Aggregation of risk indicators to cardiometabolic and musculoskeletal health in Brazilian adolescents in the periods 2008/09 and 2013/14

Cardiometabolic risk factors in South American children: A systematic review and meta-analysis

BACKGROUND

Cardiometabolic risk factors (impaired fasting glucose, abdominal obesity, high blood pressure, dyslipidemia) cluster in children, may predict adult disease burden, and are inadequately characterized in South American children.

OBJECTIVES

To quantify the burden of cardiometabolic risk factors in South American children (0-21 years) and identify knowledge gaps.

METHODS

We systematically searched PubMed, Google Scholar, and the Latin American and Caribbean Health Sciences Literature via Virtual Health Library from 2000-2021 in any language. Two independent reviewers screened and extracted all data.

RESULTS

179 studies of 2,181 screened were included representing 10 countries (n = 2,975,261). 12.2% of South American children experienced obesity, 21.9% elevated waist circumference, 3.0% elevated fasting glucose, 18.1% high triglycerides, 29.6% low HDL cholesterol, and 8.6% high blood pressure. Cardiometabolic risk factor definitions varied widely. Chile exhibited the highest prevalence of obesity/overweight, low HDL, and impaired fasting glucose. Ecuador exhibited the highest prevalence of elevated blood pressure. Rural setting (vs. urban or mixed) and indigenous origin protected against most cardiometabolic risk factors.

CONCLUSIONS

South American children experience high rates of obesity, overweight, and dyslipidemia. International consensus on cardiometabolic risk factor definitions for children will lead to improved diagnosis of cardiometabolic risk factors in this population, and future research should ensure inclusion of unreported countries and increased representation of indigenous populations.

Neck circumference and cardiometabolic risk in children and adolescents: the moderator role of cardiorespiratory fitness

BACKGROUND

The increased incidence of cardiometabolic risk factors has become a public health issue, especially in childhood and adolescence. Thus, early identification is essential to avoid or reduce future complications in adulthood. In this sense, the present study aimed to verify the influence of cardiorespiratory fitness (CRF) as a moderator in the association between neck circumference (NC) and cardiometabolic risk in children and adolescents.

METHODS

Cross-sectional study that included 2418 randomly selected children and adolescents (52.5% girls), aged 6 to 17 years old. Anthropometric measurements, such as NC and body mass index (BMI), and CRF was measured by the six-minute running/walking test, as well as cardiometabolic risk (systolic blood pressure, glucose, HDL-C, and triglycerides), were assessed.

RESULTS

For all age groups, NC showed a negative relationship with CRF. A significant interaction term was found for CRF x NC with cardiometabolic risk for children (6 to 9 years old), early adolescents (10 to 12 years old), and middle adolescents (13 to 17 years old). It was found that children who accomplished more than 1092.49 m in CRF test were protected against cardiometabolic risk when considering NC. In adolescents, protection against cardiometabolic risk was found when the CRF test was completed above 1424.14 m and 1471.87 m (early and middle stage, respectively).

CONCLUSIONS

CRF is inversely associated with NC and acts as a moderator in the relationship between NC and cardiometabolic risk in children and adolescents. Therefore, this detrimental health impact linked to fatness might be attenuated by improving CRF levels.

Prevalence of Brazilian children and adolescents who met health criteria for aerobic fitness: systematic review update for Report Card Brazil Project

abstract The aim of the study was to update Brazilian evidence on the prevalence of children and adolescents who met health criteria for aerobic fitness. This systematic review is part of the Report Card Brazil Project and the search was restricted to studies published during the period from January 2018 to December 2019 in nine electronic databases. Studies with different designs, which allowed extracting information about the prevalence of children and adolescents who met health criteria for aerobic fitness (age up to 19 years or average age up to 19 years) were included. Studies published from 2020 were not included due to the possible effect of the pandemic on this indicator and because there is no certainty as to when the pandemic will end. Of the 694 studies initially identified, 13 studies with information of 14,673 children and adolescents were included after reading titles, abstracts, full texts and references. The prevalence of children and adolescents who met health criteria for aerobic fitness was 26.9% (29.7% for girls; 44.6% for boys). In this search, eight different cutoff points were used to determine adequate aerobic fitness levels and five tests were used to determine aerobic fitness. Analyzing data from the present review with the previous systematic review of this project, one third of children and adolescents in Brazil meet health criteria for aerobic fitness.

