Is Body Fat Mass Associated with Worse Gross Motor Skills in Preschoolers?

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Juliana Nobre, Rosane Morais, Amanda Fernandes, Ângela Viegas, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-120980/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives: To compare the motor competence of overweight/obese preschoolers with eutrophic peers with a similar level of physical activity, sex, age, socioeconomic status, maternal education, quality of the home environment and quality of the school environment, and to verify the association of body fat mass with gross motor skills in preschoolers. Design: Quantitative, exploratory, cross-sectional study design. Methods: Forty-nine children, aged 3 to 5 years old, from public schools in a Brazilian city were classified into eutrophic and overweight/obese groups. Results: Overweight/obese preschoolers had worse Locomotor subtest standard scores than their eutrophic peers (p = 0.01), but similar skills, Object Control subtest scores and Gross Motor Quotient (p > 0.05). Excess body fat mass explained 13% of the low Locomotor subtest standard scores in preschoolers (R 2 = 0.13; p = 0.007). Conclusion: Excess body fat mass is associated with worse locomotor performance when the model is adjusted for contextual factors such as level of physical activity, sex, age, socioeconomic status, maternal education, quality of the home environment and quality of the school environment. Thus, excess body fat mass partly explains lower locomotor skills in preschoolers. These findings may assist with the development of public guidelines aimed at child health in order to outline strategies that enable the stimulation of locomotor skills in preschoolers with excess body fat mass. Pediatrics Child Motor skill Physical Activity Pediatric Obesity Locomotor Performance Object Control 1. Introduction Pediatric obesity is a serious public health issue around the world and is associated with environmental, social, psychological and genetic factors 1 . Early detection and knowledge on factors that influence children's lifestyle habits may support public policies and promote the creation of healthy lifestyle habits in subsequent life stages, including among adults 2 . Early childhood, especially the preschool period between 3 to 5 years 3 , is the stage of life when the body mass index (BMI) is reduced to a minimum physiological value known as adiposity rebound 4 . It is also considered a sensitive phase for learning fundamental movements; it is a time to expand the motor repertoire and experience the movements that will contribute to the development of future skills that will evolve into sports or leisure practices 5 . Studies indicate the preschool period as the critical moment for the development of motor skills and healthy behaviors that may last with physical activity (PA) practices throughout life 6 , 7 . In a systematic review 8 on obesity in Brazilian children, the authors stated that studies are scarce, although there has been an increase in publications in recent years. Thus, there is lack of studies including only children in the preschool phase, since the literature presents research with children in a wide range of ages, and at many stages of biological maturation 9 . Regarding motor competence (MC), studies that examined the relationship between MC and body fat mass in preschoolers used variables such as BMI 9 , waist-hip circumference 7 , or body fat mass measured with bioelectrical impedance 10 . Research indicates that there is an inverse relationship between excess weight and MC 11 , and it has been suggested that overweight/obese children have worse motor skills 7 , 12 . However, to avoid bias in data interpretation, it is crucial to verify the relationship between excess weight and MC while controlling for other factors that may influence motor development in preschoolers, such as socioeconomic status, maternal education 13 , home environment, school environment 14 , and PA 10 . Thus, to the best of our knowledge, there remains a gap in the literature regarding the control of these factors in studies with preschoolers. In addition, the wide age range of previous studies limits the validity, interpretation and extrapolation of the results for preschoolers 8 . In light of the above, is excess body fat mass a factor associated with worse gross motor skills when factors such as socioeconomic status, home and school environment, maternal education, and PA are controlled in preschoolers? Thus, the objective of the study was: 1) To compare the gross MC of overweight/obese preschoolers with eutrophic peers, controlling for PA, sex, age, socioeconomic status, maternal education, quality of the home environment and quality of the school environment. 2) Investigate to what extent excess body fat mass explains gross motor skills in preschoolers. The strength of the present study is the consideration of multiple factors that influence child development 10 , 14 . 2. Methods This is a quantitative, exploratory, cross-sectional study approved by the Research Ethics Committee of Universidade Federal dos Vales do Jequitinhonha e Mucuri UFVJM (Protocol: 2.773.418), with written informed head parent consent and participant assent. All methods were carried out in accordance with relevant guidelines and regulations in the manuscript. Data collection took place from July to December 2019. Pre-school children, that is, children from 3 to 5 years old, from public schools in a Brazilian municipality, were eligible. Exclusion criteria were: preterm and low birth weight infants; infants with pregnancy and delivery complications; infants with signs of malnutrition or illness that interfere with growth and development; and infants who had been subject to an infectious process (such as fever, influenza, and diarrhea) in the previous 21 days. The sample size was based on a pilot study with five children in each group, in which a minimum difference of 2.70 was found between the groups for Locomotor subtest standard scores of the TGMD2, with a standard deviation (SD) of 3.50. For sample calculation, a power of 90%, and an alpha error of 5% were considered, with 20 participants thus being required for each group, totaling 40 subjects. For the assessment of body composition, total body mass was measured and body fat mass was found using dual energy radiological absorptometry (DEXA) (Pediatric medium scan mode software, Lunar Radiation Corporation, Madison, Wisconsin, USA, model-DPX). Weight and height measurements were taken during the study visits. The children’s weight was measured to the nearest 0.1 kg with an electronic scale. The standing height of the children was measured to the nearest millimeter with a wall-mounted stadiometer. The children removed their shoes and socks before stepping on the scale and were told to stand in an upright position when measuring height. Age-specific BMI was calculated as body weight (kg) divided by body height squared (m 2 ) 16 . Considering the high correlation found between the amount of body fat mass and BMI (r = 0.90, p = 0.00), and according to studies on body composition and BMI 15 , participants were classified into groups according to BMI, following World Health Organization (WHO) recommendations. The WHO reference curves by gender and age were considered, using the calculation software WHO Anthro version 3.2.2 16 . Children with a BMI < 85 were considered eutrophic and allocated to Group 1, whereas children with a BMI ≥ 97 were considered overweight/obese and allocated to Group 2. Sex, age, socioeconomic status, maternal education 13 , PA 10 , quality of the home environment and quality of the school environment 14 were collected for control. Sociodemographic variables were collected using a specific questionnaire. To verify the economic level of families, the Brazil economic classification criterion, from the Brazilian Association of Research Companies was used. This is a questionnaire that stratifies the general economic classification resulting from this criterion from A1 (high economic class) to E (very low economic class) 17 . The quality of the environment in which the child lives was assessed using the Early Childhood Home Observation for Measurement of the Environment (EC_HOME) 18 . The EC_HOME is applied through observation and semi-structured interviews during home visits, standardized for children aged 3 to 5 years. The instrument contains 55 items divided into 8 scales: I-Learning materials, II-Language stimulation, III-Physical environment, IV-Responsiveness, V-Academic stimulation, VI-Modeling, VII-Variety, VII-Acceptance. For analysis, the sum of the raw scores of the subscales was used. The quality of the school environment was assessed using the Early Childhood Environment Rating Scales (ECERS) 19 , which contain inclusive and culturally sensitive indicators for many items. The scale consists of 43 items organized into 7 subscales (1-Space and Furnishings, 2-Personal Care Routines, 3-Language and Literacy, 4-Learning activities, 5-Interactions, 6-Program Structure, 7- Parents and staff). Each quality indicator was marked, considering its presence or absence in each collective environment (classroom), with the items scored from 1 to 7. The final score of the scale is given by the mean of the seven subscales. It is an ordinal, increasing scale, from 1 to 7, the interpretation of quality being 1: inadequate; 3: minimal (basic); 5: good; 