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Wimalasena ST, Ramírez Silva CI, Gonzalez Casanova I, Rivera JA, Sun YV, Stein AD, Ferranti EP, Alvarez JA, Demmelmair H, Koletzko B, Ramakrishnan U. Maternal and Offspring Fatty Acid Desaturase Variants, Prenatal DHA Supplementation, and Dietary n-6:n-3 Fatty Acid Ratio in Relation to Cardiometabolic Health in Mexican Children. J Nutr 2024; 154:1540-1548. [PMID: 38453026 PMCID: PMC11347803 DOI: 10.1016/j.tjnut.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/21/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Single-nucleotide polymorphisms (SNPs) in fatty acid desaturase (FADS) genes may modify dietary fatty acid requirements and influence cardiometabolic health (CMH). OBJECTIVES We evaluated the role of selected variants in maternal and offspring FADS genes on offspring CMH at the age of 11 y and assessed interactions of genotype with diet quality and prenatal docosahexaenoic acid (DHA) supplementation. METHODS We used data from offspring (n = 203) born to females who participated in a randomized controlled trial of DHA supplementation (400 mg/d) from midgestation to delivery. We generated a metabolic syndrome (MetS) score from body mass index, high-density lipoprotein cholesterol, triglycerides, systolic blood pressure, and fasting glucose and identified 6 distinct haplotypes from 5 offspring FADS SNPs. Dietary n-6 (ω-6):n-3 fatty acid ratios were derived from 24-h recall data (n = 141). We used generalized linear models to test associations of offspring diet and FADS haplotypes with MetS score and interactions of maternal and offspring FADS SNP rs174602 with prenatal treatment group and dietary n-6:n-3 ratio on MetS score. RESULTS Associations between FADS haplotypes and MetS score were null. Offspring SNP rs174602 did not modify the association of prenatal DHA supplementation with MetS score. Among children with TT or TC genotype for SNP rs174602 (n = 88), those in the highest n-6:n-3 ratio tertile (>8.61) had higher MetS score relative to the lowest tertile [<6.67) (Δ= 0.36; 95% confidence interval (CI): 0.03, 0.69]. Among children with CC genotype (n = 53), those in the highest n-6:n-3 ratio tertile had a lower MetS score relative to the lowest tertile (Δ= -0.23; 95% CI: -0.61, 0.16). CONCLUSIONS There was evidence of an interaction of offspring FADS SNP rs174602 with current dietary polyunsaturated fatty acid intake, but not with prenatal DHA supplementation, on MetS score. Further studies may help to determine the utility of targeted supplementation strategies and dietary recommendations based on genetic profile.
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Affiliation(s)
- Sonia Tandon Wimalasena
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
| | | | | | - Juan A Rivera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Yan V Sun
- Department of Epidemiology, Emory University, Atlanta, GA, United States
| | - Aryeh D Stein
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States
| | - Erin P Ferranti
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Jessica A Alvarez
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Hans Demmelmair
- LMU - Ludwig Maximilians Universität Munich, Department of Pediatrics, LMU University Hospitals, Munich, Germany
| | - Berthold Koletzko
- LMU - Ludwig Maximilians Universität Munich, Department of Pediatrics, LMU University Hospitals, Munich, Germany
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States.