Physical fitness attenuates the genetic predisposition to obesity in children and adolescents

Obesity is an important risk factor associated with non-communicable cardiometabolic diseases. Previous studies have indicated that children and adolescents with a predisposed genetic risk for obesity could benefit from an active lifestyle, but there are no studies investigating whether physical fitness moderates the association of genetics and obesity. The aim of this study was to verify the moderating role of physical fitness in the relationship between genetic risk score (GRS) and body mass index (BMI) in children and adolescents. This cross-sectional study was carried out with 1471 children and adolescents, aged between 6 and 17 years from Santa Cruz do Sul, Brazil. Weight and height were assessed to determine BMI. Physical fitness components (cardiorespiratory fitness [CRF], lower limb strength [LLS], upper limb strength, and abdominal strength) were evaluated. The GRS was based on previously associated obesity single-nucleotide polymorphism rs9939609 (FTO), rs6548238 (TMEM18), and rs16835198 (FNDC5). Moderation analyses were tested using linear regression models, and the interactions were represented by physical fitness components X GRS (categorical variable). All analyses were adjusted for skin color/ethnicity, sex, and sexual maturation. Significant interactions for CRF (P = 0.041), LLS (P = 0.041), and abdominal strength (P = 0.046) X 5 and 6 risk alleles with BMI were found only in adolescents. In addition, there was evidence that fitness components attenuated the high genetic predisposition to high BMI. Physical fitness components are moderators in the relationship between GRS and BMI in adolescents. These findings highlight the need for interventions targeting to improve this aspect, which is an important health indicator in all ages.

Relationship between sleep duration and TV time with cardiometabolic risk in adolescents

Objective

To verify the association between sleep duration and television time with cardiometabolic risk and the moderating role of age, gender, and skin color/ethnicity in this relationship among adolescents.

Methods

Cross-sectional study with 1411 adolescents (800 girls) aged 10 to 17 years. Television time, sleep duration, age, gender, and skin color/ethnicity were obtained by self-reported questionnaire. Cardiometabolic risk was evaluated using the continuous metabolic risk score, by the sum of the standard z-score values for each risk factor: high-density lipoprotein cholesterol, triglycerides, glycemia, cardiorespiratory fitness, systolic blood pressure, and waist circumference. Generalized linear regression models were used.

Results

There was an association between television time and cardiometabolic risk (β, 0.002; 95% CI, 0.001; 0.003). Short sleep duration (β, 0.422; 95% CI, 0.012; 0.833) was positively associated with cardiometabolic risk. Additionally, age moderated the relationship between television time and cardiometabolic risk (β, − 0.009; 95% CI, − 0.002; − 0.001), suggesting that this relationship was stronger at ages 11 and 13 years (β, 0.004; 95% CI, 0.001; 0.006) compared to 13 to 15 years (β, 0.002; 95% CI, 0.001; 0.004). No association was found in older adolescents (β, 0.001; 95% CI, − 0.002; 0.002).

Conclusions

Television time and sleep duration are associated with cardiometabolic risk; adolescents with short sleep have higher cardiometabolic risk. In addition, age plays a moderating role in the relationship between TV time and cardiometabolic risk, indicating that in younger adolescents the relationship is stronger compared to older ones.

Physical fitness as a moderator in the relationship between adiposity and cardiometabolic risk factors in children and adolescents

BACKGROUND

The aim of this study was to verify the moderator role of physical fitness in the relationship between adiposity and cardiometabolic risk factors in normal weight and overweight/obese children and adolescents.

METHODS

Cross-sectional study comprising 2482 children and adolescents, aged 7-17 years. Physical fitness was evaluated according the procedures of Projeto Esporte Brazil, and waist circumference (WC) with an inelastic tape. Cardiometabolic risk score was defined by the z-score sum of glucose, total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol. Moderation analysis was done through linear regression models.