7: excellent. The PA level was measured using an accelerometer (Actigraph®- Model GT9X); for a period of 3 days, without including the weekend 21 , for a minimum of 570 minutes a day 10 , which is considered suitable for preschoolers 21 . Accelerometers were initialized and analyzed using 5-second epochs. In all analyses, consecutive periods of ≥ 20 minutes of zero counts were defined as non-wear time 20 , with a sampling rate of 60 Hz. The acceleration units were expressed in triaxial vector magnitude (VM). The accelerometer was positioned on the right side of the hip to capture accelerations and decelerations of the body and determine objective measurements of gross acceleration, intensity of physical activity, heart rate intervals and total time of suspension of use 20 . Pediatric cutoff points validated for preschool children, with score values, classify as sedentary (0 to 819 counts / m), mild (820 to 3907), moderate (3908 to 6111) and vigorous (above 6612) 22 . For this study, the child's mean time at these intensities was used. The classification adopted for “active” or “insufficiently active” was established according to the WHO, which considers an active child to be one who has a PA of at least 180 minutes/day, with a minimum of 60 minutes/day in moderate to vigorous PA 2 . In addition, information was gathered on environmental opportunities for active and sedentary behavior, such as the time of exposure to screens; the presence of internal (30 m 2 per inhabitant) and external (backyard) physical space at home; and the presence of a playground at school, among other variables relevant to the study. The variable “time of exposure to screens” was classified considering the parents' report of the time in minutes that the child was exposed to a screen (television and cell phone) and later classified within the recommended limit (less than two hours) and above the recommended limit (two hours and over) according to the guidelines of the American Pediatric Association 23 . MC was measured using the Test of Gross Motor Development second edition (TGMD-2). The reference is based on a norm and criterion for the development of children between three and ten years old. It consists of 12 motor skills divided into two subtests, locomotor (run, leap, gallop, hop, jump, and slide) and object control (catch, strike, bounce, over and underhand throw, and kick). For each skill, specific motor criteria was observed, based on mature movement patterns referenced in the literature and by professionals in the field. The results obtained for each subtest were added and the raw scores were converted into normalized scores for sex and age with a mean of 100 ± 15 24 , validated for Brazilian children 25 . For the study, the standardized scores described in Locomotor subtest standard scores (LS), Object Control subtest (OC) and Sum of the Gross Motor Quotient (GMQ) (which includes the LS and OC) were used. The reliability for TGMD2 showed intra-class correlation coefficients (ICC) of 0.895 for the LS, 0.925 for OC and 0.841 for GMQ. All tests and measurements including body weight, height, assessment of gross MC, as well as questionnaires were applied by one trained examiner. The children were evaluated in the same places, following the order of previously defined evaluations, with an interval between collections of a maximum of 3 weeks. The data were analyzed using the Statistical Package for the Social Sciences (SPSS version 2.2). First, the Shapiro-Wilk test was performed to assess data normality, followed by Levene's test to verify the homogeneity of the variance. Subsequently, the descriptive statistics of continuous variables were demonstrated as median (minimum and maximum) and mean (standard deviation), as appropriate. Subsequently, Chi-squared tests were applied to compare the proportion of eutrophic groups (G1) and overweight (G2). To verify differences between groups, the t-test for independent samples (for variables with normal distribution) or the Mann-Whitney test (for variables with non-normal distribution) was used. Spearman's or Pearson’s correlation was performed to verify the relationship between body fat mass and gross motor competence variables, followed by the multiple linear regression model. Statistical significance was set at 5%. Since sex, age, maternal education, socioeconomic status, PA level, quality of the home environment and quality of the school environment could be confounding factors, the analysis was adjusted for these variables. A residual analysis showed a normal distribution and homogeneous variance in all regression models. The magnitude of the effect (d) was also verified. 3. Results Forty-nine children, 25 eutrophic and 24 overweight were evaluated and their characteristics are shown in Table 1 . Of the group with excess body weight, 17 children (70.8%) were obese and 7 (29.2%) were overweight. Table 1 Characterization of participants Variable Eutrophic Overweight Test p-value N = 25 N = 24 Age (years) 5(3–5) 5(3–5) 274.0 a 0.534 School shift (Full-time) 10(40.0) 7(29.1) 0.63 c 0.420 Sex 0.19 c 0.656 Female 12(48.0) 10(41.6) Male 13(52.0) 14(58.3) Mother's age (years) 31.17 ± 5.92 31.88 ± 5.81 -0.41 b 0.670 economic status 225.50 a 0.121 B 4(16.0) 9(37.5) C 18(72.0) 13(54.1) D-E 3(12.0) 2(8.3) Maternal Education 290.50 a 0.827 Primary 3(12.0) 5(20.8) Secondary 18(72.0) 12(50.0) Higher 4(16.0) 7(29.1) School has playground / space 0.01 c 0.921 Yes 17(68.0) 16(66.6) No 8(32.0) 8(33.3) House has 30 m 2 / inhabitant 2.48 c 0.115 Yes 10(40.0) 15(62.5) No 15(60.0) 9(37.5) House has backyard 0.02 c 0.869 Yes 11(44.0) 10(4.6) No 14(56.0) 14(58.3) Screen time (%) 1.64 c 0.200 Less than two hours 17(68.0) 12(50.0) Two hours and over 8(32.0) 12(50.0) Amount of body fat mass 3.74(2.49–6.47) 11.10(6.14–18.12) 1.00 a < 0.001 Mean Intensity of PA(minutes) Sedentary 398.29 ± 40.7 397.74 ± 46.42 0.04 b 0.965 Light PA 190.23 ± 36.8 185.08 ± 32.94 0.51 b 0.612 Moderate PA 37.33 ± 10.93 42.02 ± 9.51 -1.43 b 0.158 Moderate to Vigorous PA 58.93 ± 15.15 61.09 ± 14.30 -0.50 b 0.614 Classification of PA d N = 48 0.07 c 0.509 Active 12 (50) 14 (58.33) Insufficiently active 12 (50) 10 (41.66) EC-HOME 37(30–47) 41(30–50) 212.5 a 0.077 ECERS Room quality 2.6(1.9–2.9) 2.7(1.9–2.9) 288.0 a 0.809 Data presented by mean ± standard deviation, median (min-max) or n (%). PA: physical activity. EC-HOME: Early Childhood Home Observation for Measurement of the Environment. ERCS: Early Childhood Environment Rating Scales. a Mann-Whitney U Test. b T test for independent samples. c chi-squared test. d N = 48. The mean age in both groups of preschoolers was 5 years. Most of the children belong to extract C in the economic classification. In both groups there was a predominance of young adult mothers with complete high school education. Of the participants, more than half study part-time in schools whose facilities contain a playground and some physical space for PA, assessed with marks corresponding to the minimum rating for quality of the school environment (Table 1 ). There was no difference between groups for variables that influence children's motor behavior and others that characterize them. However, the amount of body fat mass differed between groups (Table 1 ). There was no difference between groups for OC subscales and GMQ. A significant difference was found in the LS between the groups, with lower values for the group with excess body weight compared to normal weight peers (Table 2 ). The post-hoc analysis, considering an effect size of 0.73 (alpha value = 0.05), revealed a large statistical power for the LS (Power = 0.81). Table 2 Comparison between groups for Motor Competence Eutrophic (N = 25) Overweight (N = 24) Difference between groups* p-value 95%CI TGMD2 LS 9.08 ± 1.86 7.63 ± 2.08 2.58 0.013 0.31–2.59 TGMD2 OC 8(4–15) 8(6–12) 287.5 0.800 0.39–0.41 TGMD2 GQM 93.20 ± 10.97 87.54 ± 9.09 1.96 0.055 -0.14-11.46 Data presented by Mean ± standard deviation or median (Minimum-Maximum). *T-test for independent samples u Mann-Whitney U test. Abbreviations: TGMD2 LS = Locomotor subtest standard score. TGMD2 OC = standardized Object Control subtest, TGMD2 GMQ = Gross Motor Quotient. The amount of body fat mass correlated with the LS (inverse relationship, r = -0.38, p-value = 0.007). Multiple linear regression analysis showed that there was an inverse relationship between body fat mass and LS. The increase for body fat mass explained 13% of the low values in the LS in preschoolers. In other words, the increase of 1 kg of body fat mass leads to a reduction of 0.38 points in the LS, with medium effect size (d = 0.16) (Table 3 ). Finally, control variables were inserted in the regression model, but they did not affect the values of β and R 2 . Table 3 Multiple linear regression between body fat mass and Locomotor standard score (N = 49). Variable ẞ B 95% CI p-value R 2 Body fat mass -0.388 -0,199 -0.341– (-0.057) 0.007 0.13 Note: ẞ= standard regression coefficient; B = non-standard regression coefficient; 95% CI = 95% confidence interval; estimate of the increase or decrease of the dependent variable for each increase of one unit of the independent variable; p = statistical significance; R 2 = coefficient of determination. 