International Journal of Obesity (1997) 21, 372±379
ß 1997 Stockton Press All rights reserved 0307±0565/97 $12.00
Physical activity and body composition in 10
year old French children: linkages with
nutritional intake?
M Deheeger1, MF Rolland-Cachera1 and AM Fontvieille2
1
INSERM, U 290 Saint Lazare Hospital, 107 rue du Faubourg Saint Denis, 75010, Paris, France; and 2 SANOFI Recherche, Nutrition
Department, 82, Avenue Raspail, 94255, Gentilly Cedex, France
OBJECTIVES: To investigate the relationships between physical activity, dietary intake and body composition in
children.
DESIGN: A cross-sectional study on physical activity, nutritional intakes and body composition conducted in 86
healthy 10 y old French children. In addition, growth parameters and nutritional intakes were available from the age of
10 months.
MEASUREMENTS: Physical activity level (using a validated activity questionnaire over the past year), nutritional
intake (dietary history method), anthropometric measurements (body weight, height, arm circumference, triceps and
subscapular skinfolds, Body Mass Index (BMI), arm muscle and arm fat areas calculated from these measurements) at
the age of 10 y. Anthropometric measurements and nutritional intakes were recorded in the same children at the age
of 10 months and every 2 y from the age of 2 y.
RESULTS: At the age of 10 y, active children ingested signi®cantly more energy than less active children, mostly due
to higher energy intake at breakfast and in the afternoon. This higher energy intake was accounted for by increased
consumption of carbohydrates (281 g vs 246 g; 49.6% vs 47.4% of total energy). Even if the amounts of fat consumed
were similar in both groups (90 g vs 84 g; P ˆ 0.09), the percentage of fat intake was lower in active children (35.4% vs
37.4%; P ˆ 0.04). The percentage of protein was not different (14.9% vs 15.3%; P ˆ 0.33). In spite of a higher energy
intake in the active group, active and less active children had similar BMI at the age of 10 y. However, their body
composition differed signi®cantly: active children had a higher proportion of fat-free mass, a lower proportion of fatmass as measured in the arm and they had a later adiposity rebound. Fatness was signi®cantly and positively
associated with the time spent watching television and video games.
CONCLUSIONS: Physical activity was associated with improved body composition and growth pattern. This
association may be related to nutritional changes: active children consumed more energy by increasing carbohydrate,
thus reducing the relative fat content of their diet. These results provide support to encourage physical activity during
childhood.
Keywords: physical activity; body composition; nutritional intake; children
Introduction
Decreased physical activity is probably the main
factor accounting for the increasing prevalence of
obesity in industrialised countries.1,2 This conclusion
mainly derives from indirect evidence, as few baseline
data exist on the trends of physical exercise through
the last decades. The importance of physical activity
is suggested by the fact that most studies on the
secular changes in energy intake and body fatness,
report an increase in body fatness, in spite of a
constant or even decreased energy intake.1±6 Time
spent watching television (TV), an index of inactivity,
has been strongly associated with the risk of obesity.7
In addition, low levels of physical activity are associated with higher levels of body fat in pre-school
Correspondence: Dr MF Rolland-Cachera.
Received 22 July 1996; revised 9 December 1996; accepted 20
January 1997
children.8 In Pima Indians, a population highly prone
to obesity, it has been reported that children had a
decreased physical activity as compared to their
Caucasian peers.9
Exercise not only decreases the risk of obesity, but
also has bene®cial effects on health. It increases
functional capacities and reduces cardiovascular risk
factors.10±12 Health improvements can derive from the
direct effect of exercise, but can also be a consequence of increased energy needs affecting food
intake.13,14 In a study conducted in Sweden,2 active
children tended to have a lower body fat content
despite a higher energy intake. This increase in
spontaneous energy intake compensates for the elevated daily energy expenditure.13 The lower body
fatness in active children could be explained by
increased energy expenditure as well as by changes
in food choice and nutrient balance.
Longitudinal studies also demonstrated the bene®cial effect of exercise on body composition.15,16
Physical activity in children
M Deheeger et al
Besides, they reported that the level of physical
activity tracks signi®cantly with age, suggesting that
children who are active at a given period were
probably active throughout their growth.
Although there are many studies relating physical
activity to body composition, only a few of them
considered the role of nutrition in this relationship in a
general population of children.
In order to investigate the relationships between
physical activity, body composition and nutrition, we
have conducted a cross-sectional study in 10 y old
French children. We have compared anthropometric
measurements and nutritional intakes in those children
who had low or high activity levels at the age of ten
years. In addition, as growth parameters had been
recorded in these children from the age of ten
months,17±19 we have also compared their growth
patterns.