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Wimalasena ST, Ramirez-Silva CI, Gonzalez Casanova I, Stein AD, Sun YV, Rivera JA, Demmelmair H, Koletzko B, Ramakrishnan U. Effects of prenatal docosahexaenoic acid supplementation on offspring cardiometabolic health at 11 years differs by maternal single nucleotide polymorphism rs174602: follow-up of a randomized controlled trial in Mexico. Am J Clin Nutr 2023; 118:1123-1132. [PMID: 37839707 PMCID: PMC10797513 DOI: 10.1016/j.ajcnut.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/20/2023] [Accepted: 10/11/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND There is limited evidence regarding long-term effects of prenatal docosahexaenoic acid (DHA) supplementation on offspring cardiometabolic health (CMH). Inconsistent results may be attributable to variants of fatty acid desaturase (FADS) genes. OBJECTIVE We aimed to evaluate the effect of prenatal DHA supplementation on offspring CMH and investigate effect modification by maternal FADS2 single nucleotide polymorphism (SNP) rs174602. METHODS We used follow-up data from a double-blind, randomized controlled trial in Mexico in which pregnant females received 400 mg/d of algal DHA or placebo from midgestation until delivery. The study sample included 314 offspring with data at age 11 y and maternal FADS genetic data (DHA: n = 160; Placebo: n = 154). We derived a Metabolic Syndrome (MetS) score from body mass index, HDL, triglycerides, fasting glucose concentrations, and systolic blood pressure. Generalized linear models were used to evaluate the effect of the intervention on offspring MetS score and test interactions between treatment group and genotype, adjusting for maternal, offspring, and household factors. RESULTS Offspring MetS score did not differ significantly by treatment group. We observed evidence of effect modification by maternal SNP rs174602 (P = 0.001); offspring of maternal TT genotype who received DHA had lower MetS score relative to the placebo group (DHA (mean ± standard error of the mean (SEM)): -0.21 ± 0.11, n = 21; Placebo: 0.05 ± 0.11, n = 23; Δ= -0.26 (95% CI: -0.55, 0.04), P = 0.09); among CC maternal genotype carriers, offspring of mothers who received DHA had higher MetS score (0.18 ± 0.06, n = 62) relative to the placebo group (-0.05 ± 0.06, n = 65, Δ=0.24 (0.06, 0.41), P < 0.01). CONCLUSION The effect of prenatal DHA supplementation on offspring MetS score differed by maternal FADS SNP rs174602. These findings further support incorporating genetic analysis of FADS polymorphisms in DHA supplementation trials. CLINICAL TRIAL DETAILS This trial was registered at clinicaltrials.gov as NCT00646360.
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Affiliation(s)
- Sonia Tandon Wimalasena
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
| | | | | | - Aryeh D Stein
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States; Hubert Department of Global Health, Emory University, Atlanta, GA, United States
| | - Yan V Sun
- Department of Epidemiology, Emory University, Atlanta, GA, United States
| | - Juan A Rivera
- National Institute of Public Health, Cuernavaca, Mexico
| | - Hans Demmelmair
- LMU-Ludwig Maximilians Universität, Department of Pediatrics, LMU University Hospitals, Munich, Germany
| | - Berthold Koletzko
- LMU-Ludwig Maximilians Universität, Department of Pediatrics, LMU University Hospitals, Munich, Germany
| | - Usha Ramakrishnan
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States; Hubert Department of Global Health, Emory University, Atlanta, GA, United States.
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Tandon S, Ivonne Ramirez Silva C, Sun YV, Stein AD, Rivera JA, Ramakrishnan U. Clustering of Cardiometabolic Risk Factors in Mexican Pre-Adolescents. Diabetes Res Clin Pract 2023:110818. [PMID: 37422166 DOI: 10.1016/j.diabres.2023.110818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE To examine clustering of cardiometabolic markers in Mexican children at age 11 years and compare a metabolic syndrome (MetS) score to an exploratory cardiometabolic health (CMH) score. METHODS We used data from children enrolled in the POSGRAD birth cohort with cardiometabolic data available (n = 413). We used principal component analysis (PCA) to derive a Metabolic Syndrome (MetS) score and an exploratory cardiometabolic health (CMH) score, which additionally included adipokines, lipids, inflammatory markers, and adiposity. We assessed reliability of individual cardiometabolic risk as defined by MetS and CMH by calculating % agreement and Cohen's kappa statistic. RESULTS At least one cardiometabolic risk factor was present in 42% of study participants; the most common risk factors were low High-Density Lipoprotein (HDL) cholesterol (31.9%) and elevated triglycerides (18.2%). Measures of adiposity and lipids explained the most variation in cardiometabolic measures for both MetS and CMH scores. Two-thirds of individuals were categorized in the same risk category by both MetS and CMH scores (κ = 0.42). CONCLUSIONS MetS and CMH scores capture a similar amount of variation. Additional follow-up studies comparing predictive abilities of MetS and CMH scores may enable improved identification of children at risk for cardiometabolic disease.
