fitness and accelerometer-derived physical activity and sedentary time in the general population. Mayo Clin Proc 2014;89:1063-71.
47. Collings PJ, Westgate K, Vaisto J, Wijndaele K, Atkin AJ, Haapala EA,et al. Cross-sectional associations of objectively-measured physical activity and sedentary time with body composition and cardiorespiratory fitness in mid-childhood:the PANIC study. Sport Med 2017;47:769-80.
48. Hawley JA, Hargreaves M, Joyner MJ, Zierath JR. Integrative biology of exercise. Cell 2014;159:738-49.
49. Ekelund U, Steene-Johannessen J, Brown WJ, Fagerland MW, Owen N,Powell KE, et al. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. The Lancet 2016;388:1302-10.
50. Garcia-Hermoso A, Saavedra JM, Ramirez-Velez R, Ekelund U, Del Pozo-Cruz B. Reallocating sedentary time to moderate-to-vigorous physical activity but not to light-intensity physical activity is effective to reduce adiposity among youths:a systematic review and meta-analysis. Obes Rev2017;18:1088-95.
51. Setia M. Methodology series module 3:cross-sectional studies. Indian J Dermatol 2016;61:261-4.
2. Jimenez-Pavon D, Fernandez-Vazquez A, Alexy U, Pedrero R, CuencaGarcia M, Polito A, et al. Association of objectively measured physical activity with body components in European adolescents. BMC Public Health 2013;13:667. doi:10.1186/1471-2458-13-667.
3. Ruiz JR, Huybrechts I, Cuenca-Garcia M, Artero EG, Labayen I, Meirhaeghe A, et al. Cardiorespiratory fitness and ideal cardiovascular health in European adolescents.Heart 2015;101:766-73.
4. Santos R, Mota J, Okely AD, Pratt M, Moreira C, Coelho-E-Silva MJ,et al. The independent associations of sedentary behaviour and physical activity on cardiorespiratory fitness. Br J Sports Med 2014;48:1508-12.
5. Armstrong N. Young people are fit and active-fact or fiction? J Sport Heal Sci 2012;1:131-40.
6. Jimenez-Pavon D, Ruiz JR, Ortega FB, Martinez-Gomez D, Moreno S,Urzanqui A, et al. Physical activity and markers of insulin resistance in adolescents:role of cardiorespiratory fitness levels-the HELENA study.Pediatr Diabetes 2013;14:249-58.
7. Herman KM, Chaput JP, Sabiston CM, Mathieu ME, Tremblay A, Paradis G. Combined physical activity/sedentary behavior associations with indices of adiposity in 8-to 10-year-old children. J Phys Act Heal2015;12:20-9.
8. Marques A, Santos R, Ekelund U, Sardinha LB. Association between physical activity, sedentary time, and healthy fitness in youth. Med Sci Sports Exerc 2015;47:575-80.
9. Rendo-Urteaga T, de Moraes ACF, Collese TS, Manios Y, Hagstromer M,Sjostrom M, et al. The combined effect of physical activity and sedentary behaviors on a clustered cardio-metabolic risk score:the Helena study. Int J Cardiol 2015;186:186-95.
10. Tarp J, Brond JC, Andersen LB, Moller NC, Froberg K, Grontved A.Physical activity, sedentary behavior, and long-term cardiovascular risk in young people:a review and discussion of methodology in prospective studies. J Sport Health Sci 2016;5:145-50.
11. Ruiz JR, Ortega FB, Martinez-Gomez D, Labayen I, Moreno LA, De Bourdeaudhuij I, et al. Objectively measured physical activity and sedentary time in European adolescents:the HELENA study. Am J Epidemiol2011;174:173-84.
12. Tremblay MS, Aubert S, Barnes JD, Saunders TJ, Carson V, LatimerCheung AE, et al. Sedentary Behavior Research Network(SBRN)-Terminology Consensus Project process and outcome. Int J Behav Nutr Phys Act 2017;14:75. doi:10.1186/s12966-017-0525-8.
13. Saunders TJ, Chaput JP, Tremblay MS. Sedentary behaviour as an emerging risk factor for cardiometabolic diseases in children and youth. Can J Diabetes 2014;38:53-61.
14. Pedersen BK, Saltin B. Exercise as medicine-evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sport2015;25:1-72.
15. Tremblay MS, Carson V, Chaput JP, Connor Gorber S, Dinh T, Duggan M, et al. Canadian 24-hour movement guidelines for children and youth:an integration of physical activity, sedentary behaviour, and sleep. Appl Physiol Nutr Metab 2016;41(Suppl. 3):S311-27.
16. Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol 2012;2:1143-211.
17. Koster A, Caserotti P, Patel KV, Matthews CE, Berrigan D, van Domelen DR, et al. Association of sedentary time with mortality independent of moderate to vigorous physical activity. PLoS One 2012;7:e37696.doi:10.1371/journal.pone.0037696.
18. Bakrania K, Edwardson CL, Bodicoat DH, Esliger DW, Gill JMR, Kazi A,et al. Associations of mutually exclusive categories of physical activityand sedentary time with markers of cardiometabolic health in English adults:a cross-sectional analysis of the Health Survey for England. BMC Public Health 2016;16:25. doi:10.1186/s12889-016-2694-9.
19. Loprinzi PD, Cardinal BJ, Lee H, Tudor-Locke C. Markers of adiposity among children and adolescents:implications of the isotemporal substitution paradigm with sedentary behavior and physical activity patterns. J Diabetes Metab Disord 2015;14:46. doi:10.1186/s40200-015-0175-9.
20. Spittaels H, Van Cauwenberghe E, Verbestel V, De Meester F, Van Dyck D, Verloigne M, et al. Objectively measured sedentary time and physical activity time across the lifespan:a cross-sectional study in four age groups.Int J Behav Nutr Phys Act 2012;9:149. doi:10.1186/1479-5868-9-149.
21. Cristi-Montero C. An integrative methodology for classifying physical activity level in apparently healthy populations for use in public health.Rev Panam Salud Publica 2017;41:e 161. doi:10.26633/RPSP.2017.161.
22. Roman-Vinas B, Chaput JP, Katzmarzyk PT, Fogelholm M, Lambert EV, Maher C, et al. Proportion of children meeting recommendations for 24-hour movement guidelines and associations with adiposity in a12-country study. Int J Behav Nutr Phys Act 2016;13:123. doi:10.1186/s12966-016-0449-8.
23. Martinez-Gomez D, Ortega FB, Ruiz JR, Vicente-Rodriguez G, Veiga OL,Widhalm K, et al. Excessive sedentary time and low cardiorespiratory fitness in European adolescents:the HELENA study. Arch Dis Child2011;96:240-6.
24. Andersen LB, Harro M, Sardinha LB, Froberg K, Ekelund U, Brage S,et al. Physical activity and clustered cardiovascular risk in children:a cross-sectional study(The European Youth Heart Study). The Lancet2006;368:299-304.
25. Azevedo LB, Ling J, Soos I, Robalino S, Ells L. The effectiveness of sedentary behaviour interventions for reducing body mass index in children and adolescents:systematic review and meta-analysis. Obes Rev2016;17:623-35.
26. World Health Organization(WHO). Global recommendations on physical activity for health. Geneva:WHO; 2010. p. 60. doi:10.1080/11026480410034349.
27. Riner WF, Sellhorst SH. Physical activity and exercise in children with chronic health conditions.J Sport Health Sci 2013;2:12-20.
28. Vicente-Rodriguez G, Libersa C, Mesana MI, Beghin L, Iliescu C, Moreno Aznar LA, et al. Healthy lifestyle by nutrition in adolescence(HELENA). A new EU funded project. Therapie 2007;62:259-70.
29. Moreno LA, De Henauw S, Gonzalez-Gross M, Kersting M, Molnar D,Gottrand F, et al. Design and implementation of the healthy lifestyle in Europe by nutrition in adolescence cross-sectional study. Int J Obes2008;32(Suppl. 5):S4-11.
30. Nagy E, Vicente-Rodriguez G, Manios Y, Beghin L, Iliescu C, Censi L,et al. Harmonization process and reliability assessment of anthropometric measurements in a multicenter study in adolescents. Int J Obes(Lond)2008;32(Suppl. 5):S58-65.
31. Gonzalez-Gross M, Breidenassel C, Gomez-Martinez S, Ferrari M,Beghin L, Spinneker A, et al. Sampling and processing of fresh blood samples within a European multicenter nutritional study:evaluation of biomarker stability during transport and storage. Int J Obes(Lond)2008;32(Suppl. 5):S66-75.
32. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment:insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412-9.
33. Ortega FB, Artero EG, Ruiz JR, Vicente Rodriguez G, Bergman P,Hagstromer M, et al. Reliability of health-related physical fitness tests in European adolescents. The HELENA Study. Int J Obes(Lond)2008;32:49-57.