Subjects and methods
The follow-up study started in 1985 for children in
Public Health Centers in Paris. The children were
recruited among a population consulting for clinical
examinations. In these centers, three examinations
were offered free of charge at 10 months, 2 and 4 y.
The main motivation of families was to obtain a free
check-up. On the ®rst visit, the parents were interviewed by the dietitian of the research team. The
families who answered the ®rst nutritional interview
had no commitment to further participation. When
they accepted the second and subsequently the third
invitation for a check-up, the dietician made the
interview. This procedure likely accounts for the
drop out rate in the study: 278 children were seen at
the age of 10 months, 192 came back for the second
check-up at 2 y and 162 for the third at 4 y of age. At
the age of 6 and 8 y, the dietitian visited the families at
home. One-hundred and twenty-six children at 6 y and
112 children at 8 y were still participating in the study.
Dietary intake
The survey was performed by a skilled and experienced dietitian on the basis of the `dietary history'
method.20,21 From the age of 6 y, the child and the
mother were interviewed for approximately 45 min
about a typical day's eating pattern. Each meal was
discussed in turn to ®nd out which food was eaten and
how often, what alternative might be used on other
days of the week and any irregularities in eating
patterns, in order to establish a menu for the month
preceeding the interview.
Variations in the child's appetite were taken into
account. When children ate outside the home, information on menus, portion size and appetite of the
child was obtained from the person or institution in
charge of the child. Nutritional intake was evaluated
according to the British food Composition Table.22
Dietary interview as well as anthropometric measurements were recorded by the same well trained investigator in all subjects.
Anthropometric measurements
Direct measurements Body weight, body height,
skinfolds and arm circumference were recorded in
the Health Centers at the ages of 10 months, 2 and 4 y
and at home, at 6, 8 and 10 y. Body weight was
obtained in children wearing light clothing on an
electronic scale. Body height was measured using a
portable stadiometer (Raven Equipment Limited).
Skinfold thickness (triceps (TRI) and subscapular
(SS) skinfolds (in mm) were measured using an
Harpenden caliper. Arm circumference was measured
with a ¯exible 1.5 cm wide tape at mid-arm.
Indices of fatness and body composition Adiposity
was assessed by the Body Mass Index (weight/
height2). Body fat distribution was assessed by using
the SS/TRI skinfold ratio (SS/TRI).
Body composition was assessed on the basis of
equations used to calculate arm areas23 from arm
circumference (C in cm) and triceps skinfold (TRI
in cm). Total upper arm area (TUA in cm2) ˆ C2/4p.
Upper arm muscle area (UMA in cm2) ˆ
(C 7 pTRI)2/4p. Upper arm fat area (UFA) is calculated by difference: TUA 7 UMA. The arm fat index
(% fat) is calculated from UFA and TUA and the arm
muscle index (% muscle) from UMA and TUA.
The BMI was calculated at all ages, and individual
BMI curves were drawn. As a rule, the curve increases
over the ®rst months of life, and then decreases until
the age of 6 y.24 A subsequent increase of the curve is
named the `adiposity rebound'. Age at adiposity
rebound is associated with bone age and is a predictor
of adult fatness.25,26
For each subject, the age at adiposity rebound,
corresponding to the nadir of the BMI curve, was
recorded. Age at adiposity rebound presented in Table
1 (n ˆ 86) was assessed on the basis of the six
measurements recorded for the study (mean age ˆ
5.6 1.7 y). Intermediate measurements (measured by
the mother or recorded in the child's health booklet)
were also obtained. In 57 children, adiposity rebound
was assessed on the basis of the yearly recorded
measurements (mean age ˆ 5.6 1.8 y). Results were
similar using both sets of data. In the ®gure, values
recorded for the study (on even years) and intermediate values (on odd years) are given.
Physical activity interviews
Physical activity was assessed in 86 children at the
age of 10 y between May 1994 and March 1995 using
a questionnaire27,28 adapted for children8 (see Appendix A). The parents and the child were interviewed
373
Physical activity in children
M Deheeger et al
374
Table 1 Anthropometric measurements and food intake in 10-year-old children according to physical activity level
Physical activity level
Total
low
high
n ˆ 86 boys ˆ 54
girls ˆ 32
mean s.d.
n ˆ 57 boys ˆ 36
girls ˆ 21
mean s.d.
n ˆ 29 boys ˆ18
girls ˆ11
mean s.d.