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Affiliation(s)
- Sonia Tandon
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA
| | | | - Yan V Sun
- Department of Epidemiology, Emory University, Atlanta, GA
| | - Aryeh D Stein
- Hubert Department of Global Health, Emory University, Atlanta, GA
| | - Juan A Rivera
- National Institute of Public Health, Cuernavaca, Mexico
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Fernández-Aparicio Á, Perona JS, Schmidt-RioValle J, Montero-Alonso MA, Navarro-Pérez CF, González-Jiménez E. cMetS Based on Z-Scores as an Accurate and Efficient Scoring System to Determine Metabolic Syndrome in Spanish Adolescents. J Pers Med 2022; 13:jpm13010010. [PMID: 36675671 PMCID: PMC9865991 DOI: 10.3390/jpm13010010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/30/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
The definition of metabolic syndrome (MetS) based on dichotomous cut-off points is efficient in the adult population. However, to date, there is no international consensus on how to define MetS in the pediatric population. For that reason, a continuous MetS score (cMetS) has been proposed for the pediatric population. However, despite multiple attempts, cMetS has not been fully validated as there is no agreement about the most accurate score to calculate it. The purpose of the present study was to compare the validity of different scores (three siMS scores, z-score, principal components analysis (PCA), the sum of PCA, and confirmatory factor analysis) to calculate cMetS and determine MetS in Spanish adolescents. There were 981 subjects, ranging 11-16 years old, recruited for this cross-sectional study. Seven different approaches to pediatric cMetS scores were calculated. All cMetS scores calculated strongly correlated with each other, especially siMS scores. The area under the curve obtained from receiving operating characteristic curves was particularly elevated for z-scores 0.81 (95% CI: 0.784-0.838), showing a specificity of 64.4%. Our study shows that cMetS based on z-scores is accurate and efficient to be used for research instead of the dichotomized definition of MetS in adolescents; and cMetS based on siMS scores is useful for clinical practice.
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Affiliation(s)
- Ángel Fernández-Aparicio
- Department of Nursing, Faculty of Health Sciences, Melilla Campus, University of Granada, 52005 Melilla, Spain
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain
| | - Javier S. Perona
- Department of Food and Health, Instituto de la Grasa-CSIC, Campus of the University Pablo de Olavide, 41013 Seville, Spain
| | - Jacqueline Schmidt-RioValle
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
- Correspondence: ; Tel.: +34-958-243-495
| | - Miguel A. Montero-Alonso
- Department of Statistics and O.I., Faculty of Medicine, University of Granada, 18016 Granada, Spain
| | - Carmen Flores Navarro-Pérez
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain
| | - Emilio González-Jiménez
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
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Li A, Zhou Q, Mei Y, Zhao J, Zhao M, Xu J, Ge X, Xu Q. Novel Strategies for Assessing Associations Between Selenium Biomarkers and Cardiometabolic Risk Factors: Concentration, Visit-to-Visit Variability, or Individual Mean? Evidence From a Repeated-Measures Study of Older Adults With High Selenium. Front Nutr 2022; 9:838613. [PMID: 35711534 PMCID: PMC9196882 DOI: 10.3389/fnut.2022.838613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 05/11/2022] [Indexed: 12/23/2022] Open
Abstract
Background and Aims Previous studies have focused only on the cardiometabolic effects of selenium concentrations. We explored whether selenium levels and their visit-to-visit variability (VVV) and individual mean (IM) are independently associated with cardiometabolic risk factors. Methods A three-wave repeated-measures study of older adults with high selenium (n = 201) was conducted in Beijing from 2016 to 2018. Whole blood selenium and urinary selenium concentrations were measured. VVV and IM were used to profile the homeostasis of the selenium biomarkers. Four indicators, namely standard deviation, coefficient of variation, average real variability, and variability independent of the mean, were employed to characterize VVV. We considered 13 cardiometabolic factors: four lipid profile indicators, three blood pressure indices, glucose, uric acid, waistline, hipline, waist-hip ratio, and sex-specific metabolic syndrome score. Linear mixed-effects regression models with random intercepts for the participants were employed to explore the associations of the selenium concentrations, VVV, and IM with the cardiometabolic factors. Results The geometric mean whole blood and urinary selenium levels were 134.30 and 18.00 μg/L, respectively. Selenium concentrations were significantly associated with numerous cardiometabolic factors. Specifically, whole blood selenium was positively associated with total cholesterol [0.22, 95% confidence interval (CI): 0.12, 0.33], low-density lipoprotein cholesterol (LDL-C; 0.28, 95% CI: 0.13, 0.42), glucose (0.22, 95% CI: 0.10, 0.34), and uric acid (0.16, 95% CI: 0.04, 0.28). After adjustment for VVV, the IM of whole blood selenium was positively correlated with total cholesterol (0.002, 95% CI: 0.001, 0.004), triglycerides (0.007, 95% CI: 0.004, 0.011), and LDL-C (0.002, 95% CI: 0.000, 0.004). However, we did not observe any robust associations between the VVV of the selenium biomarkers and cardiometabolic risk factors after adjustment for IM. Conclusion Our findings suggest that selenium concentrations and their IMs are significantly associated with cardiometabolic risk factors among older adults with high selenium. Longer repeated-measures studies among the general population are required to validate our findings and elucidate the relevant underlying mechanisms.
