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Background: Physical fitness in childhood and adolescence is associated with a variety of health outcomes and is a powerful marker of current and future health. However, inconsistencies in tests and protocols limit international monitoring and surveillance. The objective of the study was to seek international consensus on a proposed, evidence-informed, Youth Fitness International Test (YFIT) battery and protocols for health monitoring and surveillance in children and adolescents aged 6-18 years., Methods: We conducted an international modified Delphi study to evaluate the level of agreement with a proposed, evidence-based, international fitness battery (YFIT) of core health-related fitness tests and protocols to be used worldwide in 6- to 18-year-olds. This proposal was based on previous European and North American projects that systematically reviewed the existing evidence to identify the most valid, reliable, health-related, safe, and feasible fitness tests to be used in children and adolescents aged 6-18 years. We designed a single-panel modified Delphi study and invited 216 experts from all around the world to answer this Delphi survey, of whom one-third are from low-to-middle income countries and one-third are women. Four experts were involved in the piloting of the survey and did not participate in the main Delphi study to avoid bias. We pre-defined an agreement of ≥80% among the expert participants to achieve consensus., Results: We obtained a high response rate (78%) with a total of 169 fitness experts from 50 countries and territories, including 63 women and 61 experts from low- or middle-income countries/territories. Consensus (>85% agreement) was achieved for all proposed tests and protocols, supporting the YFIT battery, which includes weight and height (to compute body mass index as a proxy of body size/composition), the 20-m shuttle run (cardiorespiratory fitness), handgrip strength, and standing long jump (muscular fitness)., Conclusion: This study contributes to standardizing fitness tests and protocols used for research, monitoring, and surveillance across the world, which will allow for future data pooling and the development of international and regional sex- and age-specific reference values, health-related cut-points, and a global picture of fitness among children and adolescents., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024. Production and hosting by Elsevier B.V.)

Importance: Despite its relevance for pediatric blood pressure (BP) screening, the long-term predictive utility and natural progression of pediatric BP classification remain understudied., Objective: To evaluate BP tracking from childhood to midadulthood using the American Academy of Pediatrics (AAP) thresholds and estimate transition probabilities among BP classifications over time considering multiple time points., Design, Setting, and Participants: The analyses were performed in 2023 using data gathered from September 1980 to August 2018 within the longitudinal Cardiovascular Risk in Young Finns Study. Participants had BP examined 9 times over 38 years, from childhood (aged 6-12 years) or adolescence (15-18 years) to young adulthood (21-27 years), late young adulthood (30-37 years), and midadulthood (39-56 years)., Exposures: BP classifications (normal, elevated, hypertension) were based on AAP guidelines for children and adolescents and the 2017 American College of Cardiology/American Heart Association guidelines for adults., Main Outcomes and Measures: Outcomes were BP classifications at follow-up visits. Tracking coefficients were calculated using generalized estimated equations. Transition probabilities among BP classifications were estimated using multistate Markov models., Results: This study included 2918 participants (mean [SD] baseline age, 10.7 [5.0] years; 1553 female [53.2%]). Over 38 years, the tracking coefficient (odds ratio [OR]) for maintaining elevated BP/hypertension was 2.16 (95% CI, 1.95-2.39). Males had a higher probability than females of progressing to and maintaining hypertension and a lower probability of reverting to normal BP from childhood to midadulthood (transition probability: from normal BP to stage 2 hypertension, 0.20; 95% CI, 0.17-0.22 vs 0.08; 95% CI, 0.07-0.10; maintaining stage 2 BP, 0.32; 95% CI, 0.27-0.39 vs 0.14; 95% CI, 0.09-0.21; from stage 2 hypertension to normal BP, 0.23; 95% CI, 0.19-0.26 vs 0.58; 95% CI, 0.52-0.62. For both sexes, the probability of transitioning from adolescent hypertension to normal BP in midadulthood was lower (transition probability, ranging from 0.16; 95% CI, 0.14-0.19 to 0.44; 95% CI, 0.39-0.48) compared with childhood hypertension (transition probability, ranging from 0.23; 95% CI, 0.19-0.26 to 0.63; 95% CI, 0.61-0.66). The probability of maintaining normal BP sharply decreased in the first 5 to 10 years, stabilizing thereafter. Children with normal BP generally maintained this status into adolescence (male: transition probability, 0.64; 95% CI, 0.60-0.67; female: transition probability, 0.81; 95% CI, 0.79-0.84) but decreased by young adulthood (male: transition probability, 0.41; 95% CI, 0.39-0.44; female: transition probability, 0.69; 95% CI, 0.67-0.71)., Conclusion and Relevance: Results of this cohort study reveal an enduring association of childhood and adolescent BP (AAP thresholds) with later BP. Although childhood normal BP tends to be maintained into adolescence, the probability of reverting to and sustaining normal BP decreases notably from adolescence to young adulthood. The findings of this study underscore the importance of prevention to maintain normal BP starting in childhood, suggesting adolescence as a potential critical period. The results suggest the potential for less frequent screenings for children with initially normal BP.

Objective: Child and adult body mass index (BMI) associates with adult carotid artery intima-media thickness (cIMT). However, the relative contribution of BMI at different life-periods on adult cIMT has not been quantified. This study aimed to determine the life-course model that best explains the relative contribution of BMI at different life-periods (childhood, adolescence, and young-adulthood) on cIMT in adulthood., Methods: BMI was calculated from direct measurements of height and weight at up to seven time-points from childhood to adulthood (1973-2007) among 2485 participants of the Cardiovascular Risk in Young Finns Study (YFS) and 1271 participants in the Bogalusa Heart Study (BHS). BMI measures at three ages representative of childhood (9-years), adolescence (18 years) and young-adulthood (30 years) life-periods were used. B-mode ultrasound was used to measure common cIMT in adulthood (>30 years). Associations were evaluated using the Bayesian relative life-course exposure model., Results: In both cohorts, cumulative exposure to higher levels of BMI across the life-course was associated with greater cIMT. Of the examined life-periods, BMI in young-adulthood provided the greatest relative contribution towards the development of adult cIMT for YFS (49.9 %, 95 % CrI = 34-68 %) and white BHS participants (48.6 %, 95 % CrI = 9-86 %), whereas BMI in childhood had the greatest relative contribution for black BHS participants (54.0 %, 95 % CrI = 8-89 %)., Conclusion: Although our data suggest sensitive periods in the life-course where prevention and intervention aimed at reducing BMI might provide most benefit in limiting the effects of BMI on cIMT, maintaining lower BMI across the life-course appears to be optimal., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Youth leisure-time physical activity participation benefits physical activity habits and health outcomes later in life. However, it is unknown if certain types of leisure-time physical activity contribute to these benefits in different ways; this knowledge could enhance public health efforts. This systematic review aimed to synthesise evidence of the longitudinal associations between childhood and adolescent leisure-time physical activity on adulthood physical activity behaviours and health outcomes., Methods: A systematic search of the literature was conducted across five databases from inception to July 2022. English, peer-reviewed observational studies with a minimum of two timepoints of data collection were eligible for inclusion. We included studies that investigated the association between participation in leisure-time physical activity types in children and adolescents (i.e., 5-18 years), and physical activity, mental health, or cardiovascular outcomes in adulthood (i.e., ≥ 18 years)., Results: Fourteen studies were included in the review, totalling 34,388 observations across five countries. Running in adolescence was associated with increased adulthood physical activity in both sexes, while sports involvement was associated with an increase in physical activity in males only. Adolescent team sports participation was associated with reduced odds of early adulthood depression, with varying findings for anxiety disorders. There was preliminary evidence of minimum threshold requirements for participation in certain activities before associations with future physical activity or health outcome benefits were observed., Conclusions: Preliminary findings suggest that the lifelong behavioural and health benefits of adolescent participation in leisure-time physical activity appear to be related to the type of activity undertaken, with potential differences between sexes. With the rarity of longitudinal studies spanning from childhood into adulthood, these findings provide important insights for public health strategies to optimise lifelong health and physical activity participation., Prospero Registration: CRD42022347792., (© 2024. The Author(s).)