F
P
Past year physical activity h/week
(Boys)
(Girls)
including sport, h/week
Weight kg
Height cm
BMI kg/m2
Skinfolds: triceps mm
subscapular mm
Subscapular/triceps
Arm circumference cm
arm fat %
arm muscle %
Age at adiposity rebound yrs
14.3 4.8
15.2 4.9
12.6 3.9
1.8 1.7
32.9 6.2
138.6 6.0
17.0 2.3
11.4 3.7
7.5 3.0
0.66 0.16
19.9 2.1
32.2 7.1
67.8 7.1
5.6 1.7
11.6 3.1
12.3 3.2
10.7 2.8
1.4 1.5
33.2 6.6
138.7 6.3
17.1 2.5
12.1 4.3
8.0 3.0
0.68 0.19
20.1 0.29
33.0 6.9
67.0 6.9
5.4 1.8
19.4 2.8
20.3 2.8
17.5 1.6
2.6 1.7
32.4 5.4
138.3 5.5
16.8 1.9
10.4 3.8
6.8 3.0
0.66 0.13
19.9 0.4
29.5 7.1
70.5 7.1
6.1 1.5
128
85.7
47.4
11.9
0.39
0.10
0.27
3.11
2.65
0.51
0.17
4.70
4.70
4.00
< 0.001
< 0.001
< 0.001
< 0.001
0.56
0.75
0.60
0.08
0.10
0.48
0.67
0.03
0.03
0.049
Nutritional intakes
Energy kcal
Protein g
Fat g
CHO g
including sucrose g
2123 377
79.8 13.6
85.8 14.4
258.0 61.5
60.1 31.5
2058 353
77.8 13.3
84.0 14.9
246.4 59.9
57.7 33.4
2252 389
83.4 13.9
89.9 15.9
281.4 58.4
65.1 27.6
5.39
3.23
2.91
6.55
1.06
0.02
0.08
0.09
0.01
0.31
% energy
Protein %
Fat %
CHO %
including sucrose %
15.1 1.7
36.7 4.3
48.1 5.1
11.2 4.7
15.3 1.6
37.4 4.5
47.4 5.3
10.7 5.0
14.9 1.8
35.4 3.7
49.6 4.3
12.0 4.1
0.95
4.44
4.09
1.41
0.33
0.04
0.046
0.24
together. The questionnaire assesses physical activity
over the past year: daily activity (such as walking,
running, cycling, skating . . .) weekly activity (sports
at school or in a club) and occasional sports and
activity (during holidays). Total annual physical activity is expressed as a mean in hour/week. Time spent in
a club for regular sport or competitions is included in
the weekly mean of past year sport leisure activity, but
is also presented separately (Table 1). Time spent
watching TV or video games was also recorded in the
questionnaire.
The two subgroups of children were constituted on
the basis of the physical activity level. As boys are
more active (15.3 h/week) than girls (12.6 h/week),
subgroups were established separately for boys and
girls. In total, the mean physical activity, corresponds
to 2 h/d in this population. In order to identify really
active children and because of the similarity between
the two ®rst tertiles (both groups had 33% arm fat
area), we have selected two subgroups as follow: the
low active group includes the ®rst and second tertiles
(<17.5 h/week in boys and <14 h/week in girls), the
active group corresponds to the third tertiles of the
activity level distribution. Expressed in h/d, the low
active group corresponds to less than 2.5 h/d in boys
and less than 2 h/d in girls.
Socio economic status
Social groups were established on the basis of the
INSEE (Institut National de la Statistique et des
Etudes Economiques) classi®cation. The partition of
the sample was made according to the profession of
the person in charge of the family: executive and
liberal professions (39%), skilled workers (39%),
unskilled and semiskilled workers (22%). This classi®cation differs from the classi®cation of the professions in the Paris area (active population): 19%, 58%
and 22% in the three categories respectively. We
found more executive and liberal professional and
less skilled workers in our sample.
Statistical analysis
The results were expressed as mean standard deviation. Pearson correlation coef®cients (r) were determined to test the relationships between variables.
Anova test was applied for comparison of parameters
between groups. The impact of Socio Economic
Status (SES) on physical activity and nutritional
intakes was analysed with Anova two ways for testing
the interactions between these variables. Statistics
were performed using Abacus Concepts Statview. A
P-value of less than 0.05 was considered statistically
signi®cant.
Results
Anthropometric measurements and nutritional intakes
are presented in Table 1 according to the level of
physical activity.