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Affiliation(s)
- Ang Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.,Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Quan Zhou
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.,Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yayuan Mei
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.,Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jiaxin Zhao
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.,Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Meiduo Zhao
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.,Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jing Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.,Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiaoyu Ge
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.,Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Qun Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.,Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Tan KML, Tint MT, Kothandaraman N, Yap F, Godfrey KM, Lee YS, Tan KH, Gluckman PD, Chong YS, Chong MFF, Eriksson JG, Cameron-Smith D. Association of plasma kynurenine pathway metabolite concentrations with metabolic health risk in prepubertal Asian children. Int J Obes (Lond) 2022; 46:1128-1137. [PMID: 35173282 PMCID: PMC7612806 DOI: 10.1038/s41366-022-01085-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The tryptophan-kynurenine (KYN) pathway is linked to obesity-related systemic inflammation and metabolic health. The pathway generates multiple metabolites, with little available data on their relationships to early markers of increased metabolic disease risk in children. The aim of this study was to examine the association of multiple KYN pathway metabolites with metabolic risk markers in prepubertal Asian children. METHODS Fasting plasma concentrations of KYN pathway metabolites were measured using liquid chromatography-tandem mass spectrometry in 8-year-old children (n = 552) from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) prospective mother-offspring cohort study. The child's weight and height were used to ascertain overweight and obesity using local body mass index (BMI)-for-age percentile charts. Body fat percentage was measured by quantitative magnetic resonance. Abdominal circumference, systolic and diastolic blood pressure, homeostatic model assessment for insulin resistance (HOMA-IR), triglyceride, and HDL-cholesterol were used for the calculation of Metabolic syndrome scores (MetS). Serum triglyceride, BMI, gamma-glutamyl transferase (GGT), and abdominal circumference were used in the calculation of the Fatty liver index (FLI). Associations were examined using multivariable regression analyses. RESULTS In overweight or obese children (n = 93; 16.9% of the cohort), all KYN pathway metabolites were significantly increased, relative to normal weight children. KYN, kynurenic acid (KA), xanthurenic acid (XA), hydroxyanthranilic acid (HAA) and quinolinic acid (QA) all showed significant positive associations with body fat percentage (B(95% CI) = 0.32 (0.22,0.42) for QA), HOMA-IR (B(95% CI) = 0.25 (0.16,0.34) for QA), and systolic blood pressure (B(95% CI) = 0.14(0.06,0.22) for QA). All KYN metabolites except 3-hydroxykynurenine (HK) significantly correlated with MetS (B (95% CI) = 0.29 (0.21,0.37) for QA), and FLI (B (95% CI) = 0.30 (0.21,0.39) for QA). CONCLUSIONS Higher plasma concentrations of KYN pathway metabolites are associated with obesity and with increased risk for metabolic syndrome and fatty liver in prepubertal Asian children.