Objective: To examine and summarise evidence from meta-analyses of cohort studies that evaluated the predictive associations between baseline cardiorespiratory fitness (CRF) and health outcomes among adults., Design: Overview of systematic reviews., Data Source: Five bibliographic databases were searched from January 2002 to March 2024., Results: From the 9062 papers identified, we included 26 systematic reviews. We found eight meta-analyses that described five unique mortality outcomes among general populations. CRF had the largest risk reduction for all-cause mortality when comparing high versus low CRF (HR=0.47; 95% CI 0.39 to 0.56). A dose-response relationship for every 1-metabolic equivalent of task (MET) higher level of CRF was associated with a 11%-17% reduction in all-cause mortality (HR=0.89; 95% CI 0.86 to 0.92, and HR=0.83; 95% CI 0.78 to 0.88). For incident outcomes, nine meta-analyses described 12 unique outcomes. CRF was associated with the largest risk reduction in incident heart failure when comparing high versus low CRF (HR=0.31; 95% CI 0.19 to 0.49). A dose-response relationship for every 1-MET higher level of CRF was associated with a 18% reduction in heart failure (HR=0.82; 95% CI 0.79 to 0.84). Among those living with chronic conditions, nine meta-analyses described four unique outcomes in nine patient groups. CRF was associated with the largest risk reduction for cardiovascular mortality among those living with cardiovascular disease when comparing high versus low CRF (HR=0.27; 95% CI 0.16 to 0.48). The certainty of the evidence across all studies ranged from very low-to-moderate according to Grading of Recommendations, Assessment, Development and Evaluations., Conclusion: We found consistent evidence that high CRF is strongly associated with lower risk for a variety of mortality and incident chronic conditions in general and clinical populations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Aims: The utility of lipid screening in pediatric settings for preventing adult atherosclerotic cardiovascular diseases partly depends on the lifelong tracking of lipid levels. This systematic review aimed to quantify the tracking of lipid levels from childhood and adolescence to adulthood., Methods: We systematically searched MEDLINE, Embase, Web of Science, and Google Scholar in March 2022. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO; ID: CRD42020208859). We included cohort studies that measured tracking of lipids from childhood or adolescence (<18 years) to adulthood (≥18) with correlation or tracking coefficients. We estimated pooled correlation and tracking coefficients using random-effects meta-analysis. Risk of bias was assessed with a review-specific tool., Results: Thirty-three studies of 19 cohorts (11,020 participants) were included. The degree of tracking from childhood and adolescence to adulthood differed among lipids. Tracking was observed for low-density lipoprotein cholesterol (pooled r = 0.55-0.65), total cholesterol (pooled r = 0.51-0.65), high-density lipoprotein cholesterol (pooled r = 0.46-0.57), and triglycerides (pooled r = 0.32-0.40). Only one study included tracking of non-high-density lipoprotein cholesterol (r = 0.42-0.59). Substantial heterogeneity was observed. Study risk of bias was moderate, mostly due to insufficient reporting and singular measurements at baseline and follow-up., Conclusions: Early-life lipid measurements are important for predicting adult levels. However, further research is needed to understand the tracking of non-high-density lipoprotein cholesterol and the stability of risk classification over time, which may further inform pediatric lipid screening and assessment strategies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Importance: Although cardiovascular disease (CVD) begins in early life, the extent to which blood pressure (BP) at different life stages contributes to CVD is unclear., Objective: To determine the relative contribution of BP at different life stages across the early-life course from infancy to young adulthood with carotid intima-media thickness (IMT)., Design, Setting, and Participants: The analyses were performed in 2022 using data gathered from July 1989 through January 2018 within the Special Turku Coronary Risk Factor Intervention Project, a randomized, infancy-onset cohort of 534 participants coupled with annual BP (from age 7 months to 20 years), biennial IMT measurements (from ages 13 to 19 years), who were followed up with again at age 26 years., Exposures: BP measured from infancy (aged 7 to 13 months), preschool (2 to 5 years), childhood (6 to 12 years), adolescence (13 to 17 years), and young adulthood (18 to 26 years)., Main Outcomes and Measures: Primary outcomes were carotid IMT measured in young adulthood at age 26 years. Bayesian relevant life-course exposure models assessed the relative contribution of BP at each life stage., Results: Systolic BP at each life stage contributed to the association with young adulthood carotid IMT (infancy: relative weight, 25.3%; 95% credible interval [CrI], 3.6-45.8; preschool childhood: relative weight, 27.0%; 95% CrI, 3.3-57.1; childhood: relative weight, 18.0%; 95% CrI, 0.5-40.0; adolescence: relative weight, 13.5%; 95% CrI, 0.4-37.1; and young adulthood: relative weight, 16.2%; 95% CrI, 1.6-46.1). A 1-SD (at single life-stage) higher systolic BP accumulated across the life course was associated with a higher carotid IMT (0.02 mm; 95% CrI, 0.01-0.03). The findings for carotid IMT were replicated in the Cardiovascular Risk in Young Finns Study that assessed systolic BP from childhood and carotid IMT in adulthood (33 to 45 years)., Conclusion and Relevance: In this cohort study, a life-course approach indicated that accumulation of risk exposure to BP levels at all life stages contributed to adulthood carotid IMT. Of those, the contribution attributed to each observed life stage was approximately equal. These results support prevention efforts that achieve and maintain normal BP levels across the life course, starting in infancy.