34. Leger LA, Mercier D, Gadoury C, Lambert J. The multistage 20 metre shuttle run test for aerobic fitness. J Sports Sci 1988;6:93-101.
35. Andersen LB, Lauersen JB, Brnd JC,Anderssen SA,Sardinha LB,Steene-Johannessen J, et al. A new approach to define and diagnose cardiometabolic disorder in children. J Diabetes Res 2015;2015:539835.doi:10.1155/2015/539835.
36. Freedson P, Pober D, Janz KF. Calibration of accelerometer output for children. Med Sci Sports Exerc 2005;37(Suppl. 11):S523-30.
37. Ward DS, Evenson KR, Vaughn A, Rodgers AB, Troiano RP. Accelerometer use in physical activity:best practices and research recommendations.Med Sci Sport Exerc 2005;37(Suppl. 11):S582-8.
38. Carson V, Hunter S, Kuzik N, Gray CE, Poitras VJ, Chaput JP, et al. Systematic review of sedentary behaviour and health indicators in schoolaged children and youth:an update. Appl Physiol Nutr Metab 2016;41(Suppl. 3):S240-65.
39. Ekelund U, Luan J, Sherar LB, Esliger DW, Griew P, Cooper A, et al.Moderate to vigorous physical activity and sedentary time and cardiometabolic risk factors in children and adolescents. JAMA 2012;307:704-12.
40. Ferrari GL, Oliveira LC, Araujo TL, Matsudo V, Barreira TV, TudorLocke C,et al. Moderate-to-vigorous physical activity and sedentary behavior:Independent associations with body composition variables in Brazilian children. Pediatr Exerc Sci 2015;27:380-9.
41. Peterson MD, Al Snih S, Stoddard J, McClain J, Lee IM. Adiposity and insufficient MVPA predict cardiometabolic abnormalities in adults. Med Sci Sports Exerc 2014;46:1133-9.
42. Cliff DP, Hesketh KD, Vella SA, Hinkley T, Tsiros MD, Ridgers ND,et al. Objectively measured sedentary behaviour and health and development in children and adolescents:systematic review and meta-analysis.Obes Rev 2016;17:330-44.
43. Boddy LM, Murphy MH, Cunningham C, Breslin G, Foweather L, Gobbi R, et al. Physical activity, cardiorespiratory fitness, and clustered cardiometabolic risk in 10-to 12-year-old school children:the REACH Y6study. Am J Hum Biol 2014;26:446-51.
44. Garcia-Hermoso A, Cerrillo-Urbina AJ, Herrera-Valenzuela T, CristiMontero C, Saavedra JM, Martinez-Vizcaino V. Is high-intensity interval training more effective on improving cardiometabolic risk and aerobic capacity than other forms of exercise in overweight and obese youth? A meta-analysis. Obes Rev 2016; 17:531-40.
45. Rey-Lopez JP, Bel-Serrat S, Santaliestra-Pasias A, de Moraes AC, Vicente-Rodriguez G, Ruiz JR, et al. Sedentary behaviour and clustered metabolic risk in adolescents:the HELENA study. Nutr Metab Cardiovasc Dis2013;23:1017-24.
46. Kulinski JP, Khera A, Ayers CR, Das SR, de Lemos JA, Blair SN, et al.Association between cardiorespiratory fitness and accelerometer-derived physical activity and sedentary time in the general population. Mayo Clin Proc 2014;89:1063-71.
47. Collings PJ, Westgate K, Vaisto J, Wijndaele K, Atkin AJ, Haapala EA,et al. Cross-sectional associations of objectively-measured physical activity and sedentary time with body composition and cardiorespiratory fitness in mid-childhood:the PANIC study. Sport Med 2017;47:769-80.
48. Hawley JA, Hargreaves M, Joyner MJ, Zierath JR. Integrative biology of exercise. Cell 2014;159:738-49.
49. Ekelund U, Steene-Johannessen J, Brown WJ, Fagerland MW, Owen N,Powell KE, et al. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. The Lancet 2016;388:1302-10.
50. Garcia-Hermoso A, Saavedra JM, Ramirez-Velez R, Ekelund U, Del Pozo-Cruz B. Reallocating sedentary time to moderate-to-vigorous physical activity but not to light-intensity physical activity is effective to reduce adiposity among youths:a systematic review and meta-analysis. Obes Rev2017;18:1088-95.
51. Setia M. Methodology series module 3:cross-sectional studies. Indian J Dermatol 2016;61:261-4.