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Affiliation(s)
- Karen Mei-Ling Tan
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Mya-Thway Tint
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine (YLLSOM), National University of Singapore, Singapore, Singapore
| | - Narasimhan Kothandaraman
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Fabian Yap
- Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
- Department of Pediatric Endocrinology, KK Women's and Children's Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University of Southampton Hospital, Southampton, UK
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat - National University Children's Medical Institute (KTPCMI), National University Health System, Singapore, Singapore
| | - Kok Hian Tan
- Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
- Perinatal Audit and Epidemiology, Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine (YLLSOM), National University of Singapore, Singapore, Singapore
| | - Mary F F Chong
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Johan G Eriksson
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine (YLLSOM), National University of Singapore, Singapore, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine (YLLSOM), National University of Singapore, Singapore, Singapore
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - David Cameron-Smith
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Abstract
Cardiovascular diseases caused by atherosclerosis do not typically manifest before middle age; however, the disease process begins early in life. Preclinical atherosclerosis can be quantified with imaging methods in healthy populations long before clinical manifestations present. Cohort studies have shown that childhood exposure to risk factors, such as dyslipidaemia, elevated blood pressure and tobacco smoking, are associated with adult preclinical atherosclerotic phenotypes. Importantly, these long-term effects are substantially reduced if the individual becomes free from the risk factor by adulthood. As participants in the cohorts continue to age and clinical end points accrue, the strongest evidence linking exposure to risk factors in early life with cardiovascular outcomes has begun to emerge. Although science has deciphered the natural course of atherosclerosis, discovered its causal risk factors and developed effective means to intervene, we are still faced with an ongoing global pandemic of atherosclerotic diseases. In general, atherosclerosis goes undetected for too long, and preventive measures, if initiated at all, are inadequate and/or come too late. In this Review, we give an overview of the available literature suggesting the importance of initiating the prevention of atherosclerosis in early life and provide a summary of the major paediatric programmes for the prevention of atherosclerotic disease. We also highlight the limitations of current knowledge and indicate areas for future research.
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Association between Metabolic Syndrome Diagnosis and the Physical Activity-Sedentary Profile of Adolescents with Obesity: A Complementary Analysis of the Beta-JUDO Study. Nutrients 2021; 14:nu14010060. [PMID: 35010936 PMCID: PMC8746544 DOI: 10.3390/nu14010060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 01/09/2023] Open
Abstract
Metabolic syndrome (MetS) is highly prevalent in children and adolescents with obesity and places them at an increased risk of cardiovascular-related diseases. However, the associations between objectively measured movement-related behaviors and MetS diagnosis remain unexplored in youths with obesity. The aim was to compare profiles of sedentary (SED) time (more sedentary, SED+ vs. less sedentary, SED−), moderate to vigorous physical activity (MVPA) time (more active, MVPA+ vs. less active, MVPA−) and combinations of behaviors (SED−/MVPA+, SED−/MVPA−, SED+/MVPA+, SED+/MVPA−) regarding the MetS diagnosis. One hundred and thirty-four adolescents with obesity (13.4 ± 2.2 years) underwent 24 h/7 day accelerometry, waist circumference (WC), blood pressure (BP), high-density lipoprotein-cholesterol (HDL-c), triglycerides (TG) and insulin-resistance (IR) assessments. Cumulative cardiometabolic risk was assessed by using (i) MetS status (usual dichotomic definition) and (ii) cardiometabolic risk z-score (MetScore, mean of standardized WC, BP, IR, TG and inverted HDL-c). SED− vs. SED+ and MVPA+ vs. MVPA− had lower MetS (p < 0.01 and p < 0.001) and MetScore (p < 0.001). SED−/MVPA+ had the lowest risk. While SED and MVPA times were lower in SED−/MVPA− vs. SED+/MVPA+ (p < 0.001), MetScore was lower in SED−/MVPA− independently of body mass index (BMI) (p < 0.05). MVPA, but not SED, time was independently associated with MetS diagnosis (p < 0.05). Both MVPA (p < 0.01) and SED times (p < 0.05) were associated with MetScore independently of each other. A higher MVPA and lower SED time are associated with lower cumulative cardiometabolic risk.
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Alternative pediatric metabolic syndrome definitions impact prevalence estimates and socioeconomic gradients. Pediatr Res 2021; 90:694-700. [PMID: 33446919 DOI: 10.1038/s41390-020-01331-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND There is no consensus regarding the definition of pediatric metabolic syndrome (MetS). This study assessed the impact of alternative definitions on the prevalence, children identified, and association with socioeconomic status (SES). METHODS Data were from the prospective multigenerational Dutch Lifelines Cohort Study. At baseline, 9754 children participated, and 5085 (52.1%) with average follow-up of 3.0 (SD = 0.75) years were included in the longitudinal analyses; median ages were 12 (IQR = 10-14) and 14 years (IQR = 12-15), respectively. We computed MetS prevalence according to five published definitions and measured the observed proportion of positive agreement. We used logistic regression to assess the SES-MetS association, adjusted for age and sex. Longitudinal models were also adjusted for baseline MetS. RESULTS MetS prevalence and positive agreement varied between definitions, from 0.7 to 3.0% and from 0.34 (95% CI: 0.28; 0.41) to 0.66 (95% CI: 0.58; 0.75) at baseline, respectively. We consistently found a socioeconomic gradient; in the longitudinal analyses, each additional year of parental education reduced the odds of having MetS by 8% (95% CI: 1%; 14%) to 19% (95% CI: 7%; 30%). CONCLUSIONS Alternative MetS definitions had differing prevalence estimates and agreed on 50% of the average number of cases. Additionally, regardless of the definition, low SES was a risk factor for MetS. IMPACT Little is known about the impact of using different definitions of pediatric metabolic syndrome on study results. Our study showed that the choice of pediatric metabolic syndrome definition produces very different prevalence estimates. We also showed that the choice of definition influences the socioeconomic gradient. However, low socioeconomic status was consistently a risk factor for having pediatric metabolic syndrome. In conclusion, studies using different definitions of metabolic syndrome could be reasonably compared when investigating the association with socioeconomic status but not always validly when comparing prevalence studies.