To quantify the tracking of apolipoprotein B (apoB) levels from childhood and adolescence and compare the tracking of apoB with low-density lipoprotein (LDL) cholesterol, a systematic search of MEDLINE, Embase, Web of Science, and Google Scholar was performed in October 2023 (PROSPERO protocol: CRD42022298663). Cohort studies that measured tracking of apoB from childhood/adolescence (< 19 years) with a minimum follow-up of 1 year, using tracking estimates such as correlation coefficients or tracking coefficients, were eligible. Pooled correlations were estimated using random-effects meta-analysis. Risk of bias was assessed with a review-specific tool. Ten studies of eight unique cohorts involving 4677 participants met the inclusion criteria. Tracking of apoB was observed (pooled r = 0.63; 95% confidence interval [CI] = 0.53-0.71; I 2  = 96%) with no significant sources of heterogeneity identified. Data from five cohorts with tracking data for both lipids showed the degree of tracking was similar for apoB (pooled r = 0.59; 95% CI = 0.55-0.63) and LDL cholesterol (pooled r = 0.58; 95% CI = 0.47-0.68). Study risk of bias was moderate, mostly due to attrition and insufficient reporting., Conclusion: ApoB levels track strongly from childhood, but do not surpass LDL cholesterol in this regard. While there is strong evidence that apoB is more effective at predicting ASCVD risk than LDL cholesterol in adults, there is currently insufficient evidence to support its increased utility in pediatric settings. This also applies to tracking data, where more comprehensive data are required., What Is Known: • Apolipoprotein B is a known cause of atherosclerotic cardiovascular disease. • Apolipoprotein B levels are not typically measured in pediatric settings, where low-density lipoprotein cholesterol remains the primary lipid screening measure., What Is New: • This meta-analysis of 10 studies showed apolipoprotein B levels tracked strongly from childhood but did not exceed low-density lipoprotein cholesterol in this regard. • More comprehensive tracking data are needed to provide sufficient evidence for increased utility of apolipoprotein B in pediatric settings., (© 2023. The Author(s).)

This 26-year study found that non-high-density lipoprotein cholesterol (non-HDL-C) levels tracked from infancy to young adulthood suggesting early-life non-HDL-C could predict future levels. However, infancy-onset dietary counseling reduced the odds of maintaining at-risk non-HDL-C, highlighting the potential importance of early interventions in preventing cardiovascular risk associated with high pediatric non-HDL-C., Competing Interests: Declaration of Competing Interest This work was financially supported by the Academy of Finland (grants 206374, 294834, 251360, 275595, 307996, and 322112), the Juho Vainio Foundation, the Finnish Foundation for Cardiovascular Research, the Finnish Ministry of Education and Culture, the Finnish Cultural Foundation, the Sigrid Juselius Foundation, special governmental grants for Health Sciences Research (Turku University Hospital), the Yrjö Jahnsson Foundation, the Finnish Medical Foundation, and the Turku University Foundation. K.P. is funded by an Academy of Finland research fellowship (no. 322112). C.M. is supported by a National Health and Medical Research Council (NHMRC) investigator grant (APP1176494). The contents of the published material are solely the responsibility of the individual authors and do not reflect the views of the NHMRC. The authors declare no conflicts of interest disclose., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

High cardiorespiratory fitness (CRF) in adulthood is important for survival from major chronic diseases and preserving good health. We examined how childhood CRF tracks, or persists, into adulthood. Among a cohort of 748 school children followed over 34 years, we found child CRF correlated with young- (r = 0.30) and mid-adulthood (r = 0.16) CRF., Competing Interests: Declaration of Competing Interest The Childhood Determinants of Adult Health Study was supported by Grants and fellowships from the Commonwealth Departments of Sport, Recreation and Tourism, and Health, the Commonwealth Schools Commission, the National Heart Foundation (GOOH 0578), the National Health and Medical Research Council (211316, 1128373, 1098369), Veolia Environmental Services and the Mostyn Family Foundation. The authors declare no conflict of interest., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Aim: Determine if asymmetric handgrip strength exists in childhood and adulthood and quantify the degree of tracking of handgrip strength asymmetry over time., Methods: Participants from the Childhood Determinants of Adult Health Study had their right and left handgrip strength measured using handgrip dynamometry in childhood (1985: 9-15 y), young adulthood (2004-06: 26-36 y) and/or mid-adulthood (2014-19: 36-49 y). Handgrip strength asymmetry was calculated as: strongest handgrip strength/strongest handgrip strength on the other hand. Participants were categorised based on the degree of their asymmetry (0.0%-10.0%, 10.1%-20.0%, 20.1%-30.0%, >30.0%). Tracking was quantified using Spearman's correlations and log binomial regression., Results: Handgrip strength asymmetry was present in childhood and adulthood (>30.0% asymmetry: childhood = 6%, young adulthood = 3%, mid-adulthood = 4%). Handgrip strength asymmetry did not track between childhood and young- (r = 0.06, 95% CI = -0.02, 0.12) and mid-adulthood (r = 0.01, 95% CI = -0.09, 0.10). Tracking was more apparent between young- and mid-adulthood (r = 0.16, 95% CI = 0.09, 0.22). Participants with >30.0% asymmetry were at greater risk to maintain this status between childhood and young- (RR = 3.53, 95% CI = 1.15, 10.87) and mid-adulthood (RR = 2.14, 95% CI = 0.45, 10.20)., Conclusion: Although handgrip strength asymmetry tracked relatively poorly, asymmetric handgrip strength was apparent in children and adults. Handgrip strength asymmetry does not exclusively affect older adults and should be considered in protocols to better understand its role across the life course., (© 2023 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Background The origins of sex differences in cardiovascular diseases are not well understood. We examined the contribution of childhood risk factors to sex differences in adult carotid artery plaques and intima-media thickness (carotid IMT). Methods and Results Children in the 1985 Australian Schools Health and Fitness Survey were followed up when they were aged 36 to 49 years (2014-19, n=1085-1281). Log binomial and linear regression examined sex differences in adult carotid plaques (n=1089) or carotid IMT (n=1283). Childhood sociodemographic, psychosocial, and biomedical risk factors that might contribute to sex differences in carotid IMT/plaques were examined using purposeful model building with additional adjustment for equivalent adult risk factors in sensitivity analyses. Women less often had carotid plaques (10%) than men (17%). The sex difference in the prevalence of plaques (relative risk [RR] unadjusted 0.59 [95% CI, 0.43 to 0.80]) was reduced by adjustment for childhood school achievement and systolic blood pressure (RR adjusted 0.65 [95% CI, 0.47 to 0.90]). Additional adjustment for adult education and systolic blood pressure further reduced sex difference (RR adjusted 0.72 [95% CI, 0.49 to 1.06]). Women (mean±SD 0.61±0.07) had thinner carotid IMT than men (mean±SD 0.66±0.09). The sex difference in carotid IMT (β unadjusted -0.051 [95% CI, -0.061 to -0.042]) reduced with adjustment for childhood waist circumference and systolic blood pressure (β adjusted -0.047 [95% CI, -0.057 to -0.037]) and further reduced with adjustment for adult waist circumference and systolic blood pressure (β adjusted -0.034 [95% CI, -0.048 to -0.019]). Conclusions Some childhood factors contributed to adult sex differences in plaques and carotid IMT. Prevention strategies across the life course are important to reduce adult sex differences in cardiovascular diseases.