Physical activity in children
M Deheeger et al
Nutritional intakes and physical activity
Figure 1 BMI development between birth and 10 y of age
according to physical activity level at the age of 10 y: Low,
n ˆ 57 (- - -), High, n ˆ 29 (ÐÐ). Age at adiposity rebound is
5.4 1.8 y in the less active group and 6.1 1.5 y in the more
active group (P ˆ 0.049). *P ˆ 0.02 between the BMI of the two
groups at the age of 4 y.
Past-year physical activity corresponds to 11.6 h/
week in the less active group and 19.4 h/week in the
more active group. Time spent in a club for regular
sport or competition, which is included in this previous mean, is twice as high in the active (2.6 h/week)
than in the less active group (1.4 h/week).
Anthropometric measurements and physical activity
At the age of 10 y, body weight, height, the BMI,
skinfolds (SS and TRI), the SS/TRI skinfold ratio and
arm circumference do not differ according to the
physical activity level (Table 1).
However, body composition is different: the percentage of fat-mass in the less active group is signi®cantly higher than in the more active group:
33.0 6.9% vs 29.5 7.1% respectively (P ˆ 0.03).
Total physical activity is positively associated with
the percentage of fat free mass (r ˆ 0.23; P ˆ 0.03)
but when free living exercise and sports are considered separately, the correlations are r ˆ 0.17
(P ˆ 0.13) and r ˆ 0.20 (P ˆ 0.06) respectively.
The BMI development differs between the less
active and the more active children (Figure 1).
Before the age of 6 y, the BMI tends to be lower in
the less active than in the more active children. The
difference reaches the signi®cant level at the age of
4 y (15.2 1.2 vs 15.9 1; P ˆ 0.02). Subsequently
after an earlier adiposity rebound in the less active
children (5.4 1.8 and 6.1 1.5 y in the less and the
more active groups respectively; P < 0.05), their BMI
catches up with the BMI level of the more active
group.
From the age of 4 y, the percentage of arm muscle
area tends to be higher in the more active group, and
the difference reaches the signi®cant level at the age
of 10 y.
At the age of 10 y, energy intake and physical activity
are closely related: the more active the children, the
higher their energy intake (r ˆ 0.38; P < 0.001). When
free living exercise and sports are considered separately, the correlations are r ˆ 0.33 (P ˆ 0.002) and
r ˆ 0.16 (P ˆ 0.14) respectively.
Active children consume daily, 196 kcal more than
less active children. This difference is only accounted
for by an increase in carbohydrate (CHO) intake, but
not by sucrose. As a consequence, the percentages of
energy from CHO and from fat differ between the two
groups: active children consume a higher proportion
of CHO and a lower proportion of fat. A signi®cant
positive correlation between physical activity and
food consumption is recorded for bread (r ˆ 0.22;
P ˆ 0.04), vegetables (r ˆ 0.22; P ˆ 0.04) and yoghurt
(r ˆ 0.27; P ˆ 0.02).
Increased energy intake in active children is related
to an increase in energy at breakfast: 444 kcal 143
vs 359 kcal 123 (P ˆ 0.01) and in the afternoon:
407 kcal 156 vs 313 kcal 166 (P ˆ 0.01). Energy
intakes at lunch, dinner and from snack are similar
between the two groups.
Over the whole period of growth, active children
tend to consume more energy than the less active
children (22 kcal at the age of 2 y, 68 kcal at 4 y,
35 kcal at 6 y and 91 kcal at 8 y), but the difference
does not reach the signi®cant level.
Physical activity and social class
Socio economic status is not signi®cantly associated
with physical activity and does not interact in any
relationship examined here. However, children from
unskilled workers families (n ˆ 20) tend to be less
active (13.1 4.9 h/week) than children from families
of intermediate (n ˆ 33) and executive or liberal
professions (n ˆ 33): respectively 14.7 5.7 and
14.7 4.2 h/week (P ˆ 0.36).
Television watching and physical activity
Time spent watching TV at the age of 10 y is signi®cantly and positively correlated with the BMI
(r ˆ 0.27; P ˆ 0.01), the triceps skinfold (r ˆ 0.24;
P ˆ 0.03) and the subscapular skinfold (r ˆ 0.26;
P ˆ 0.02).
All analyses were also performed separately by sex.
The same tendencies were observed for all variables.
Discussion
Exercise is often recommended for its health bene®ts.