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Öğütlü H, Taydas O, Karadag M, Çalışgan B, Kantarci M. Is common carotid artery intima-media thickness (cIMT) a risk assessment marker in children with attention deficit/hyperactivity disorder? Int J Psychiatry Clin Pract 2021; 25:325-330. [PMID: 34097567 DOI: 10.1080/13651501.2021.1933043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Attention deficit/hyperactivity disorder (ADHD) is associated with impairment in social, academic and job-related functioning in both children and adults. The purpose of this study is to investigate the susceptibility to cardiovascular risk factors in children with ADHD diagnosis through common carotid artery intima-media thickness (cIMT) measurement, to compare cIMT in ADHD and control groups and to evaluate the association between cIMT and ADHD symptom severity. METHODS The mean cIMT of 42 children with ADHD, ADHD symptom scales and a semi-structured psychiatric interview, and 42 age and sex matched healthy controls were measured with B-mode Doppler neck ultrasonography. RESULTS The median cIMT was significantly higher for the ADHD group compared to the healthy controls. There was a statistically significant, negative, moderate correlation between cIMT and Conners ADHD index score, hyperactivity score, oppositional score and the presence of ODD comorbidity. CONCLUSIONS In this study, we found significantly higher cIMT in children with ADHD when compared to healthy controls. Considering that increased cIMT is a sign of atherosclerosis and it can be used as a marker of cardiovascular risk factors, our finding may indicate that children with ADHD are at increased risk for cardiovascular diseases.KeypointscIMT was significantly higher in children with ADHD when compared to healthy controls.Higher cIMT in children with ADHD may indicate that children with ADHD are at increased risk for cardiovascular diseases.cIMT measurement may be studied as a potential tool for risk assessment before a child with ADHD is started on psychostimulant medications.
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Affiliation(s)
- Hakan Öğütlü
- Department of Child and Adolescent Psychiatry, Ankara City Hospital, Ankara, Turkey
| | - Onur Taydas
- Department of Radiology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Mehmet Karadag
- Child and Adolescent Psychiatry Department, Gaziantep University Medical Faculty, Gaziantep, Turkey
| | - Baran Çalışgan
- Child and Adolescent Psychiatry Department, Gaziantep University Medical Faculty, Gaziantep, Turkey
| | - Mecit Kantarci
- Department of Radiology, Ataturk University School of Medicine, Erzurum, Turkey
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11
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Socioeconomic Health Inequalities in Adolescent Metabolic Syndrome and Depression: No Mediation by Parental Depression and Parenting Style. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147716. [PMID: 34300166 PMCID: PMC8303316 DOI: 10.3390/ijerph18147716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/12/2021] [Accepted: 07/17/2021] [Indexed: 11/23/2022]
Abstract
We assessed to what extent parental depression and parenting style mediate the relationships between different measures of parental socioeconomic status (SES) and both depression and metabolic syndrome (MetS) in adolescents, and whether sex moderates these mechanisms. Data were from the prospective multigenerational Dutch Lifelines Cohort Study. Our sample consisted of 1217 adolescents with an average follow-up of 33.3 (SD = 7.33) months and a median baseline age of 13 (IQR:13–14) years. We used structural equation models to assess the direct and indirect effects of SES on baseline and changes at follow-up in both depression and MetS, and to assess moderation by sex. For each additional year of education, continuous MetS scores were 0.098 (95%CI: 0.020; 0.184) units lower at baseline and decreased 0.079 (95%CI: 0.004; 0.158) units at follow-up. No other direct or indirect effects of SES were found, and there was no moderation by sex. Additionally, warmer parenting style was generally associated with more favorable outcome scores. Therefore, improving parenting style may improve health for all adolescents. However, in this study parental depression and parenting style did not account for adolescent socioeconomic health inequalities. This may be partly due to good access to social services within the Netherlands.