Background: The measurement of physical fitness has a history that dates back nearly 200 years. Recently, there has been an increase in international research and surveillance on physical fitness creating a need for setting international priorities that could help guide future efforts., Objective: This study aimed to produce a list of the top 10 international priorities for research and surveillance on physical fitness among children and adolescents., Methods: Using a twin-panel Delphi method, two independent panels consisting of 46 international experts were identified (panel 1 = 28, panel 2 = 18). The panel participants were asked to list up to five priorities for research or surveillance (round 1), and then rated the items from their own panel on a 5-point Likert scale of importance (round 2). In round 3, experts were asked to rate the priorities identified by the other panel., Results: There was strong between-panel agreement (panel 1: r s  = 0.76, p < 0.01; panel 2: r s  = 0.77, p < 0.01) in the priorities identified. The list of the final top 10 priorities included (i) "conduct longitudinal studies to assess changes in fitness and associations with health". This was followed by (ii) "use fitness surveillance to inform decision making", and (iii) "implement regular and consistent international/national fitness surveys using common measures"., Conclusions: The priorities identified in this study provide guidance for future international collaborations and research efforts on the physical fitness of children and adolescents over the next decade and beyond., (© 2022. Crown.)

Background: Strength asymmetries are a type of muscle function impairment that is associated with several health conditions. However, the prevalence of these asymmetries among adults from the United States remains unknown. We sought to estimate the prevalence and trends of handgrip strength (HGS) asymmetry in American adults., Methods: The unweighted analytic sample included 23,056 persons aged at least 50-years with information on HGS for both hands from the 2006-2016 waves of the Health and Retirement Study. A handgrip dynamometer measured HGS, with the highest recorded values for each hand used to calculate asymmetry. Persons were categorized into the following asymmetry severity categories: (1) >10%, (2) >20.0%, and (3) >30.0%. Survey weights were used to generate nationally-representative asymmetry estimates., Results: Overall, there were no statistically significant trends in HGS asymmetry categories over time. The prevalence of HGS asymmetry in the 2014-2016 wave was 53.4% (CI: 52.2-54.4), 26.0% (CI: 25.0-26.9), and 11.7% (CI: 10.9-12.3) for asymmetry at >10%, >20%, and >30%, respectively. HGS asymmetry was generally higher in older Americans compared to middle-aged adults at each wave. In the 2014-2016 wave, >30% asymmetry prevalence was 13.7% (CI: 12.7-14.6) in females and 9.3% (CI: 8.4-10.2) in males. Some differences in asymmetry prevalence by race and ethnicity were observed., Conclusions: The prevalence of asymmetry was generally high, especially in women and older adults. Ongoing surveillance of strength asymmetry will help monitor trends in muscle dysfunction, guide screening for disablement, identify subpopulations at risk for asymmetry, and inform relevant interventions., Competing Interests: In the past 5-years, BCC has received research funding from NMD Pharma, Astellas Pharma Global Development Inc., and Myolex Inc. for contracted studies that involved aging and muscle-related research. BCC has also received consulting fees from Regeneron Pharmaceuticals, Zev industries, and the Gerson Lehrman Group for consultation specific to age-related muscle weakness. The other authors declare no conflicts.

Purpose: To promote greater muscular strength across the life course and, in turn, help improve long-term health outcomes, strategies aimed at increasing muscular strength are required. To inform these strategies, this study identified childhood factors associated with muscular strength trajectories., Methods: Prospective longitudinal study of 1280 Childhood Determinants of Adult Health participants who had a range of potentially modifiable factors (e.g., anthropometric measures, physical activity) and health and risk motivation items (e.g., attitudes, beliefs, and intentions on health-related actions) measured in childhood and had their muscular strength assessed up to three times between childhood and midlife. Associations between childhood factors and three predetermined life course muscular strength trajectories (identified previously using group-base trajectory modeling as follows: above average and increasing, average, and below average and decreasing) were examined using log multinomial regression., Results: Greater physical fitness, physical activity, fat-free mass, enjoyment of physical activity, physical education, and school sports, and positive attitudes regarding the importance of exercising, staying fit, and body image were associated with a lower likelihood of being in the below average and decreasing muscular strength trajectory (relative risk range, 0.45-0.98). Greater physical fitness, physical activity, and fat-free mass, and attending an independent school were associated with a higher likelihood of being in the above average and increasing muscular strength trajectory (relative risk range, 1.03-1.93)., Conclusions: In addition to providing health benefits in the short term, physical activity, physical fitness, positive health attitudes, and healthy weight in childhood may lead to better muscular strength in the long term., (Copyright © 2022 by the American College of Sports Medicine.)

Transmembrane protease, serine 2 (TMPRSS2) has been identified as key host cell factor for viral entry and pathogenesis of SARS-CoV-2. Specifically, TMPRSS2 proteolytically processes the SARS-CoV-2 Spike (S) protein, enabling virus-host membrane fusion and infection of the airways. We present here a recombinant production strategy for enzymatically active TMPRSS2 and characterization of its matured proteolytic activity, as well as its 1.95 Å X-ray cocrystal structure with the synthetic protease inhibitor nafamostat. Our study provides a structural basis for the potent but nonspecific inhibition by nafamostat and identifies distinguishing features of the TMPRSS2 substrate binding pocket that explain specificity. TMPRSS2 cleaved SARS-CoV-2 S protein at multiple sites, including the canonical S1/S2 cleavage site. We ranked the potency of clinical protease inhibitors with half-maximal inhibitory concentrations ranging from 1.4 nM to 120 µM and determined inhibitor mechanisms of action, providing the groundwork for drug development efforts to selectively inhibit TMPRSS2., (© 2022. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Objectives: Clusters of low fitness and high obesity in childhood are associated with poorer health outcomes in later life, however their relationship with cognition is unknown. Identifying such profiles may inform strategies to reduce risk of cognitive decline. This study examined whether specific profiles of childhood fitness and obesity were associated with midlife cognition., Design: Prospective study., Methods: In 1985, participants aged 7-15 years from the Australian Childhood Determinants of Adult Health study were assessed for fitness (cardiorespiratory, muscular power, muscular endurance) and anthropometry (waist-to-hip ratio). Participants were followed up between 2017 and 2019 (aged 39-50). Composites of psychomotor speed-attention, learning-working memory and global cognition were assessed using CogState computerised battery. Latent profile analysis was used to derive mutually exclusive profiles based on fitness and anthropometry. Linear regression analyses examined associations between childhood profile membership and midlife cognition adjusting for age, sex and education level., Results: 1244 participants were included [age: 44.4 ± 2.6 (mean ± SD) years, 53% female]. Compared to those with the highest levels of fitness and lowest waist-to-hip ratio, three different profiles characterised by combinations of poorer cardiorespiratory fitness, muscular endurance and power were associated with lower midlife psychomotor-attention [up to -1.09 (-1.92, -0.26) SD], and lower global cognition [up to -0.71 (-1.41, -0.01) SD]. No associations were detected with learning-working memory., Conclusions: Strategies that improve low fitness and decrease obesity levels in childhood could contribute to improvements in cognitive performance in midlife., (Copyright © 2022 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Background Blood pressure associates with arterial stiffness, but the contribution of blood pressure at different life stages is unclear. We examined the relative contribution of childhood, young- and mid-adulthood blood pressure to mid-adulthood large artery stiffness. Methods and Results The sample comprised 1869 participants from the Cardiovascular Risk in Young Finns Study who had blood pressure measured in childhood (6-18 years), young-adulthood (21-30 years), and mid-adulthood (33-45 years). Markers of large artery stiffness were pulse wave velocity and carotid distensibility recorded in mid-adulthood. Bayesian relevant life course exposure models were used. For each 10-mm Hg higher cumulative systolic blood pressure across the life stages, pulse wave velocity was 0.56 m/s higher (95% credible interval: 0.49 to 0.63) and carotid distensibility was 0.13%/10 mm Hg lower (95% credible interval: -0.16 to -0.10). Of these total contributions, the highest contribution was attributed to mid-adulthood systolic blood pressure (relative weights: pulse wave velocity, childhood: 2.6%, young-adulthood: 5.4%, mid-adulthood: 92.0%; carotid distensibility, childhood: 5.6%; young-adulthood: 10.1%; mid-adulthood: 84.3%), with the greatest individual contribution coming from systolic blood pressure at the time point when pulse wave velocity and carotid distensibility were measured. The results were consistent for diastolic blood pressure, mean arterial pressure, and pulse pressure. Conclusions Although mid-adulthood blood pressure contributed most to mid-adulthood large artery stiffness, we observed small contributions from childhood and young-adulthood blood pressure. These findings suggest that the burden posed by arterial stiffness might be reduced by maintaining normal blood pressure levels at each life stage, with mid-adulthood a critical period for controlling blood pressure.

