TOPLINE

Children with obesity who displayed more dynamic physical activity (PA) patterns — characterized by frequent activity transitions and lower sedentary time — had lower body fat percentage and better insulin sensitivity compared to peers with more sedentary patterns.

METHODOLOGY

• Researchers conducted a cross-sectional analysis of 91 children and adolescents with obesity (43% girls; mean age, 11.2 years) enrolled in the PODiaCar project in Milan, Italy.
• Participants wore thigh-mounted accelerometers for 7 days to capture PA patterns, and data were analyzed using discriminative dimensionality reduction via learning a tree to identify distinct multidimensional behavioral phenotypes.
• Three phenotypes were identified: Sedentary Pattern (noted in 24% of children), Light Activity Pattern (noted in 55%), and Higher Activity Pattern (noted in 21%), based on activity volume, intensity distribution, accumulation of sedentary time, temporal fragmentation, and transitions between activities.
• Children in the Higher Activity Pattern had less sedentary time and more time spent in moderate-to-vigorous physical activity and light and moderate activity than children in the Sedentary Pattern. Only 3 participants met WHO-recommended moderate-to-vigorous physical activity levels.
• Outcome measures included body composition (fat mass percentage, fat-free mass percentage), metabolic markers (fasting glucose, insulin, Single Point Insulin Sensitivity Estimator [SPISE], triglyceride-glucose index), and cardiometabolic risk.

TAKEAWAY

• Children in the Higher Activity Pattern had significantly lower fat mass percentage (38.8%) and higher fat-free mass percentage (61.2%) compared to those in the Light and Sedentary Patterns (P < .05 for both).
• SPISE, a marker of insulin sensitivity, was significantly higher in the Higher Activity Pattern vs the Sedentary Pattern (mean difference, 0.90; P = .016).
• Metabolic risk z-score was significantly lower in the Higher Activity Pattern compared to the Sedentary Pattern (mean difference, -0.42; P = .017).
• No significant differences were found among phenotypes for fasting glucose, insulin, homeostatic model assessment for insulin resistance, blood pressure, or lipid levels.

IN PRACTICE

"These findings support a shift toward a more nuanced conceptualization of PA behavior that integrates sedentary patterns, movement dynamics, and intensity distribution, and they highlight the potential value of phenotype-based approaches for risk stratification and intervention development in pediatric obesity," the authors of the study wrote.

SOURCE

The study was led by Alessandro Gatti, Laboratory of Adapted Motor Activity, Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, Italy. It was published online on August 6 in European Journal of Pediatrics.

LIMITATIONS

The cross-sectional design precludes causal inference. Biological maturation status was not assessed, which could influence PA patterns and metabolic outcomes; hence residual confounding could not be excluded. Body composition was estimated using validated equations and direct measures were not used.

DISCLOSURES

Open access funding was provided by Università degli Studi di Pavia within the CRUI-CARE Agreement. The study was performed in context with PODiaCar Project co-funded by the European Union. The authors reported no relevant competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.