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Does adiposity mediate the relationship between physical activity and biological risk factors in youth?: a cross-sectional study from the International Children’s Accelerometry Database (ICAD)



To model the association between accumulating 60 daily minutes of moderate-to-vigorous physical activity and a composite score of biological risk factors into a direct and an indirect effect, using abdominal obesity as the mediator.


Cross-sectional data from the International Children’s Accelerometry Database (ICAD) including 6–18-year-old children and adolescents (N=3412) from 4 countries providing at least 3 days of accelerometry-assessed physical activity. A standardized composite risk score was calculated from systolic blood pressure and fasting blood samples of insulin, glucose, triacylglycerol and inverse HDL-cholesterol. Abdominal obesity was assessed by the waist-circumference:height ratio. Two-stage regression analysis, allowing for exposure–mediator interaction, was used for the effect decomposition.


Participants achieving 60 daily minutes of moderate-to-vigorous physical activity had a 0.31 (95% CI: −0.39, −0.23) standard deviations lower composite risk score than those achieving less than 60 min. Modelling the associations suggested that 0.24 standard deviations (95% CI: −0.32, −0.16) was attributed to the direct effect and −0.07 (95% CI: −0.11, −0.02) to the indirect effect indicating that 22% of the total effect was mediated by central adiposity. Modelling 30 and 90 min of moderate-to-vigorous physical activity per day resulted in changes in the direct but not the indirect effect.


One hour of daily moderate-to-vigorous physical activity was associated with clinically relevant differences in metabolic control compared to engagement in less than this minimally recommended amount. The majority of the difference was explained by the direct effect of physical activity.

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We would like to thank all participants and funders of the original studies that contributed data to ICAD. We also gratefully acknowledge the contribution of Professor Chris Riddoch, Professor Ken Judge, Professor Ashley Cooper and Dr Pippa Griew to the development of ICAD. The ICAD Collaborators include: Prof LB Andersen, University of Southern Denmark, Odense, Denmark (Copenhagen School Child Intervention Study (CoSCIS)); Prof S Anderssen, Norwegian School for Sport Science, Oslo, Norway (European Youth Heart Study (EYHS), Norway); Dr AJ Atkin, MRC Epidemiology Unit & Centre for Diet and Activity Research, University of Cambridge, UK; Prof G Cardon, Department of Movement and Sports Sciences, Ghent University, Belgium (Belgium Pre-School Study); Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Hyattsville, MD USA (National Health and Nutrition Examination Survey (NHANES)); Dr R Davey, Centre for Research and Action in Public Health, University of Canberra, Australia (Children’s Health and Activity Monitoring for Schools (CHAMPS)); Prof U Ekelund, Norwegian School of Sport Sciences, Oslo, Norway & MRC Epidemiology Unit, University of Cambridge, UK; Dr DW Esliger, School of Sports, Exercise and Health Sciences, Loughborough University, UK; Dr P Hallal, Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil (1993 Pelotas Birth Cohort); Dr BH Hansen, Norwegian School of Sport Sciences, Oslo, Norway; Prof KF Janz, Department of Health and Human Physiology, Department of Epidemiology, University of Iowa, Iowa City, USA (Iowa Bone Development Study); Prof S Kriemler, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Switzerland (Kinder-Sportstudie (KISS)); Dr N Møller, University of Southern Denmark, Odense, Denmark (European Youth Heart Study (EYHS), Denmark); Ms L Molloy, School of Social and Community Medicine, University of Bristol, UK (Avon Longitudinal Study of Parents and Children (ALSPAC)); Dr A Page, Centre for Exercise, Nutrition and Health Sciences, University of Bristol, UK (Personal and Environmental Associations with Children’s Health (PEACH)); Prof R Pate, Department of Exercise Science, University of South Carolina, Columbia, USA (Physical Activity in Pre-school Children (CHAMPS-US) and Project Trial of Activity for Adolescent Girls (Project TAAG)); Dr JJ Puder, Service of Endocrinology, Diabetes and Metabolism, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland (Ballabeina Study); Prof J Reilly, Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK (Movement and Activity Glasgow Intervention in Children (MAGIC)); Prof J Salmon, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia (Children Living in Active Neigbourhoods (CLAN)); Prof LB Sardinha, Exercise and Health Laboratory, Faculty of Human Movement, Universidade de Lisboa, Lisbon, Portugal (European Youth Heart Study (EYHS), Portugal); Dr LB Sherar, School of Sports, Exercise and Health Sciences, Loughborough University, UK; Dr A Timperio, Centre for Physical Activity and Nutrition Research, Deakin University Melbourne, Australia (Healthy Eating and Play Study (HEAPS)); Dr EMF van Sluijs, MRC Epidemiology Unit & Centre for Diet and Activity Research, University of Cambridge, UK (Sport, Physical activity and Eating behaviour: Environmental Determinants in Young people (SPEEDY)). JT was funded by TrygFonden (Grant Number: 11683), the University of Southern Denmark, and received financial support from ‘Christian og Ottilia Brorsons Rejselegat’ while contributing to this work. The pooling of the data was funded through a grant from the National Prevention Research Initiative (Grant Number: G0701877) ( The funding partners relevant to this award are: British Heart Foundation; Cancer Research UK; Department of Health; Diabetes UK; Economic and Social Research Council; Medical Research Council; Research and Development Office for the Northern Ireland Health and Social Services; Chief Scientist Office; Scottish Executive Health Department; The Stroke Association; Welsh Assembly Government and World Cancer Research Fund. This work was additionally supported by the Medical Research Council (MC_UU_12015/3; MC_UU_12015/7), The Research Council of Norway (249932/F20), Bristol University, Loughborough University and Norwegian School of Sport Sciences. The study sponsors were not involved in the design of the study; the collection, analysis and interpretation of data; writing the report; or the decision to submit the report for publication.

Author contributions

JT conceived the study, performed the analysis, led the analysis and writing of the manuscript. AB conceived the study, analyzed the data and critically revised the manuscript. NCM conceived the study, analyzed the data, critically revised the manuscript and is an ICAD Collaborator. LBA conceived the study, analyzed the data, critically revised the manuscript and is an ICAD Collaborator. LBS analyzed the data, critically revised the manuscript and is an ICAD Collaborator. UE analyzed the data, critically revised the manuscript and is an ICAD Collaborator. SB analyzed the data and critically revised the manuscript. All authors approved the final version of the manuscript. JT is the guarantor of this work.

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Correspondence to J Tarp.

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Supplementary Information accompanies this paper on International Journal of Obesity website

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Tarp, J., Bugge, A., Andersen, L. et al. Does adiposity mediate the relationship between physical activity and biological risk factors in youth?: a cross-sectional study from the International Children’s Accelerometry Database (ICAD). Int J Obes 42, 671–678 (2018).

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