4. Discussion This study aimed to verify the MC of overweight/obese and eutrophic preschoolers controlled for PA 10 , sex, age, socioeconomic status, maternal education 13 , quality of the home environment and quality of the school environment 14 . The identification of variables that could interfere with development has an important clinical meaning, since the child's reciprocal relationships with the environment can influence child development 14 , 26 . Regarding gross MC, body fat mass was the only factor that showed a difference between the groups. To the best of our knowledge, this study is the first that presents robustness in the comparison between eutrophic and overweight/obese preschoolers, as direct measurement of energy expenditure was used. Moreover, variables that interfere in the development of preschoolers were controlled, these being socioeconomic status, maternal education 13 , the quality of the domestic environment and with it, availability of resources and toys, trips and opportunities for stimulating experiences, use of free time, family routines and meetings, physical space of the home environment and the direct involvement of parents in the child's life 18 , 14 . In addition, the quality of the school environment 19 , and screen time 23 were also controlled. As such, none of the controlled variables differed between the groups. The amount of body fat mass, namely excess body fat mass, appears as a factor that interferes with MC in LS; however, it did not interfere with OC skills, which are tasks that require more specific skills without large displacements 7 . Being overweight/obese seems to hinder displacements and body image, since antigravity activities are more difficult 27 , 9 due to the morphological restrictions to movement within high biomechanical restrictions that make it more challenging to perform tasks involving changes in the center of mass 12 . Other studies have also found an inverse relationship between weight and motor skills 28 , 26 and between excess body fat mass and motor skills in preschoolers 10 , 12 . In Brazil, studies 7 using the same motor test as the present study found an inverse relationship between LS and central obesity in preschoolers in the same age group (3 to 5 years). The authors also found no association between central obesity and OC. Excess body fat mass is associated with worse MC 10 , as being overweight/obese seems to contribute to declines in motor proficiency. Cheng et al., 29 investigated temporal precedence in the relationship between MC and weight status in schoolchildren aged between 5 and 10, finding that poor MC did not predict weight gain. However, higher weight status is a precursor and not a consequence of poor MC. These data corroborate the findings of the present study and confirm the hypothesis, since having a greater amount of body fat mass predicts 13% of the worse result on the LS. Thus, the results of the present study add to the current literature, as they provide additional evidence for the development of protective policies related to pediatric health, since the relative declines in children's motor proficiency can serve as a catalyst for inactivity and consequent weight gain with advancing age 26 , 30 . This study has both limitations and strengths. The sample was small. However, the sample calculation and post hoc analysis demonstrated that the sample size was sufficient to achieve a medium to large effect size. The study has a cross-sectional format, which does not allow inferring a cause-and-effect relationship, requiring more longitudinal studies that examine the development of MC over time and its relationship with other health-related results. However, as far as is known, this is the first study that controlled for determining factors in development to compare overweight/obese and paired-eutrophic preschoolers. Among the strengths are the short data collection interval (maximum of three weeks), the use of a standardized instrument for assessing MC 24 , validated for Brazilian children 25 , direct measurement of PA 10 , and a gold-standard measure to determine body fat 15 . Finally, relevant factors that interfere in child development were taken into account, these being socioeconomic level, maternal schooling 13 , quality of the school environment 14 , 20 and quality of the home environment 14 , 18 . 5. Conclusions Children with excess body fat mass in developmental conditions similar to eutrophic children have worse LS, demonstrating that excess body fat mass influences competence in locomotor skills in the preschool phase. These findings may assist with the development of public guidelines aimed at child health in order to outline strategies that enable the stimulation of locomotor skills in preschoolers with excess body fat mass. Practical implications: When factors that interfere with child motor development, i.e., maternal education, socioeconomic status, PA, sex, age, quality of the home environment and quality of the school environment are controlled, preschoolers with excess body fat mass have worse locomotor skills than eutrophic preschoolers. Excess body fat mass is probably a precursor to lower locomotor competence, showing the importance of strategies to stimulate locomotor skills in preschoolers, especially in the context of pediatric obesity. Public guidelines could include strategies that enable the stimulation of locomotor skills in preschoolers with excess body fat mass. Declarations ETHICS APPROVAL AND CONSENT TO PARTICIPATE This study was approved by the Research Ethics Committee of Universidade Federal dos Vales do Jequitinhonha e Mucuri UFVJM (Protocol: 2.773.418), with written informed head parent consent and participant assent. All methods were carried out in accordance with relevant guidelines and regulations in the manuscript. CONSENT FOR PUBLICATION The researchers of this study confirm that they have given due consideration to protect the intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. In so doing we confirm that we have followed the regulations of our institutions concerning intellectual property. AVAILABILITY OF DATA AND MATERIALS The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. COMPETING INTERESTS 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. The authors declare no financial interests/personal relationships which may be considered as potential competing interests. FUNDING There are currently no Funding Sources in the list. AUTHORS' CONTRIBUTIONS Juliana Nogueira Pontes Nobre: Formal analysis, Data Curation, Methodology Rosane Luzia De Souza Morais: Formal analysis, Data Curation, Methodology, Writing Review & Editing – Original Draft Amanda Cristina Fernandes: Writing – Review & Editing Ângela Alves Viegas: Conceptualization, Data Curation, Writing, Review & Editing – Original Draft Pedro Henrique Scheidt Figueiredo: Writing – Review & Editing Henrique Silveira Costa: Writing – Review & Editing Ana Cristina Resende Camargos: Writing – Review & Editing Vanessa Amaral Mendonça: Writing – Review & Editing Ana Cristina Rodrigues Lacerda (corresponding author): Formal analysis, Data Curation, Methodology, Writing – Review & Editing ACKNOWLEDGMENTS We would like to thank the Federal University of the Jequitinhonha and Mucuri Valleys (Universidade Federal dos Vales do Jequitinhonha e Mucuri) for institutional support. We also thank the National Council for Scientific and Technological Development (CNPq), the Research Support Foundation for the state of Minas Gerais (FAPEMIG), and the Coordination for the Improvement of Higher Education Personnel (CAPES). The authors are grateful to the municipal education secretary and the directors of the public schools of Diamantina (MG), Brazil. References Blüher M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol . 2019;15(5):288–98. https://doi.org/10.1038/ s41574-019-0176-8 World Health Organization et al. Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age: web annex: evidence profiles. World Health Organization, 2019.https://apps.who.int/iris/handle/10665/311664 Barnett LM, Salmon J, Hesketh KD. More active pre-school children have better motor competence at school starting age: an observational cohort study. 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Coll Antropol . 2015;39:21–8 Coppens E, Bardid F, Deconinck FJA, et al. Developmental Change in Motor Competence: A Latent Growth Curve Analysis. Front Physiol . 2019;10:1–10. https://doi.org/10.3389/fphys.2019.01273 Cheng J, East P, Blanco E, et al. Obesity leads to declines in motor skills across childhood. Child Care Health Dev. 2016;42(3):343–50. https://doi.org/10.1111/cch.12336 Rodrigues LP, Stodden DF, Lopes VP. Developmental pathways of change in fitness and motor competence are related to overweight and obesity status at the end of primary school. J Sci Med Sport . 