Objectives: To investigate the relationship of childhood cardiorespiratory fitness with early markers of chronic kidney disease, glomerular hyperfiltration and albuminuria, in midlife., Design: Prospective cohort study., Methods: This study included 1371 participants aged 36-49 years who participated in the 1985 Australian Schools Health and Fitness Survey when they were 7-15 years of age. Childhood cardiorespiratory fitness was estimated by the time taken to complete a 1.6- km run. Blood and urine samples were collected at follow-up. Log-binomial regression was used to determine the associations of childhood cardiorespiratory fitness with glomerular hyperfiltration [estimated glomerular filtration rate (mL/min/1.73 m 2 ) > 95th percentile standardized for age and sex] and albuminuria (urine albumin-to-creatinine ratio ≥ 2.5 mg/mmol in males or ≥3.5 mg/mmol in females) in midlife., Results: Compared with women with high childhood cardiorespiratory fitness, those with lower childhood cardiorespiratory fitness had a higher risk of glomerular hyperfiltration in midlife after adjusting for childhood age, the duration of follow-up, and midlife smoking status [adjusted relative risk = 2.86, 95% confidence interval, 1.04-7.86 for individuals with moderate childhood cardiorespiratory fitness (P = 0.04), and adjusted relative risk = 3.38, 95% confidence interval, 1.13-10.14 for individuals with low childhood cardiorespiratory fitness (P = 0.03)]. Further adjustment for childhood and midlife body mass index resulted in a slightly attenuated and statistically non-significant association. No significant associations were found with glomerular hyperfiltration in males or albuminuria in either males or females., Conclusions: Low cardiorespiratory fitness in childhood may increase the risk of glomerular hyperfiltration in midlife in females, possibly via a path through adult cardiorespiratory fitness., (Copyright © 2022 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Background and Aims: Low muscular strength associates with the metabolic syndrome (MetS). However, how muscular strength measured at different life stages contribute to the development of MetS is unknown. This study compared the contribution of muscular strength measured in youth, young- and mid-adulthood with MetS in midlife., Methods and Results: Prospective longitudinal study of 267 Childhood Determinants of Adult Health Study participants who between 1985 and 2019 had measures of muscular strength (dominant grip strength) at three life stages (youth = 9-15 years, young adulthood = 26-36 years, mid-adulthood = 36-49 years) and had their MetS status assessed in mid-adulthood. Bayesian relevant life-course exposure models quantified associations between muscular strength at each life stage with MetS and estimated the maximum accumulated effect of lifelong muscular strength. The contribution of muscular strength at each life stage with MetS was equal (youth = 38%, young adulthood = 28%, mid-adulthood = 34%). A one standard deviation increase in cumulative muscular strength was associated with 46% reduced odds of MetS. Of all MetS components, muscular strength was most strongly negatively associated with high waist circumference., Conclusion: A life-course approach demonstrated reduced odds of MetS in midlife was associated with cumulatively high muscular strength since youth. This supports efforts to promote physical fitness throughout life., Competing Interests: Declaration of competing interest Funding bodies and sponsors did not play a role in the study design, collection, analysis, or interpretation of data, in the writing of the manuscript, or the decision to submit the manuscript for publication. The authors declare no conflict of interest., (Copyright © 2022 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

When the 2020 semester began in the USA in January, it was unimaginable that the near-total closure of educational system across the globe would become the new normal. To mitigate the spread of the COVID-19 virus, teaching faculty hastily converted to an online learning environment in order for instruction to continue. This mixed-methods study used the What Is Happening In this Class? (WIHIC) questionnaire and analysis of student course evaluations to explore changes in student perceptions of learning environments from before to after the switch to remote learning because of the pandemic. Students perceived a statistically-significant decline in student cohesiveness, teacher support, involvement, task orientation and equity, with the largest decline of 0.56 standard deviations occurring for student cohesiveness. Qualitative comments illuminated reasons for these declines and suggested ways to mitigate declines in the future., (© The Author(s), under exclusive licence to Springer Nature B.V. 2021.)