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12
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Khazdouz M, Hasani M, Mehranfar S, Ejtahed HS, Djalalinia S, Mahdavi Gorabi A, Esmaeili-Abdar M, Karbalahi Saleh S, Arzaghi SM, Zahedi H, Kasaeian A, Qorbani M. Validity of continuous metabolic syndrome score for predicting metabolic syndrome; a systematic review and meta-analysis. J Diabetes Metab Disord 2021; 20:497-510. [PMID: 34222074 PMCID: PMC8212237 DOI: 10.1007/s40200-021-00771-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/11/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Nowadays, use of continuous metabolic syndrome (cMetS) score has been suggested to improve recognition of metabolic syndrome (MetS). The aim of this study was to evaluate the validity of cMetS scores for predicting MetS. METHODS We searched the electronic databases included MEDLINE/PubMed, Embase, ISI Web of Science, and Scopus from 1 January 1980 to 30 September 2020. Observational studies on participants with different cMetS scores were included in this meta-analysis. The sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR) and diagnostic odds ratio (DOR) with 95% CI were calculated. RESULTS Ten studies involving a total of 25,073 participants were included. All studies had cross-sectional design. The pooled sensitivity and specificity of cMetS scores for predicting MetS were 0.90 (95% CI: 0.83 to 0.95) and 0.86 (95% CI: 0.83 to 0.89), respectively. Moreover, cMetS scores had the pooled LR+ of 6.5 (95% CI: 5.0 to 8.6), and a pooled (LR-) of 0.11 (95% CI: 0.063 to 0.21). The pooled DOR of cMetS scores to predict MetS were 57 (95% CI: 26 to 127). CONCLUSIONS The high sensitivity and specificity of cMetS scores indicates that it has a high accuracy to predict the risk of MetS. Furthermore, the cMetS scores has a good ability to rule out healthy people. STUDY REGISTRATION This study was registered as PROSPERO CRD42020157273.
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Affiliation(s)
- Maryam Khazdouz
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Motahareh Hasani
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Sanaz Mehranfar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hanieh-Sadat Ejtahed
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Djalalinia
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | | | - Mohammad Esmaeili-Abdar
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Shahrokh Karbalahi Saleh
- Department of Cardiology, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Masoud Arzaghi
- Elderly Health Research Center, Endocrinology and Metabolism Population Science Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hoda Zahedi
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Kasaeian
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Inflammation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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13
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Mielke GI, Menezes AMB, da Silva BGC, Ekelund U, Crochemore-Silva I, Wehrmeister FC, Gonçalves H, Brown WJ. Associations between Device-measured Physical Activity and Cardiometabolic Health in the Transition to Early Adulthood. Med Sci Sports Exerc 2021; 53:2076-2085. [PMID: 33966000 DOI: 10.1249/mss.0000000000002696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSES The aims of this study were to investigate the cross-sectional and prospective associations between accelerometer-measured physical activity and cardiometabolic health in the transition to adulthood. METHODS Data from the 1993 Pelotas (Brazil) Birth Cohort were analysed (N=2,280). Moderate-to-vigorous intensity physical activity (MVPA, measured using a triaxial accelerometer) and cardiometabolic health (total fat mass, blood glucose, non-HDL cholesterol, triglycerides and mean resting blood pressure) were examined at age 18 and 22 yr. RESULTS Overall, inverse dose-response associations between MVPA and cardiometabolic health at age 18 and 22 yr were observed in cross-sectional analyses of data from males and females. Prospective analyses showed that, in general, MVPA declined, and cardiometabolic health worsened in this 4-yr period in both males and females. Cardiometabolic health at age 22 reflected both MVPA at age 18 [β: -0.007 (95% CI: -0.014; 0.000)] and changes in MVPA from 18 to 22 yr [β: -0.030 (95% CI: -0.043; -0.016)] in males, but only changes in MVPA in females [β: -0.035 (95% CI: -0.058; -0.011)]. In analyses of change over time, males who improved MVPA by 20-30 min per day showed significant improvements in cardiometabolic health over 4 yr. The magnitude of association was slightly stronger for MVPA in 10-min bouts than for MVPA accumulated in bouts of 1-min, especially in females. CONCLUSION MVPA is an important predictor of cardiometabolic health in early adulthood. Strategies to prevent declines in MVPA at this life stage are required to prevent deteriorating cardiometabolic health profiles.