2016;19(1):87–92. http://dx.doi.org/10.1016/j.jsams.2015.01.002 Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-120980","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":6061506,"identity":"ce2a63cd-071b-4a77-b259-e84e5e2c3593","order_by":0,"name":"Juliana Nobre","email":"","orcid":"","institution":"Universidade Federal dos Vales do Jequitinhonha e Mucuri","correspondingAuthor":false,"prefix":"","firstName":"Juliana","middleName":"","lastName":"Nobre","suffix":""},{"id":6061508,"identity":"f5c0961e-dffc-476c-8f8a-16c983d1ec67","order_by":1,"name":"Rosane Morais","email":"","orcid":"","institution":"Universidade Federal dos Vales do Jequitinhonha e Mucuri","correspondingAuthor":false,"prefix":"","firstName":"Rosane","middleName":"","lastName":"Morais","suffix":""},{"id":6061510,"identity":"a439339a-3c79-4174-9b50-157f55f4b514","order_by":2,"name":"Amanda Fernandes","email":"","orcid":"","institution":"Universidade Federal dos Vales do Jequitinhonha e Mucuri","correspondingAuthor":false,"prefix":"","firstName":"Amanda","middleName":"","lastName":"Fernandes","suffix":""},{"id":6061513,"identity":"2cd21188-04da-4ff7-8c98-32a522ec81b9","order_by":3,"name":"Ângela Viegas","email":"","orcid":"","institution":"Universidade Federal dos Vales do Jequitinhonha e Mucuri","correspondingAuthor":false,"prefix":"","firstName":"Ângela","middleName":"","lastName":"Viegas","suffix":""},{"id":6061514,"identity":"4f9581bd-dfc0-43d3-88d6-64e220ba36fb","order_by":4,"name":"Pedro Figueiredo","email":"","orcid":"","institution":"Universidade Federal dos Vales do Jequitinhonha e Mucuri","correspondingAuthor":false,"prefix":"","firstName":"Pedro","middleName":"","lastName":"Figueiredo","suffix":""},{"id":6061520,"identity":"1a70e879-e3fe-459e-a205-3d20e97b4493","order_by":5,"name":"Henrique Costa","email":"","orcid":"","institution":"Universidade Federal dos Vales do Jequitinhonha e Mucuri","correspondingAuthor":false,"prefix":"","firstName":"Henrique","middleName":"","lastName":"Costa","suffix":""},{"id":6061521,"identity":"5fdb6a90-2fce-498d-8e50-c34986277d22","order_by":6,"name":"Ana Cristina Camargos","email":"","orcid":"","institution":"Universidade Federal de Minas Gerais","correspondingAuthor":false,"prefix":"","firstName":"Ana","middleName":"Cristina","lastName":"Camargos","suffix":""},{"id":6061525,"identity":"5702084f-a036-454d-8bc1-a118c1b5454c","order_by":7,"name":"Vanessa Mendonça","email":"","orcid":"","institution":"Universidade Federal dos Vales do Jequitinhonha e Mucuri","correspondingAuthor":false,"prefix":"","firstName":"Vanessa","middleName":"","lastName":"Mendonça","suffix":""},{"id":6061529,"identity":"b4c11611-1adf-4252-88fa-1c8adb6cf872","order_by":8,"name":"Ana Cristina Lacerda","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2UlEQVRIiWNgGAWjYBACPjDJBiKYDwAJCRmCWtgQJFsCSAsPKVp4DMAkYS3shx8+riizk+effebzqxs1FjwM7IePbsCrhSfN2PDMuWTDGedyt1nnHAM6jCct7QZ+h+WwSTa2MTNu4OHdZpzDBtQiwWOGXwv/G/afjW319ht4eJ4Z5/wjRotEDhtjY9vhRKAW5se5bURpeWYs2XDuePKMM2xmzLl9EjxshPzCz5/88GNDWbVtfw/z48853+rk+NkPH8OrBdVGMEmschBg/kCK6lEwCkbBKBg5AAAzUT7EAIUtsAAAAABJRU5ErkJggg==","orcid":"","institution":"Universidade Federal dos Vales do Jequitinhonha e Mucuri","correspondingAuthor":true,"prefix":"","firstName":"Ana","middleName":"Cristina","lastName":"Lacerda","suffix":""}],"badges":[],"createdAt":"2020-12-03 10:44:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-120980/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-120980/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13630595,"identity":"1007b52a-c378-4c46-a7d1-ce91902b4a06","added_by":"auto","created_at":"2021-09-17 08:12:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":293076,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-120980/v1/843ba483-29a9-412a-a164-1c09a5fe7447.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eIs Body Fat Mass Associated with Worse Gross Motor Skills in Preschoolers?\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":" \u003cp\u003ePediatric obesity is a serious public health issue around the world and is associated with environmental, social, psychological and genetic factors\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Early detection and knowledge on factors that influence children's lifestyle habits may support public policies and promote the creation of healthy lifestyle habits in subsequent life stages, including among adults \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eEarly childhood, especially the preschool period between 3 to 5\u0026nbsp;years \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e, is the stage of life when the body mass index (BMI) is reduced to a minimum physiological value known as adiposity rebound \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. It is also considered a sensitive phase for learning fundamental movements; it is a time to expand the motor repertoire and experience the movements that will contribute to the development of future skills that will evolve into sports or leisure practices \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Studies indicate the preschool period as the critical moment for the development of motor skills and healthy behaviors that may last with physical activity (PA) practices throughout life \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn a systematic review \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e on obesity in Brazilian children, the authors stated that studies are scarce, although there has been an increase in publications in recent years. Thus, there is lack of studies including only children in the preschool phase, since the literature presents research with children in a wide range of ages, and at many stages of biological maturation \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eRegarding motor competence (MC), studies that examined the relationship between MC and body fat mass in preschoolers used variables such as BMI \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e, waist-hip circumference \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e, or body fat mass measured with bioelectrical impedance \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Research indicates that there is an inverse relationship between excess weight and MC \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e, and it has been suggested that overweight/obese children have worse motor skills \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. However, to avoid bias in data interpretation, it is crucial to verify the relationship between excess weight and MC while controlling for other factors that may influence motor development in preschoolers, such as socioeconomic status, maternal education\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e, home environment, school environment\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e, and PA\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Thus, to the best of our knowledge, there remains a gap in the literature regarding the control of these factors in studies with preschoolers. In addition, the wide age range of previous studies limits the validity, interpretation and extrapolation of the results for preschoolers \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn light of the above, is excess body fat mass a factor associated with worse gross motor skills when factors such as socioeconomic status, home and school environment, maternal education, and PA are controlled in preschoolers? Thus, the objective of the study was: 1) To compare the gross MC of overweight/obese preschoolers with eutrophic peers, controlling for PA, sex, age, socioeconomic status, maternal education, quality of the home environment and quality of the school environment. 2) Investigate to what extent excess body fat mass explains gross motor skills in preschoolers. The strength of the present study is the consideration of multiple factors that influence child development \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e "},{"header":"2. Methods","content":" \u003cp\u003eThis is a quantitative, exploratory, cross-sectional study approved by the Research Ethics Committee of Universidade Federal dos Vales do Jequitinhonha e Mucuri UFVJM (Protocol: 2.773.418), with written informed head parent consent and participant assent. All methods were carried out in accordance with relevant guidelines and regulations in the manuscript. Data collection took place from July to December 2019. Pre-school children, that is, children from 3 to 5\u0026nbsp;years old, from public schools in a Brazilian municipality, were eligible.\u003c/p\u003e \u003cp\u003eExclusion criteria were: preterm and low birth weight infants; infants with pregnancy and delivery complications; infants with signs of malnutrition or illness that interfere with growth and development; and infants who had been subject to an infectious process (such as fever, influenza, and diarrhea) in the previous 21 days.\u003c/p\u003e \u003cp\u003eThe sample size was based on a pilot study with five children in each group, in which a minimum difference of 2.70 was found between the groups for Locomotor subtest standard scores of the TGMD2, with a standard deviation (SD) of 3.50. For sample calculation, a power of 90%, and an alpha error of 5% were considered, with 20 participants thus being required for each group, totaling 40 subjects.\u003c/p\u003e \u003cp\u003eFor the assessment of body composition, total body mass was measured and body fat mass was found using dual energy radiological absorptometry (DEXA) (Pediatric medium scan mode software, Lunar Radiation Corporation, Madison, Wisconsin, USA, model-DPX).