Objectives: The 2014 Australian Physical Activity and Sedentary Behaviour Guidelines (Adults) recommend muscle-strengthening activities ≥2 days/week. This study aimed to identify factors associated with 5-year change and stability in adherence to these guidelines., Design: Two adult follow-ups of the Childhood Determinants of Adult Health (CDAH) Study. Participants (n = 1510) were 26-36 years (CDAH-1, 2004-06) and 31-41 years (CDAH-2, 2009-11)., Methods: Information on muscle-strengthening activities, sociodemographics, health, physical activity and sedentary behaviour was collected. Participants reporting muscle-strengthening activities ≥2 days/week 'met guidelines', with change and stability categorised as 'persistent adherence', 'increasing adherence', 'decreasing adherence' and 'persistent non-adherence'. Differences in sociodemographic, health and behavioural factors were analysed using log multinomial regression., Results: Between 15-21% of women (CDAH-1: 14.5%, 95% confidence interval = 12.5-16.9; CDAH-2: 20.7%, 95% confidence interval = 18.3-23.4) and ~21% of men (CDAH-1: 22.2%, 95% confidence interval = 19.0-26.0; CDAH-2: 21.0%, 95% confidence interval = 17.8-24.7) met muscle-strengthening guidelines, but only 8.5% (95% confidence interval = 7.2-10.1) of participants were persistently adherent. Remaining in or moving from a major city, CDAH-1 weight status, cumulative self-rated health and vigorous physical activity were positively associated with persistent adherence (relative risk range = 1.51-3.92), while female gender, becoming partnered and having children at any timepoint were negatively associated with persistent adherence (relative risk range = 0.38-0.58)., Conclusions: Adherence - particularly persistent adherence - to muscle-strengthening guidelines in this sample was low. Gender, marital status, weight status, BMI, self-rated health, urban-rural status, parental status, physical activity and sedentary behaviour were associated with adherence, and should be considered in intervention development to maximise effectiveness., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objectives: Low muscular strength is a risk factor for current and future adverse health outcomes. However, whether levels of muscular strength persist, or track, and if there are distinct muscular strength trajectories across the life course is unclear. This study aimed to explore muscular strength trajectories between childhood and mid-adulthood., Design: Prospective longitudinal study., Methods: Childhood Determinants of Adult Health Study participants had their muscular strength (right and left handgrip, shoulder extension and flexion, and leg strength measured by hand-held, shoulder and leg-back dynamometers, and a combined strength score) assessed in childhood, young adulthood and mid-adulthood. The tracking of muscular strength was quantified between childhood and mid-adulthood (n=385) and young- and mid-adulthood (n=822). Muscular strength trajectory patterns were identified for participants who had their muscular strength assessed at least twice across the life course (n=1280)., Results: Levels of muscular strength were persistent between childhood and mid-adulthood and between young- and mid-adulthood, with the highest tracking correlations observed for the combined strength score (childhood to mid-adulthood: r=0.47, p<0.001; young- to mid-adulthood: r=0.72, p<0.001). Three trajectories of combined muscular strength were identified across the life course; participants maintained average, above average, or below average levels of combined muscular strength., Conclusions: Weak children are likely to become weak adults in midlife unless strategies aimed at increasing muscular strength levels are introduced. Whether interventions aimed at increasing muscular strength could be implemented in childhood to help establish favourable muscular strength trajectories across the life course and in turn, better future health, warrant further attention., (Copyright © 2021 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Importance: Elevated non-high-density lipoprotein cholesterol (non-HDL-C) is associated with the presence of coronary artery calcification (CAC), a marker of heart disease in adulthood. However, the relative importance of non-HDL-C levels at specific life stages for CAC remains unclear., Objective: To identify the relative association of non-HDL-C measured at distinct life stages (adolescence, young adulthood, mid-adulthood) with the presence of CAC measured in mid-adulthood., Design, Setting, and Participants: The Cardiovascular Risk in Young Finns Study is a population-based prospective cohort study that started in 1980 with follow-up over 28 years. Participants from 3 population centers (Kuopio, Tampere, and Turku in Finland) represent a convenience sample drawn from the 3 oldest cohorts at baseline (aged 12-18 years in 1980). Data were collected from September 1980 to August 2008. Analysis began February 2020., Exposures: Non-HDL-C levels were measured at 3 life stages including adolescence (aged 12-18 years), young adulthood (aged 21-30 years), and mid-adulthood (aged 33-45 years)., Main Outcomes and Measures: In 2008, CAC was determined from computed tomography and dichotomized as 0 (no CAC, Agatston score = 0) and 1 (presence of CAC, Agatston score ≥1) for analysis. Using a bayesian relevant life course exposure model, the relative association was determined between non-HDL-C at each life stage and the presence of CAC in mid-adulthood., Results: Of 589 participants, 327 (56%) were female. In a model adjusted for year of birth, sex, body mass index, systolic blood pressure, blood glucose level, smoking status, lipid-lowering and antihypertensive medication use, and family history of heart disease, cumulative exposure to non-HDL-C across all life stages was associated with CAC (odds ratio [OR], 1.50; 95% credible interval [CrI], 1.14-1.92). At each life stage, non-HDL-C was associated with CAC and exposure to non-HDL-C during adolescence had the strongest association (adolescence: OR, 1.16; 95% CrI, 1.01-1.46; young adulthood: OR, 1.14; 95% CrI, 1.01-1.43; mid-adulthood: OR, 1.12; 95% CrI, 1.01-1.34)., Conclusions and Relevance: These data suggest that elevated non-HDL-C levels at all life stages are associated with coronary atherosclerosis in mid-adulthood. However, adolescent non-HDL-C levels showed the strongest association with the presence of CAC in mid-adulthood, and greater awareness of the importance of elevated non-HDL-C in adolescence is needed.

Background: Although low child and adult grip strength is associated with adverse cardiometabolic health, how grip strength across the life course associates with type 2 diabetes is unknown. This study identified the relative contribution of grip strength measured at specific life stages (childhood, young adulthood, mid-adulthood) with prediabetes or type 2 diabetes in mid-adulthood., Methods: Between 1985 and 2019, 263 participants had their grip strength measured using an isometric dynamometer in childhood (9-15 years), young adulthood (28-36 years) and mid-adulthood (38-49 years). In mid-adulthood, a fasting blood sample was collected and tested for glucose and glycated haemoglobin (HbA1c). Participants were categorized as having prediabetes or type 2 diabetes if fasting glucose levels were ≥ 5.6 mmol or if HbA1c levels were ≥ 5.7% (≥ 39 mmol/mol). A Bayesian relevant life course exposure model examined the association between lifelong grip strength and prediabetes or type 2 diabetes., Results: Grip strength at each time point was equally associated with prediabetes or type 2 diabetes in mid-adulthood (childhood: 37%, young adulthood: 36%, mid-adulthood: 28%). A one standard deviation increase in cumulative grip strength was associated with 34% reduced odds of prediabetes or type 2 diabetes in mid-adulthood (OR 0.66, 95% credible interval 0.40, 0.98)., Conclusions: Greater grip strength across the life course could protect against the development of prediabetes and type 2 diabetes. Strategies aimed at increasing muscular strength in childhood and maintaining behaviours to improve strength into adulthood could improve future cardiometabolic health. The Association Between Grip Strength Measured in Childhood, Young- and Mid-adulthood and Prediabetes or Type 2 Diabetes in Mid-adulthood.

Background: We examined whether grip strength differentiates youth with obesity with increased cardiometabolic risk., Methods: The sample comprised 43 youth with severe obesity (mean age 14.8, standard deviation 3.0 years) enrolled in the Childhood Overweight BioRepository of Australia. Grip strength was normalized to body mass and categorized as low and moderate/high., Results: Youth with low grip strength had higher systolic blood pressure (mean difference 13mmHg), low-density lipoprotein cholesterol (0.26mmol/l), continuous metabolic syndrome score (0.36), and carotid intima-media thickness (0.05mm) compared with those with moderate/high grip strength., Conclusions: Low grip strength may differentiate youth with obesity with increased cardiometabolic risk., (Copyright © 2020 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.)

To help inform strategies aimed at increasing muscular fitness levels, we examined factors associated with childhood muscular fitness (strength and power) that preceded the recently observed secular decline. Data were available from a nationally representative sample of Australian children aged 7-15 years in 1985 (n = 8469). Muscular fitness measures included strength (right and left grip, shoulder extension and flexion, and leg strength) and power (standing long jump distance). Anthropometric (adiposity, fat-free mass), cardiorespiratory fitness (CRF), flexibility, speed capability, physical activity (individual and parental), dietary quality and intake (fruit, vegetable, protein) and sociodemographic (area-level socioeconomic status (SES), school type) data were available. Statistical analyses included sex-stratified linear regression. Of all examined factors, measures of adiposity, fat-free mass, CRF, flexibility and speed capability were associated with muscular fitness at levels that met Cohen's threshold for important effects (r-squared = 0.02 to 0.28). These findings highlight the multifactorial relationship between muscular fitness and its determinants. Collectively, these factors were powerful in explaining muscular strength (females: r-squared = 0.32; males: r-squared = 0.41) and muscular power (females: r-squared = 0.36; males: r-squared = 0.42). These findings highlight modifiable and environmental factors that could be targeted to increase childhood muscular fitness.