RESULTS

Significant interaction term for cardiorespiratory fitness (CRF)×WC with cardiometabolic risk factors (P<0.001), as well as for lower limbs strength (LLS)×WC (P<0.001) and agility × WC (P=0.01) in normal weight girls. For normal weight boys it was found a significant interaction term for CRF×WC with cardiometabolic risk factor (P=0.007), and also for agility × WC (P=0.003), while overweight/obese boys showed a significant interaction term only for agility × WC with cardiometabolic risk factor (P=0.001).

CONCLUSIONS

CRF, LLS and agility are moderators in the relationship between WC and cardiometabolic risk factors in normal weight girls, while CRF and agility were moderators for normal weight boys and only agility for overweight/obese boys.

Temporal trends in the sit-ups performance of 9,939,289 children and adolescents between 1964 and 2017

We estimated international/national temporal trends in sit-ups performance for children and adolescents, and examined relationships between national trends in sit-ups performance and national trends in health-related/sociodemographic indicators. Data were obtained by systematically searching studies reporting on temporal trends in sit-ups performance for apparently healthy 9-17 year-olds, and by examining nationally representative fitness datasets. Trends at the country-sex-age level were estimated by sample-weighted regression models relating the testing year to mean sit-ups performance. International/national trends were estimated by a post-stratified population-weighting procedure. Pearson's correlations quantified relationships between national trends in sit-ups performance and national trends in health-related/sociodemographic indicators. A total of 9,939,289 children and adolescents from 31 countries/special administrative regions between 1964 and 2017 collectively showed a large improvement of 38.4% (95% CI: 36.8 to 40.0) or 7.1% per decade (95% CI: 6.8 to 7.4). Large international improvements were experienced by all age and sex groups, with the rate of improvement slowing from 1964 to 2000, stabilizing near zero until 2010, before declining. Trends differed between countries, with national trends in vigorous physical activity a strong, positive correlate of national trends in sit-ups performance. More sit-ups data are needed from low- and middle-income countries to better monitor trends in muscular fitness.

PROSPERO REGISTRATION NUMBER

CRD42013003657.

Effects and prevalence of responders after a multicomponent intervention on cardiometabolic risk factors in children and adolescents with overweight/obesity: Action for health study

This study aimed to verify the effect of a multicomponent intervention on cardiometabolic risk factors (CMRF), and to determine the prevalence of responders on CMRF among children and adolescents with overweight/obesity. This is a quasi-experimental study, developed with 35 children and adolescents with overweight/obesity (control group (CG) = 18; intervention group (IG) = 17), aged between 7 and 13 years. Participants in IG underwent a multicomponent intervention for 12 weeks. The following variables were evaluated: anthropometric measures, maturational stages and CMRF (body fatness, HOMA-IR, triglycerides, high-density and low-density lipoprotein) (HDL-C, LDL-C), total cholesterol (TC), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and AST/ALT ratio. Mixed analysis of variance and the prevalence of responders were used for statistical analysis. There was a significant time x group interaction on body fatness (p < 0.001), HOMA-IR (p = 0.01), HDL-C (p < 0.001), LDL-C (p = 0.009) and TC (p < 0.001). The prevalence of responders for CMRF in IG and CG was respectively: body fatness (47%; 0%; p = 0.04), HOMA-IR (58.8%; 16.6%; p = 0.04); triglycerides (17.6%; 5.5%; p = 0.31); HDL-C (76.4%; 5.5%; p = 0.01), LDL-C (35.3%; 5%; p = 0.08), TC (64.7%; 5%; p = 0.01), AST (5.8%; 0%; p = 0.87), ALT (29.4%; 11.1%; p = 0.24) and AST/ALT ratio (24.4%; 22.2%; p = 0.67). Multicomponent intervention induced positive changes on CMRF along with a higher prevalence of positive adaptations in IG than the CG in some of the cardiometabolic outcomes assessed.