\u003c/p\u003e \u003cp\u003eWeight and height measurements were taken during the study visits. The children\u0026rsquo;s weight was measured to the nearest 0.1\u0026nbsp;kg with an electronic scale. The standing height of the children was measured to the nearest millimeter with a wall-mounted stadiometer. The children removed their shoes and socks before stepping on the scale and were told to stand in an upright position when measuring height. Age-specific BMI was calculated as body weight (kg) divided by body height squared (m\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e) \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eConsidering the high correlation found between the amount of body fat mass and BMI (r\u0026thinsp;=\u0026thinsp;0.90, p\u0026thinsp;=\u0026thinsp;0.00), and according to studies on body composition and BMI \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e, participants were classified into groups according to BMI, following World Health Organization (WHO) recommendations. The WHO reference curves by gender and age were considered, using the calculation software WHO Anthro version 3.2.2 \u003csup\u003e16\u003c/sup\u003e. Children with a BMI\u0026thinsp;\u0026lt;\u0026thinsp;85 were considered eutrophic and allocated to Group 1, whereas children with a BMI\u0026thinsp;\u0026ge;\u0026thinsp;97 were considered overweight/obese and allocated to Group 2.\u003c/p\u003e \u003cp\u003eSex, age, socioeconomic status, maternal education\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e, PA\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e, quality of the home environment and quality of the school environment\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e were collected for control.\u003c/p\u003e \u003cp\u003eSociodemographic variables were collected using a specific questionnaire. To verify the economic level of families, the Brazil economic classification criterion, from the Brazilian Association of Research Companies was used. This is a questionnaire that stratifies the general economic classification resulting from this criterion from A1 (high economic class) to E (very low economic class) \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe quality of the environment in which the child lives was assessed using the Early Childhood Home Observation for Measurement of the Environment (EC_HOME) \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. The EC_HOME is applied through observation and semi-structured interviews during home visits, standardized for children aged 3 to 5\u0026nbsp;years. The instrument contains 55 items divided into 8 scales: I-Learning materials, II-Language stimulation, III-Physical environment, IV-Responsiveness, V-Academic stimulation, VI-Modeling, VII-Variety, VII-Acceptance. For analysis, the sum of the raw scores of the subscales was used.\u003c/p\u003e \u003cp\u003eThe quality of the school environment was assessed using the Early Childhood Environment Rating Scales (ECERS) \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e, which contain inclusive and culturally sensitive indicators for many items. The scale consists of 43 items organized into 7 subscales (1-Space and Furnishings, 2-Personal Care Routines, 3-Language and Literacy, 4-Learning activities, 5-Interactions, 6-Program Structure, 7- Parents and staff). Each quality indicator was marked, considering its presence or absence in each collective environment (classroom), with the items scored from 1 to 7. The final score of the scale is given by the mean of the seven subscales. It is an ordinal, increasing scale, from 1 to 7, the interpretation of quality being 1: inadequate; 3: minimal (basic); 5: good; 7: excellent.\u003c/p\u003e \u003cp\u003eThe PA level was measured using an accelerometer (Actigraph\u0026reg;- Model GT9X); for a period of 3 days, without including the weekend \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e, for a minimum of 570 minutes a day \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e, which is considered suitable for preschoolers \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Accelerometers were initialized and analyzed using 5-second epochs. In all analyses, consecutive periods of \u0026ge;\u0026thinsp;20 minutes of zero counts were defined as non-wear time \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e, with a sampling rate of 60\u0026nbsp;Hz. The acceleration units were expressed in triaxial vector magnitude (VM). The accelerometer was positioned on the right side of the hip to capture accelerations and decelerations of the body and determine objective measurements of gross acceleration, intensity of physical activity, heart rate intervals and total time of suspension of use \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Pediatric cutoff points validated for preschool children, with score values, classify as sedentary (0 to 819 counts / m), mild (820 to 3907), moderate (3908 to 6111) and vigorous (above 6612) \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. For this study, the child's mean time at these intensities was used. The classification adopted for \u0026ldquo;active\u0026rdquo; or \u0026ldquo;insufficiently active\u0026rdquo; was established according to the WHO, which considers an active child to be one who has a PA of at least 180 minutes/day, with a minimum of 60 minutes/day in moderate to vigorous PA \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn addition, information was gathered on environmental opportunities for active and sedentary behavior, such as the time of exposure to screens; the presence of internal (30\u0026nbsp;m\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e per inhabitant) and external (backyard) physical space at home; and the presence of a playground at school, among other variables relevant to the study. The variable \u0026ldquo;time of exposure to screens\u0026rdquo; was classified considering the parents' report of the time in minutes that the child was exposed to a screen (television and cell phone) and later classified within the recommended limit (less than two hours) and above the recommended limit (two hours and over) according to the guidelines of the American Pediatric Association \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMC was measured using the Test of Gross Motor Development second edition (TGMD-2). The reference is based on a norm and criterion for the development of children between three and ten years old. It consists of 12 motor skills divided into two subtests, locomotor (run, leap, gallop, hop, jump, and slide) and object control (catch, strike, bounce, over and underhand throw, and kick). For each skill, specific motor criteria was observed, based on mature movement patterns referenced in the literature and by professionals in the field. The results obtained for each subtest were added and the raw scores were converted into normalized scores for sex and age with a mean of 100\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003csup\u003e24\u003c/sup\u003e, validated for Brazilian children \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. For the study, the standardized scores described in Locomotor subtest standard scores (LS), Object Control subtest (OC) and Sum of the Gross Motor Quotient (GMQ) (which includes the LS and OC) were used. The reliability for TGMD2 showed intra-class correlation coefficients (ICC) of 0.895 for the LS, 0.925 for OC and 0.841 for GMQ.\u003c/p\u003e \u003cp\u003eAll tests and measurements including body weight, height, assessment of gross MC, as well as questionnaires were applied by one trained examiner. The children were evaluated in the same places, following the order of previously defined evaluations, with an interval between collections of a maximum of 3 weeks.\u003c/p\u003e \u003cp\u003eThe data were analyzed using the \u003cem\u003eStatistical Package for the Social Sciences (SPSS\u003c/em\u003e version 2.2). First, the Shapiro-Wilk test was performed to assess data normality, followed by Levene's test to verify the homogeneity of the variance. Subsequently, the descriptive statistics of continuous variables were demonstrated as median (minimum and maximum) and mean (standard deviation), as appropriate. Subsequently, Chi-squared tests were applied to compare the proportion of eutrophic groups (G1) and overweight (G2). To verify differences between groups, the t-test for independent samples (for variables with normal distribution) or the Mann-Whitney test (for variables with non-normal distribution) was used.\u003c/p\u003e \u003cp\u003eSpearman's or Pearson\u0026rsquo;s correlation was performed to verify the relationship between body fat mass and gross motor competence variables, followed by the multiple linear regression model. Statistical significance was set at 5%. Since sex, age, maternal education, socioeconomic status, PA level, quality of the home environment and quality of the school environment could be confounding factors, the analysis was adjusted for these variables. A residual analysis showed a normal distribution and homogeneous variance in all regression models. The magnitude of the effect (d) was also verified.\u003c/p\u003e "},{"header":"3. Results","content":"\u003cp\u003eForty-nine children, 25 eutrophic and 24 overweight were evaluated and their characteristics are shown in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. Of the group with excess body weight, 17 children (70.8%) were obese and 7 (29.2%) were overweight.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eCharacterization of participants\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eEutrophic\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOverweight\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTest\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eN\u0026thinsp;=\u0026thinsp;25\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eN\u0026thinsp;=\u0026thinsp;24\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge (years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5(3\u0026ndash;5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5(3\u0026ndash;5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e274.0 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.534\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSchool shift (Full-time)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10(40.