Purpose: Child and adult muscular power have been shown to associate with contemporary cardiometabolic health. Muscular power typically persists (tracks) between childhood and adulthood. Few studies span childhood to adulthood, so we aimed to identify modifiable and environmental factors associated with the persistence or change in muscular power across the life course., Methods: Prospective study examining 1938 participants who had their muscular power (standing long jump distance) measured in 1985 as children 7-15 yr old and again 20 yr later in adulthood (26-36 yr old). A selection of objectively measured anthropometric characteristics (adiposity and fat-free mass), cardiorespiratory fitness (CRF), self-reported physical activity, dietary (quality and fruit, vegetable, and protein intake), and sociodemographic data were available at both time points. Muscular power was separated into thirds, and participants were reported as having persistently low, decreasing, persistently moderate, increasing, or persistently high muscular power., Results: Higher adiposity, lower physical activity, diet quality and socioeconomic status (SES) across the life course, and lower adult CRF were associated with persistently low muscular power. Lower adult protein intake and an increase in adiposity over time were associated with decreasing muscular power. An increase in fat-free mass was associated with a reduced probability of decreasing or persistently high muscular power and an increased probability of increasing muscular power. Higher adult fruit intake was associated with increasing muscular power. Lower adiposity across the life course, higher adult CRF and SES, and higher child protein intake were associated with persistently high muscular power., Conclusion: Healthy weight, good CRF, greater protein intake, and high SES are important correlates of high muscular power maintained from childhood to adulthood.

This study aimed to assess whether the longitudinal association between childhood muscular fitness and adult measures of glucose homeostasis persist despite changes in muscular fitness across the life course. This prospective longitudinal study included 586 participants who had their muscular power (standing long jump distance), cardiorespiratory fitness (CRF), and waist circumference measured as children (aged 9, 12, 15 years) and again 20 years later as adults. In adulthood, these participants also provided a fasting blood sample which was tested for glucose and insulin. Glucose homeostasis measures including insulin resistance (HOMA2-IR) and beta cell function (HOMA2-β) were estimated. Child and adult muscular power levels were separated into thirds, and tracking groups (persistently low, decreasing, persistently moderate, increasing, and persistently high) were created. Sex-stratified multivariable linear regression models were used to examine the association between muscular power tracking groups and adult measures of glucose homeostasis. Compared with males with persistently high muscular power, males with increasing and persistently low muscular power had higher fasting insulin (increasing: β = 1.12 mU/L, P = .04; persistently low: β = 2.12 mU/L, P = .001) and HOMA2-β (increasing: β = 8.50%, P = .03; persistently low: β = 11.27%, P = .01) independent of CRF and males with persistently low muscular power had greater fasting insulin (β = 1.22 mU/L, P = .02) and HOMA2-IR (β = 0.14, P = .02) independent of waist circumference. Non-significant associations were present for females. For males, maintaining persistently high muscular power between childhood and adulthood could lead to a healthier adult glucose homeostasis profile., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Previous data have indicated relative stability over time of paediatric jumping performance, but few data exist since the early 2000s. This study quantified the 30-year secular changes in jumping performance of Australian children aged 11-12-years using data from the Australian Schools Health and Fitness Survey (1985, n = 1967) and Growing Up in Australia's Child Health CheckPoint (2015, n = 1765). Both cohorts measured jumping performance (standing long jump distance), anthropometric and demographic data. Secular changes in jumping performance means and quantiles were examined using multivariable linear and quantile regression. Between 1985 and 2015, jumping performance declined by 16.4 cm or by 11.2% (standardised change 0.66 SD, 95%CI 0.60 to 0.73). Adjustment for body mass reduced the effect by 32%, although the decline remained (absolute change - 11.1 cm, 95%CI -12.5 to -9.7; percent change 7.7%, 95%CI 6.7 to 8.6; standardised change 0.51 SD, 95%CI 0.44 to 0.57). This decline was evident across all quantiles. The jumping performance of Australian children aged 11-12-years has declined between 1985 and 2015, with body mass changes accounting for only part of the decline. Efforts should continue to promote paediatric muscular fitness, reduce adiposity, and aim to reverse this decline in jumping performance.

Background/objectives: Childhood body mass index (BMI) predicts adult glucose homeostasis measures and type 2 diabetes mellitus, but little is known about the predictive utility of other anthropometric measures in childhood. We aimed to identify the anthropometric measure in childhood that best predicts adult glucose homeostasis measures and examine if the combination of additional anthropometric measures further improves predictive utility., Methods: A 20-year follow-up of children participating in the Childhood Determinants of Adult Health Study (n = 2345, aged 7-15 years at baseline). Baseline anthropometric measures were waist circumference (WC), WC adjusted for height, weight adjusted for height, hip circumference, waist-hip-ratio, waist-height-ratio, BMI, conicity index, abdominal volume index (AVI), body adiposity index, and a body shape index. Fasting glucose and insulin levels measured at follow-up were used to define insulin resistance (HOMA2-IR), low beta-cell function (HOMA2-β), high fasting insulin, and impaired fasting glucose (IFG)., Results: All child anthropometric measures were significantly associated with HOMA2-IR, HOMA2-β, and high fasting insulin (relative risk = 1.12-1.55), but not IFG. AVI had the largest area under receiver-operating curve (AUC) in predicting adult HOMA2-IR (AUC, 95% confidence interval: 0.610, 0.584-0.637), HOMA2-β (0.615, 0.588-0.642) and high fasting insulin (0.613, 0.587-0.639). Combining each additional anthropometric measure with AVI did not appreciably increase predictive utility (an increase of 0.001-0.002 in AUC, p > 0.05 for all)., Conclusions: Anthropometric measures from a single time-point in childhood are associated with insulin-related outcomes 20-year later in adulthood. However, overall predictive utility was low and was not substantially enhanced by combining multiple different child anthropometric measures.