The present study con®rms that physical activity is
associated with improved body composition. However
this positive effect seems to appear only above a
minimal level of activity, as no difference was
recorded between the lower two tertiles of the activity
375
Physical activity in children
M Deheeger et al
376
level distribution. The same remark was reported in a
study of physical activity cardiovascular risk factors
and weight in children.29 In order to compensate for
elevated energy expenditure, active children consume
signi®cantly more energy than their less active peers.
This higher energy intake is correlated more with free
living activity than with sport. Increased energy intake
is provided by CHO, and consequently the proportion
of energy provided by fat is decreased. Then, the
nutrient balance in active children is closer to the
usual dietary recommendations of 12% energy provided by proteins, 30±35% by fat and 50±55% by
CHO.30 These recommendations are valid for children
(except for infants) and for adults. The association
between increased physical activity, increased energy
intake and improved body composition was reported
in previous studies.2,11,31,32 In a study conducted in
Finland,16 physical activity was associated with lower
percentage of energy provided by saturated fat. These
results suggest that the bene®ts of exercise could be
explained through nutritional changes. The increase in
CHO intake in our study, might result from an
increased preference for CHO14 and/or from speci®c
metabolic needs compensating CHO oxidation rate in
response to an increase in energy expenditure.13 It can
also be the consequence of an increased concentration
of neuropeptide Y induced by exercise.33 Physical
activity increased complex carbohydrate intake but
not the total amount of simple sugars. This observation is consistent with increased consumption of
starch but not of sucrose, reported in rats, when
energy needs are high (after fasting).34
The larger breakfast in active children can be
related to blood glucose and insulin circadian variations.35 The daily distribution of energy, with
increased energy intake at breakfast, has been reported
to be a more favourable practice.36,37
The later adiposity rebound recorded in active
children is also a favourable index of the growth
process, as most obese subjects have an early adiposity rebound.24,25 To relate physical activity and adiposity rebound, we speculated that the children who
were active at the age of ten years were also active at
previous periods of growth. This assumption was
based on the demonstrated tracking of physical activity during growth.15,16 The tendency of a higher
percentage of fat-free mass and a higher energy
intake from the age of 4 y in the active group, suggest
that these children were indeed active throughout their
growth. In a previous analysis conducted in the present population,17 it was observed that an early adiposity rebound, re¯ecting advanced maturation, was
associated with a high protein intake in early childhood. Inactivity is also associated with an early
adiposity rebound. From this observation, we suggest
that physical activity could regulate growth process,
avoiding too accelerated maturation.
The trend of increased body fatness and decreased
energy intake recorded in several studies2,3,38 suggest
a trend of decrease in physical activity. In a previous
study, conducted in 10 y old children examined in
1978, we observed that these children consumed more
energy than the 10 y old children of the present study
(2326 in 1978 and 2102 kcal in 1995) and had a
weaker BMI (16.5 and 17 kg/m2 respectively).38 Children examined 17 y ago were comparable for energy
intake and for BMI, with the more active children of
the present study. This observation suggests that their
activity level might also be comparable. The time
spent watching TV is an important factor contributing
to the decrease in physical activity. As reported earlier,7,39 we found a signi®cant correlation between the
time spent watching TV/videos and adiposity (BMI
and skinfolds).
Physical activity has a bene®cial effect by improving functional pulmonary indices.10 It can prevent
obesity development and risks associated with overweight such as insulin resistance and cardiovascular
diseases.13,14 It decreases blood pressure,40 plasma
insulin and triglycerides and increases HDL cholesterol.41 All these bene®cial changes could result from
exercise itself, but also from dietary changes, particularly by a decrease in the percentage of dietary fat.
Indeed, it is paradoxical that the less active children
who have lower energy needs, consume a higher
proportion of energy provided by fat, as a high fat
diet is more adapted for high energy needs.42 Other
health bene®ts of physical exercise have been discussed previously.43
Conclusions
The present study con®rms some previous studies
showing an association between physical activity
and improved body composition. This study also
suggests a bene®cial effect on growth pattern. These
associations may be related to nutritional changes:
active children consume more energy by increasing
carbohydrates and consequently, the relative fat content of their diet is reduced. The higher body fatness in
the less active children could be explained by a
greater dif®culty to adjust the balance between
energy needs and energy expenditure. This dif®culty
could be due to the alteration of nutrient balance of
their diet.
These results provide support to encourage physical
activity during childhood.
Acknowledgement
The authors gratefully acknowledge France Bellisle
for her help in improving the manuscript.
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Appendix A
Activity questionnaire
Physical activity in children
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