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7(29.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.63\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.420\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSex\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.19\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.656\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12(48.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10(41.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13(52.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14(58.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMother's age (years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.17\u0026thinsp;\u0026plusmn;\u0026thinsp;5.92\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.88\u0026thinsp;\u0026plusmn;\u0026thinsp;5.81\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.41\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.670\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eeconomic status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e225.50\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.121\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4(16.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9(37.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18(72.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13(54.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eD-E\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(12.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2(8.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMaternal Education\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e290.50 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.827\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrimary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(12.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5(20.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSecondary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18(72.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12(50.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHigher\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4(16.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7(29.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSchool has playground / space\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.01\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.921\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17(68.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16(66.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(32.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(33.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHouse has 30\u0026nbsp;m\u003csup\u003e2\u003c/sup\u003e / inhabitant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.48\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.115\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10(40.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15(62.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15(60.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9(37.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHouse has backyard\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.02\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.869\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11(44.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10(4.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14(56.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14(58.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eScreen time (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.64\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.200\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLess than two hours\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17(68.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12(50.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTwo hours and over\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(32.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12(50.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAmount of body fat mass\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.74(2.49\u0026ndash;6.47)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.10(6.14\u0026ndash;18.12)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMean Intensity of PA(minutes)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSedentary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e398.29\u0026thinsp;\u0026plusmn;\u0026thinsp;40.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e397.74\u0026thinsp;\u0026plusmn;\u0026thinsp;46.42\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.04\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.965\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLight PA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e190.23\u0026thinsp;\u0026plusmn;\u0026thinsp;36.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e185.08\u0026thinsp;\u0026plusmn;\u0026thinsp;32.94\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.51\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.612\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eModerate PA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37.33\u0026thinsp;\u0026plusmn;\u0026thinsp;10.93\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42.02\u0026thinsp;\u0026plusmn;\u0026thinsp;9.51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-1.43\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.158\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eModerate to Vigorous PA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e58.93\u0026thinsp;\u0026plusmn;\u0026thinsp;15.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e61.09\u0026thinsp;\u0026plusmn;\u0026thinsp;14.30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.50\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.614\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eClassification of PA\u003csup\u003ed\u003c/sup\u003e N\u0026thinsp;=\u0026thinsp;48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.07\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.509\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eActive\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12 (50)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14 (58.33)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInsufficiently active\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12 (50)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10 (41.66)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEC-HOME\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37(30\u0026ndash;47)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41(30\u0026ndash;50)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e212.5\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.077\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eECERS Room quality\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.6(1.9\u0026ndash;2.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.7(1.9\u0026ndash;2.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e288.0\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.809\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003eData presented by mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, median (min-max) or n (%). PA: physical activity. EC-HOME: Early Childhood Home Observation for Measurement of the Environment. ERCS: Early Childhood Environment Rating Scales. \u003csup\u003ea\u003c/sup\u003eMann-Whitney U Test. \u003csup\u003eb\u003c/sup\u003eT test for independent samples. \u003csup\u003ec\u003c/sup\u003echi-squared test. \u003csup\u003ed\u003c/sup\u003e N\u0026thinsp;=\u0026thinsp;48.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe mean age in both groups of preschoolers was 5\u0026nbsp;years. Most of the children belong to extract C in the economic classification. In both groups there was a predominance of young adult mothers with complete high school education. Of the participants, more than half study part-time in schools whose facilities contain a playground and some physical space for PA, assessed with marks corresponding to the minimum rating for quality of the school environment (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThere was no difference between groups for variables that influence children's motor behavior and others that characterize them. However, the amount of body fat mass differed between groups (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThere was no difference between groups for OC subscales and GMQ. A significant difference was found in the LS between the groups, with lower values for the group with excess body weight compared to normal weight peers (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The post-hoc analysis, considering an effect size of 0.73 (alpha value\u0026thinsp;=\u0026thinsp;0.05), revealed a large statistical power for the LS (Power\u0026thinsp;=\u0026thinsp;0.81).