Objectives: To assess whether childhood cardiorespiratory fitness (CRF) and muscular fitness phenotypes (strength, power, endurance) predict adult glucose homeostasis measures., Design: Prospective longitudinal study., Methods: Study examining participants who had physical fitness measured in childhood (aged 7-15 years) and who attended follow-up clinics approximately 20 years later and provided a fasting blood sample which was tested for glucose and insulin. Physical fitness measurements included muscular strength (right and left grip, shoulder flexion, shoulder and leg extension), power (standing long jump distance) and endurance (number of push-ups in 30s), and CRF (1.6km run duration). In adulthood, fasting glucose and insulin levels were used to derive glucose homeostasis measures of insulin resistance (HOMA2-IR) and beta cell function (HOMA2-β)., Results: A standard deviation increase in childhood CRF or muscular strength (males) was associated with fasting glucose (CRF: β=-0.06mmol/L), fasting insulin (CRF: β=-0.73mU/L; strength: β=-0.40mU/L), HOMA2-IR (CRF: β=-0.06; strength: β=-0.05) and HOMA2-β (CRF: β=-3.06%; strength: β=-2.62%) in adulthood, independent of the alternative fitness phenotype (all p<0.01). Adjustment for childhood waist circumference reduced the effect by 17-35% for CRF and 0-15% for muscular strength (males) and statistical significance remained for all associations expect between CRF, fasting glucose and HOMA2-β (p>0.06)., Conclusions: CRF and muscular fitness in childhood were inversely associated with measures of fasting insulin, insulin resistance and beta cell function in adulthood. Childhood CRF and muscular fitness could both be potential independent targets for strategies to help reduce the development of adverse glucose homeostasis., (Copyright © 2018 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Objectives: Low muscular fitness levels have previously been reported as an independent risk factor for chronic disease outcomes. Muscular fitness tracking, the ability to maintain levels measured at one point in time to another point in time, was assessed from youth to adulthood to provide insight into whether early identification of low muscular fitness in youth is possible., Design: Prospective longitudinal study., Methods: Study including 623 participants who had muscular fitness measures in 1985 (aged 9, 12 or 15 years) and again 20 years later in young adulthood. Measures of muscular fitness were strength (right and left grip, leg, shoulder extension and flexion measured by dynamometer, and a combined strength score) and power (standing long jump distance)., Results: Strength and power were relatively stable between youth and adulthood; the strongest tracking correlations were observed for the combined strength score (r=0.47, p≤0.001), right grip strength (r=0.43, p≤0.001) and standing long jump (r=0.43, p≤0.001). Youth in the lowest third of muscular fitness had an increased risk of remaining in the lowest third of muscular fitness in adulthood (strength: relative risk (RR)=4.70, 95% confidence interval (CI) (3.19, 6.92); power: RR=4.06 (2.79, 5.90))., Conclusions: Youth with low muscular fitness are at increased risk of maintaining a low muscular fitness level into adulthood. These findings warrant investigation into the long term effects of early interventions that focus on improving low muscular fitness levels in youth which could potentially improve adult muscular fitness and reduce future chronic disease outcomes., (Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Purpose: The objective of this study is to determine whether childhood muscular fitness phenotypes (strength, endurance, and power) are independently associated with adult metabolic syndrome (MetS)., Methods: We conducted a longitudinal study including 737 participants who had muscular fitness measures in 1985 when age 9, 12, or 15 yr and attended follow-up in young adulthood 20 yr later when measures of MetS were collected. Childhood measures of muscular fitness included strength (right and left grip, leg, and shoulder extension and flexion), endurance (number of push-ups in 30 s), and power (distance of a standing long jump). A muscular fitness score was created using all individual muscular fitness phenotypes. In adulthood, waist circumference, blood pressure, HDL cholesterol, triglycerides, and glucose were measured. Adult outcomes were MetS defined using the harmonized definition and a continuous MetS risk score., Results: Participants with childhood muscular strength, muscular power, and combined muscular fitness score in the highest third had significantly lower relative risk (RR) for MetS and a lower continuous MetS score in adulthood independent of cardiorespiratory fitness than those in the lowest third (strength: RR = 0.21 (0.09, 0.49) β = -0.46 (-0.59, -0.34) power: RR = 0.26 (0.12, 0.60), β = -0.36 (-0.49, -0.23) fitness score: RR = 0.20 (0.09, 0.47), β = -0.45 (-0.58, -0.33)). However, adjustment for childhood waist circumference reduced the effect sizes for both adult outcomes by 17%-60%., Conclusion: Phenotypes of childhood muscular fitness can be used to predict adult MetS independent of cardiorespiratory fitness. Although a large proportion of the effect of childhood muscular fitness on adult MetS is potentially being mediated by child waist circumference, these data suggest that promotion of muscular fitness among children might provide additional protection against developing adult MetS.

PEGylated organosilica nanoparticles have been synthesized through self-condensation of (3-mercaptopropyl)trimethoxysilane in dimethyl sulfoxide into thiolated nanoparticles with their subsequent reaction with methoxypoly(ethylene glycol) maleimide. The PEGylated nanoparticles showed excellent colloidal stability over a wide range of pH in contrast to the parent thiolated nanoparticles, which have a tendency to aggregate irreversibly under acidic conditions (pH < 3.0). Due to the presence of a poly(ethylene glycol)-based corona, the PEGylated nanoparticles are capable of forming hydrogen-bonded interpolymer complexes with poly(acrylic acid) in aqueous solutions under acidic conditions, resulting in larger aggregates. The use of hydrogen-bonding interactions allows more efficient attachment of the nanoparticles to surfaces. The alternating deposition of PEGylated nanoparticles and poly(acrylic acid) on silicon wafer surfaces in a layer-by-layer fashion leads to multilayered coatings. The self-assembly of PEGylated nanoparticles with poly(acrylic acid) in aqueous solutions and at solid surfaces was compared to the behavior of linear poly(ethylene glycol). The nanoparticle system creates thicker layers than the poly(ethylene glycol), and a thicker layer is obtained on a poly(acrylic acid) surface than on a silica surface, because of the effects of hydrogen bonding. Some implications of these hydrogen-bonding-driven interactions between PEGylated nanoparticles and poly(acrylic acid) for pharmaceutical formulations are discussed.

Purpose: Percutaneous surgical treatment of nondisplaced scaphoid fractures is becoming more common. Although the surgical anatomy at risk has been well described for the volar approach to the scaphoid, we have not found articles elucidating the dangers with a percutaneous dorsal approach. Additionally, direct placement of the screw is not possible with a percutaneous approach, and there is a risk of not seating the screw below the subchondral bone. The purpose of this study was to delineate the anatomy at risk using a dorsal percutaneous approach to the scaphoid and to determine the accuracy of using fluoroscopy to seat the screw flush with the subchondral surface., Methods: Cannulated, headless screws were placed into the scaphoids of 12 fresh-frozen cadavers in standard percutaneous fashion through a dorsal approach. Fluoroscopy was used to seat the screw just below the subchondral surface. The wrists were then dissected and the distance from the guide wire to various anatomic structures was measured. The distance that the screw was protruding above or buried below the subchondral bone was also measured., Results: The distances from the guide wire to the posterior interosseous nerve, to extensor digitorum communis to the index, and to extensor indicis proprius were 2.2 mm, 2.2 mm, and 3.1 mm, respectively. These structures were most at risk. The screw was prominent (above the subchondral bone) in 2 of 12 specimens and flush with or buried in the remaining 10 specimens., Conclusions: The results of this study show that there are anatomic structures at risk of injury with dorsal percutaneous placement of a headless screw into the scaphoid. Despite using live and static fluoroscopy views, we incorrectly placed the screw above the subchondral bone in 2 of the specimens. We support use of a limited incision when internally fixing a scaphoid from the dorsal approach.

We report here a case of an adult seeking a late night peanut butter snack who mistook for peanut butter a fluoride containing glass etching compound. The glass etching compound was of a color and consistency similar to peanut butter and was packaged in a similar appearing container. The decedent survived for six hours after the fluoride ingestion. He was admitted to the emergency room in stable condition with severe gastrointestinal symptoms. His condition deteriorated rapidly prior to death with abrupt cardiac arrest and profound hypocalcemia (5.5 mg/dl). Autopsy showed only gastric hyperemia and discoloration with a postmortem blood fluoride level of 19 mg/L.