fit or fat? adiposity, physical activity, insulin...
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Fit or fat? Adiposity, physical activity, insulin resistance and blood pressure in
children
George P. Nassis, MSc, PhD
Department of Sports Medicine and Biology of ExerciseFaculty of Physical Education and Sports ScienceNational and Kapodistrian University of Athens
Greece
Fitness versus fatness
•Prevalence of childhood obesity is increasing over the last years•Excess adiposity is associated, among others, with insulin resistance, vascular and CNS dysfunction, elevated blood pressure etc•Fitness and in particular of aerobic type may counteract some of these effects of obesity on health
Association between inactivity and adiposity
Maffeis et al. J Pediatr 1997;131:288-92
Association between physical activity, fitness and adiposity
Rowland et al. J Appl Physiol 1999;86:1428-35
The role of aerobic fitness
Nassis et al (2005) Eur J Clin Nutr 59:137-141
0
10
20
30
40
50
60
70
80
Non-overweight Overweight/obese
Su
m o
f tr
un
k s
kin
fold
s
(mm
)
UNFIT
FIT
b
#
#
Nassis et al (2005) Eur J Clin Nutr 59:137-141
The role of aerobic fitness
The role of aerobic fitness
Lee & Arslanian (2007) Eur J Clin Nutr 61:561-565
Conclusion
It seems, therefore, that aerobic (cardiorespiratory) fitness has an independent role on risk factors in overweight and obese children and
adolescents
0 30 60 90 1200
2
4
6
8
10
Time (min)
Pla
sma
glu
cose
(m
mo
l/l)
Pre
Post
Nassis et al. (2005) Metabolism 54:1472-9 Metabolism 54: 1472-9
Plasma glucose responses during the 2-hour OGTT before andafter 12 weeks of aerobic training in overweight and obese girls.Mean±SE
0 30 60 90 1200
20
40
60
80
100
120
140
160
**
Time (min)
Ser
um
in
suli
n (
U/m
l)
Pre
Post
Serum insulin responses during the 2-hour OGTT before and after12 weeks of aerobic training in overweight and obese girls . Mean±SE,**P< 0.01 vs post-intervention
Nassis et al. (2005) Metabolism 54:1472-9 Metabolism 54: 1472-9
Conclusion
It appears that an increase in cardiorespiratory fitness may improve insulin sensitivity without changes in
body weight and adiposity in overweight and obese children
The Fitness vs Fatness debate
Larson-Meyer et al. (2010) Med Sci Sports Exerc 42:152-159
Effect of diet and physical training on body composition
Larson-Meyer et al (2010) Med Sci Sports Exerc 42:152-159
Effect of physical training on risk factors
Larson-Meyer et al. (2010) Med Sci Sports Exerc 42:152-159
FFM and insulin resistance
-1.0 -0.5 0.0 0.5 1.0 1.5 2.0 2.5
-14000
-12000
-10000
-8000
-6000
-4000
-2000
0
2000
4000
6000
8000
10000
r= -0.68, p< 0.001
Ch
an
ge
in i
nsu
lin
AU
C
(Post
-Pre
,
U.m
in/m
l)
Change in lower limbs FFM (Post-Pre, kg)
Nassis et al. (2005) Metabolism 54:1472-9 Metabolism 54: 1472-9
Heitmann et al (2009) BMJ 339:b3292
Muscle mass and risk factors
Heitmann et al (2009) BMJ 339:b3292
Is there a threshold for muscle mass to observe beneficial effects on health?
Muscle mass and risk factors
Is there a threshold for cardiorespiratory fitness to observe beneficial effects on health?
It seems that there is a critical weight loss to observe significant improvements
in insulin resistance in obesity
-20
-18
-16
-14
-12
-10
-8
-6
-4
-2
0
Bo
dy w
eig
ht
ch
an
ge
fro
m b
aselin
e
(%)
D S *
Period
3 months 6 months
Florakis et al (2009) Int J Obes 32:692-9
It seems that there is a critical weight loss to observe significant improvements
in insulin resistance in obesity
Florakis et al (2009) Int J Obes 32:692-9
600
700
800
900
1000
Baseline 3 months 6 months
Glu
co
se A
UC
(m
mo
l x m
in/L
)
D S
a
How much improvement in cardiorespiratory (CR) fitness is enough for insulin sensitivity increase?
0 10 20 30 40 50 60 70
Larson-
Meyer et al,
2010
Nassis et al,
2005
Ribeiro et
al, 2005
Bell et al,
2007
van der
Heijden et
al, 2009% improvement in insulin
sensitivity
% Increase in CR fitness
How much improvement in cardiorespiratory (CR) fitness is enough for resting blood pressure
reduction?
0 20 40 60 80
Larson-Meyer et
al, 2010
Farpour-
Lambert et al,
2009
Gutin et al, 2000
Bell et al, 2007
Kriemler et al,
2010
% reduction in Systolic
BP
% Increase in CR Fitness
Effect of cardiorespiratoyr fitness and obesity on risk factors (insulin resistance, blood pressure)
Total body and
central adiposity
Cardiorespiratory
fitness
FFA, leptin,
Other factorsCNS function Insulin resistance
Vascular
function
Elevation in resting
blood pressure
Excess increase in blood pressure
during sympathetic activation
• ?
Physical activity or fitness?
Which is the most important?
Conclusions
•Exercise at moderate to vigorous intensity, that increases aerobic fitness, should be the target in pediatric population
Conclusions
•In addition, the promotion of a physically active lifestyle in overweight youth is important in reducing the risk of subsequent disease in the absence of weight loss
Study group
•Professor LS Sidossis, Harokopio University•Professor N Geladas, Athens University•Professor G Chroussos, Athens University•Ass Prof S Kavouras, Harokopio University•Ass Prof M Yannakoulia, Harokopio University•K Papadakou, MSc, Harokopio University•K Skenderi, PhD, Harokopio University•M Krekoukia, MSc, Harokopio University•G Psarra, PhD, Harokopio University•C Legantis, MSc, Athens University
Conclusions
•Elevated physical activity and cardiovascular fitness are associated with reduced adiposity in youth
•An increase in aerobic fitness is associated with improved insulin sensitivity in obese children. This effect might be without changes in total and central adiposity
Individual responses
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
-60 -40 -20 0 20 40
AA
% αλλαγή ζηο εμβαδόν ηης περιοτής κάηω από ηην καμπύλη ηης ινζοσλίνης•% change in insulin AUC
Nassis et al. (2005) Metabolism 54:1472-9 Metabolism 54: 1472-9
•Kriemer??
Physical activity or fitness?
Which is the most important?
Rowland et al. J Appl Physiol 1999;86:1428-35
Evidence
•Cross-sectional studies•Intervention studies
Physical activity or fitness?
Which is the most important?
Kriemler et al. BMJ 2010 340:c785
Questions
•Is reduction in fatness necessary in light of adequate fitness (aerobic)?•Does improvement in fitness or fatness independently change risk factors for CVD and metabolic syndrome?•Is the intensity of physical activity important?•Is physical activity more important than fitness?
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