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eComparison between groups for Motor Competence\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eEutrophic (N\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOverweight\u003c/p\u003e\n\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eDifference\u003c/p\u003e\n\u003cp\u003ebetween groups*\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e95%CI\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTGMD2 LS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.63\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.013\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.31\u0026ndash;2.59\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTGMD2 OC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(4\u0026ndash;15)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(6\u0026ndash;12)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e287.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.800\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.39\u0026ndash;0.41\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTGMD2 GQM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e93.20\u0026thinsp;\u0026plusmn;\u0026thinsp;10.97\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e87.54\u0026thinsp;\u0026plusmn;\u0026thinsp;9.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.96\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.055\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.14-11.46\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eData presented by Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or median (Minimum-Maximum). *T-test for independent samples u Mann-Whitney U test. Abbreviations: TGMD2 LS\u0026thinsp;=\u0026thinsp;Locomotor subtest standard score. TGMD2 OC\u0026thinsp;=\u0026thinsp;standardized Object Control subtest, TGMD2 GMQ\u0026thinsp;=\u0026thinsp;Gross Motor Quotient.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe amount of body fat mass correlated with the LS (inverse relationship, r = -0.38, p-value\u0026thinsp;=\u0026thinsp;0.007).\u003c/p\u003e\n\u003cp\u003eMultiple linear regression analysis showed that there was an inverse relationship between body fat mass and LS. The increase for body fat mass explained 13% of the low values in the LS in preschoolers. In other words, the increase of 1\u0026nbsp;kg of body fat mass leads to a reduction of 0.38 points in the LS, with medium effect size (d\u0026thinsp;=\u0026thinsp;0.16) (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Finally, control variables were inserted in the regression model, but they did not affect the values of \u0026beta; and R\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMultiple linear regression between body fat mass and Locomotor standard score (N\u0026thinsp;=\u0026thinsp;49).\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eẞ\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e95% CI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eR\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBody fat mass\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.388\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0,199\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.341\u0026ndash; (-0.057)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.007\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.13\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eNote: ẞ= standard regression coefficient; B\u0026thinsp;=\u0026thinsp;non-standard regression coefficient; 95% CI\u0026thinsp;=\u0026thinsp;95% confidence interval; estimate of the increase or decrease of the dependent variable for each increase of one unit of the independent variable; p\u0026thinsp;=\u0026thinsp;statistical significance; R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;coefficient of determination.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":" \u003cp\u003eThis study aimed to verify the MC of overweight/obese and eutrophic preschoolers controlled for PA \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e, sex, age, socioeconomic status, maternal education \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e, quality of the home environment and quality of the school environment \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. The identification of variables that could interfere with development has an important clinical meaning, since the child's reciprocal relationships with the environment can influence child development \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eRegarding gross MC, body fat mass was the only factor that showed a difference between the groups. To the best of our knowledge, this study is the first that presents robustness in the comparison between eutrophic and overweight/obese preschoolers, as direct measurement of energy expenditure was used. Moreover, variables that interfere in the development of preschoolers were controlled, these being socioeconomic status, maternal education \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e, the quality of the domestic environment and with it, availability of resources and toys, trips and opportunities for stimulating experiences, use of free time, family routines and meetings, physical space of the home environment and the direct involvement of parents in the child's life \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. In addition, the quality of the school environment \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e, and screen time \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e were also controlled. As such, none of the controlled variables differed between the groups.\u003c/p\u003e \u003cp\u003eThe amount of body fat mass, namely excess body fat mass, appears as a factor that interferes with MC in LS; however, it did not interfere with OC skills, which are tasks that require more specific skills without large displacements \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Being overweight/obese seems to hinder displacements and body image, since antigravity activities are more difficult \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e due to the morphological restrictions to movement within high biomechanical restrictions that make it more challenging to perform tasks involving changes in the center of mass \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Other studies have also found an inverse relationship between weight and motor skills \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e and between excess body fat mass and motor skills in preschoolers \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. In Brazil, studies \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e using the same motor test as the present study found an inverse relationship between LS and central obesity in preschoolers in the same age group (3 to 5\u0026nbsp;years). The authors also found no association between central obesity and OC.\u003c/p\u003e \u003cp\u003eExcess body fat mass is associated with worse MC \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e, as being overweight/obese seems to contribute to declines in motor proficiency. Cheng et al., \u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e investigated temporal precedence in the relationship between MC and weight status in schoolchildren aged between 5 and 10, finding that poor MC did not predict weight gain. However, higher weight status is a precursor and not a consequence of poor MC. These data corroborate the findings of the present study and confirm the hypothesis, since having a greater amount of body fat mass predicts 13% of the worse result on the LS. Thus, the results of the present study add to the current literature, as they provide additional evidence for the development of protective policies related to pediatric health, since the relative declines in children's motor proficiency can serve as a catalyst for inactivity and consequent weight gain with advancing age \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis study has both limitations and strengths. The sample was small. However, the sample calculation and post hoc analysis demonstrated that the sample size was sufficient to achieve a medium to large effect size. The study has a cross-sectional format, which does not allow inferring a cause-and-effect relationship, requiring more longitudinal studies that examine the development of MC over time and its relationship with other health-related results. However, as far as is known, this is the first study that controlled for determining factors in development to compare overweight/obese and paired-eutrophic preschoolers. Among the strengths are the short data collection interval (maximum of three weeks), the use of a standardized instrument for assessing MC \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e, validated for Brazilian children \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e, direct measurement of PA \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e, and a gold-standard measure to determine body fat \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Finally, relevant factors that interfere in child development were taken into account, these being socioeconomic level, maternal schooling\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e, quality of the school environment \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e and quality of the home environment \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e "},{"header":"5. Conclusions","content":"\u003cp\u003eChildren with excess body fat mass in developmental conditions similar to eutrophic children have worse LS, demonstrating that excess body fat mass influences competence in locomotor skills in the preschool phase. These findings may assist with the development of public guidelines aimed at child health in order to outline strategies that enable the stimulation of locomotor skills in preschoolers with excess body fat mass.