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A Cluster Mediation Analysis Confirms the Validity of the “Fat but Fit” Paradigm in Children’s Cognitive Function and Academic Achievement - 22/03/21

Doi : 10.1016/j.jpeds.2020.12.062 
Vicente Martinez-Vizcaino, MD, PhD 1, 2, Celia Álvarez-Bueno, PhD 1, 3, , Mairena Sanchez-Lopez, PhD 1, 4, Estela Jimenez-Lopez, PhD 1, 5, 6, Alba Soriano-Cano, MSc 1, Francisaco B. Ortega, PhD 7, 8, Ivan Cavero-Redondo, PhD 1, 3, Miriam Garrido-Miguel, MSc 1
1 University of Castilla-La Mancha, Social and Health Care Research Center, Cuenca, Spain 
2 Universidad Autónoma de Chile, Faculty of Medicine, Providencia Talca, Chile 
3 Universidad Politécnica y Artística de Paraguay, Asunción, Paraguay 
4 University of Castilla-La Mancha, Faculty of Education, Ciudad Real, Spain 
5 Department of Psychiatry, Hospital Virgen de La Luz, Cuenca, Spain 
6 Biomedical Research Networking Centre in Mental Health, Barcelona, Spain 
7 PROmoting FITness and Health Through Physical Activity Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain 
8 Department of Biosciences and Nutrition, Karolinska Institute, Solna, Sweden 

Reprint requests: Celia Álvarez-Bueno, PhD, C/ Santa Teresa Jornet, s/n, cp 16071, Cuenca, SpainC/ Santa Teresa Jornet, s/n, cpCuenca16071Spain

Abstract

Objective

To evaluate the fat but fit conceptual model, testing whether this paradigm for body mass index (BMI) and maximum rate of oxygen consumption (VO2max) exists in schoolchildren and whether executive functions mediate the relationship between fat but fit categories and academic achievement.

Study design

Cluster cross-sectional analyses of data from 554 children aged 9-11 from Cuenca, Spain. BMI, VO2max, core executive functions (inhibition, working memory, and cognitive flexibility) and academic achievement (language and mathematics).

Results

Cluster analysis of BMI and VO2max z-scores resulted in a 4-cluster solution that could be interpreted according to fat unfit, unfat unfit, fat fit, and unfat fit categories. ANCOVA models confirmed an increasing trend by cluster category in terms of VO2max levels and, conversely, a decreasing trend in terms of adiposity variables. These models also confirmed that children in the fat fit and unfat fit categories scored higher than their peers in the fat unfit and unfat unfit categories. Mediation analyses using fat but fit clusters as multicategory independent variable, executive functions as mediators, and academic achievement as outcome variable showed that the positive association between the BMI-VO2max clusters and academic achievement was mediated by inhibition levels in fat fit and unfat fit individuals, by working memory levels only in those classified as fat fit, and by cognitive flexibility only in unfat fit individuals.

Conclusions

This study confirms the validity of the 4-cluster conceptual model regarding BMI and VO2max and reinforces the predictive validity, proving that fitness levels are able to counteract the detrimental effect of obesity on academic achievement.

Il testo completo di questo articolo è disponibile in PDF.

Abbreviations : BMI, VO2max


Mappa


 Supported by the Ministry of Economy and Competitiveness Carlos III Health Institute and FEDER funds (FIS PI19/01919). A.S-C. (Fi 17/332) is a recipient of a predoctoral fellowship by the Spanish Ministry of Economy, Industry and Competitiveness. F.O. is supported by grants from CSD in Spain (109/UPB31/ 03), the Spanish Ministry of Education (AP2003-2128) and the Margit and Folke Pehrzon Foundation. The authors declare no conflicts of interest.


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