\u003c/p\u003e\n\u003ch2\u003ePractical implications:\u003c/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eWhen factors that interfere with child motor development, i.e., maternal education, socioeconomic status, PA, sex, age, quality of the home environment and quality of the school environment are controlled, preschoolers with excess body fat mass have worse locomotor skills than eutrophic preschoolers.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eExcess body fat mass is probably a precursor to lower locomotor competence, showing the importance of strategies to stimulate locomotor skills in preschoolers, especially in the context of pediatric obesity.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ePublic guidelines could include strategies that enable the stimulation of locomotor skills in preschoolers with excess body fat mass.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003ch2\u003eETHICS APPROVAL AND CONSENT TO PARTICIPATE\u003c/h2\u003e\n\u003cp\u003eThis study was approved by the Research Ethics Committee of Universidade Federal dos Vales do Jequitinhonha e Mucuri UFVJM (Protocol: 2.773.418), with written informed head parent consent and participant assent. All methods were carried out in accordance with relevant guidelines and regulations in the manuscript.\u003c/p\u003e\n\u003ch2\u003eCONSENT FOR PUBLICATION\u003c/h2\u003e\n\u003cp\u003eThe researchers of this study confirm that they have given due consideration to protect the intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. In so doing we confirm that we have followed the regulations of our institutions concerning intellectual property.\u003c/p\u003e\n\u003ch2\u003eAVAILABILITY OF DATA AND MATERIALS\u003c/h2\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch2\u003eCOMPETING INTERESTS\u003c/h2\u003e\n\u003cp\u003eThe 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.\u003c/p\u003e\n\u003cp\u003eThe authors declare no financial interests/personal relationships which may be considered as potential competing interests.\u003c/p\u003e\n\u003ch2\u003eFUNDING\u003c/h2\u003e\n\u003cp\u003eThere are currently no Funding Sources in the list.\u003c/p\u003e\n\u003ch2\u003eAUTHORS' CONTRIBUTIONS\u003c/h2\u003e\n\u003cp\u003eJuliana Nogueira Pontes Nobre: Formal analysis, Data Curation, Methodology\u003c/p\u003e\n\u003cp\u003eRosane Luzia De Souza Morais: Formal analysis, Data Curation, Methodology, Writing Review \u0026amp; Editing \u0026ndash; Original Draft\u003c/p\u003e\n\u003cp\u003eAmanda Cristina Fernandes: Writing \u0026ndash; Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003e\u0026Acirc;ngela Alves Viegas: Conceptualization, Data Curation, Writing, Review \u0026amp; Editing \u0026ndash; Original Draft\u003c/p\u003e\n\u003cp\u003ePedro Henrique Scheidt Figueiredo: Writing \u0026ndash; Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eHenrique Silveira Costa: Writing \u0026ndash; Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eAna Cristina Resende Camargos: Writing \u0026ndash; Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eVanessa Amaral Mendon\u0026ccedil;a: Writing \u0026ndash; Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eAna Cristina Rodrigues Lacerda (corresponding author): Formal analysis, Data Curation, Methodology, Writing \u0026ndash; Review \u0026amp; Editing\u003c/p\u003e\n\u003ch2\u003eACKNOWLEDGMENTS\u003c/h2\u003e\n\u003cp\u003eWe would like to thank the Federal University of the Jequitinhonha and Mucuri Valleys (Universidade Federal dos Vales do Jequitinhonha e Mucuri) for institutional support. We also thank the National Council for Scientific and Technological Development (CNPq), the Research Support Foundation for the state of Minas Gerais (FAPEMIG), and the Coordination for the Improvement of Higher Education Personnel (CAPES). The authors are grateful to the municipal education secretary and the directors of the public schools of Diamantina (MG), Brazil.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBl\u0026uuml;her M. Obesity: global epidemiology and pathogenesis. \u003cem\u003eNat Rev Endocrinol\u003c/em\u003e. 2019;15(5):288\u0026ndash;98. https://doi.org/10.1038/ s41574-019-0176-8\u003c/li\u003e\n\u003cli\u003eWorld Health Organization et al. Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age: web annex: evidence profiles. World Health Organization, 2019.https://apps.who.int/iris/handle/10665/311664\u003c/li\u003e\n\u003cli\u003eBarnett LM, Salmon J, Hesketh KD. 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Monitoring of physical activity in young children: how much is enough? \u003cem\u003ePediatr Exerc Sci\u003c/em\u003e,2006; 18(4): 483-491.\u003c/li\u003e\n\u003cli\u003eButte NF, Wong WW, Lee JS, et al. Prediction of energy expenditure and physical activity in preschoolers. \u003cem\u003eMed Sci Sports Exerc\u003c/em\u003e. 2014;46(6):1216\u0026ndash;26. https://doi.org/10.1249/mss.0000000000000209\u003c/li\u003e\n\u003cli\u003eAmerican Academy of Pediatrics. Children, Adolescents, and the Media, \u003cem\u003ePediatrics\u003c/em\u003e, 2013; 132 (5): 958 \u0026ndash; 961. https://doi.org/10.1542/peds.2013-2656\u003c/li\u003e\n\u003cli\u003eUlrich, D. The test of gross motor development. Austin: Prod-Ed, 2000.\u003c/li\u003e\n\u003cli\u003eValentini, N. C. (2012). 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Developmental Change in Motor Competence: A Latent Growth Curve Analysis. \u003cem\u003eFront Physiol\u003c/em\u003e. 2019;10:1\u0026ndash;10. \u003ca href=\"https://doi.org/10.3389/fphys.2019.01273\"\u003ehttps://doi.org/10.3389/fphys.2019.01273\u003c/a\u003e\u003c/li\u003e\n\u003cli\u003eCheng J, East P, Blanco E, et al. Obesity leads to declines in motor skills across childhood. \u003cem\u003eChild Care Health Dev.\u003c/em\u003e 2016;42(3):343\u0026ndash;50. \u003ca href=\"https://doi.org/10.1111/cch.12336\"\u003ehttps://doi.org/10.1111/cch.12336\u003c/a\u003e\u003c/li\u003e\n\u003cli\u003eRodrigues LP, Stodden DF, Lopes VP. Developmental pathways of change in fitness and motor competence are related to overweight and obesity status at the end of primary school. \u003cem\u003eJ Sci Med Sport\u003c/em\u003e. 2016;19(1):87\u0026ndash;92. \u003ca href=\"http://dx.doi.org/10.1016/j.jsams.2015.01.002\"\u003ehttp://dx.doi.org/10.1016/j.jsams.2015.01.002\u003c/a\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Child, Motor skill, Physical Activity, Pediatric Obesity, Locomotor Performance, Object Control ","lastPublishedDoi":"10.21203/rs.3.rs-120980/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-120980/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjectives: To compare the motor competence of overweight/obese preschoolers with eutrophic peers with a similar level of physical activity, sex, age, socioeconomic status, maternal education, quality of the home environment and quality of the school environment, and to verify the association of\u0026nbsp;body fat mass with gross motor skills in preschoolers.\u003c/p\u003e\u003cp\u003eDesign: Quantitative, exploratory, cross-sectional study design.\u003c/p\u003e\u003cp\u003eMethods: Forty-nine children, aged 3 to 5 years old, from public schools in a Brazilian\u0026nbsp;city were classified into eutrophic and overweight/obese groups.\u003c/p\u003e\u003cp\u003eResults:\u0026nbsp;Overweight/obese preschoolers had worse Locomotor subtest standard scores than their eutrophic peers (p = 0.01), but similar skills, Object Control subtest scores and Gross Motor Quotient (p \u0026gt; 0.05).\u0026nbsp;Excess body fat mass explained 13% of the low Locomotor subtest standard scores in preschoolers (R\u003csup\u003e2 \u003c/sup\u003e= 0.13; p = 0.007).\u003c/p\u003e\u003cp\u003eConclusion: Excess body fat mass is associated with worse locomotor performance when the model is adjusted for contextual factors such as level of physical activity, sex, age, socioeconomic status, maternal education, quality of the home environment and quality of the school environment. Thus, excess body fat mass partly explains lower locomotor skills in preschoolers. These findings may assist with the development of public guidelines aimed at child health\u0026nbsp;in order to\u0026nbsp;outline strategies that enable the stimulation of locomotor skills in preschoolers with excess body fat mass.\u003c/p\u003e","manuscriptTitle":"Is Body Fat Mass Associated with Worse Gross Motor Skills in Preschoolers?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-12-10 16:28:08","doi":"10.21203/rs.3.rs-120980/v1","editorialEvents":[{"type":"communityComments","content":2}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b780c640-03c0-4a55-89b1-7d1ae4267823","owner":[],"postedDate":"December 10th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":1410443,"name":"Pediatrics"}],"tags":[],"updatedAt":"2021-02-05T12:29:16+00:00","versionOfRecord":[],"versionCreatedAt":"2020-12-10 16:28:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-120980","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-120980","identity":"rs-120980","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}