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Affiliation(s)
- Gregore I Mielke
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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14
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Pool LR, Aguayo L, Brzezinski M, Perak AM, Davis MM, Greenland P, Hou L, Marino BS, Van Horn L, Wakschlag L, Labarthe D, Lloyd-Jones D, Allen NB. Childhood Risk Factors and Adulthood Cardiovascular Disease: A Systematic Review. J Pediatr 2021; 232:118-126.e23. [PMID: 33516680 DOI: 10.1016/j.jpeds.2021.01.053] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To conduct a comprehensive review of the literature on childhood risk factors and their associations with adulthood subclinical and clinical cardiovascular disease (CVD). STUDY DESIGN A systematic search was performed using the MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science databases to identify English-language articles published through June 2018. Articles were included if they were longitudinal studies in community-based populations, the primary exposure occurred during childhood, and the primary outcome was either a measure of subclinical CVD or a clinical CVD event occurring in adulthood. Two independent reviewers screened determined whether eligibility criteria were met. RESULTS There were 210 articles that met the predefined criteria. The greatest number of publications examined associations of clinical risk factors, including childhood adiposity, blood pressure, and cholesterol, with the development of adult CVD. Few studies examined childhood lifestyle factors including diet quality, physical activity, and tobacco exposure. Domains of risk beyond "traditional" cardiovascular risk factors, such as childhood psychosocial adversity, seemed to have strong published associations with the development of CVD. CONCLUSIONS Although the evidence was fairly consistent in direction and magnitude for exposures such as childhood adiposity, hypertension, and hyperlipidemia, significant gaps remain in the understanding of how childhood health and behaviors translate to the risk of adulthood CVD, particularly in lesser studied exposures like glycemic indicators, physical activity, diet quality, very early life course exposure, and population subgroups.
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Affiliation(s)
- Lindsay R Pool
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Liliana Aguayo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Michal Brzezinski
- Department of Public Health and Social Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Amanda M Perak
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Matthew M Davis
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bradley S Marino
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lauren Wakschlag
- Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Darwin Labarthe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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15
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Asghari G, Hasheminia M, Heidari A, Mirmiran P, Guity K, Shahrzad MK, Azizi F, Hadaegh F. Adolescent metabolic syndrome and its components associations with incidence of type 2 diabetes in early adulthood: Tehran lipid and glucose study. Diabetol Metab Syndr 2021; 13:1. [PMID: 33388084 PMCID: PMC7778813 DOI: 10.1186/s13098-020-00608-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/01/2020] [Accepted: 11/03/2020] [Indexed: 12/14/2022] Open
Abstract
AIM To investigate the association of youth metabolic syndrome (MetS) and its components, individually and in combination with early adulthood incident type 2 diabetes (T2DM). METHODS A total of 2798 adolescents aged 11-19 years enrolled in the study. At baseline, MetS, its components including blood pressure (BP), waist circumference (WC), triglycerides (TGs), fasting plasma glucose, and low HDL-C, and different combinations of MetS components were defined. After a mean 11.3 years of follow-up, T2DM was determined. Multivariable Cox proportional hazard regression analysis adjusted for age, sex, family history of T2DM, and adult BMI was used for data analysis. The hazard ratio (HR) and 95% confidence interval (CI) were reported. RESULTS During the follow-up, 44 incidents T2DM were developed. Among different individual components, only high WC [HR = 2.63, 95% CI (1.39-4.97)] and high TGs [HR = 1.82, 95% CI (1.00-3.34)] remained as significant predictors only in the age and sex adjusted model. Regarding combinations of MetS components, 'high TGs and high WC' [HR = 2.70, 95% CI (1.27-5.77)], 'high BP and high WC' [HR = 2.52, 95% CI (1.00-6.33)], 'high TGs and high BP' [HR = 2.27, 95% CI (1.02-5.05)] as well as MetS per se [HR = 2.82, 95% CI (1.41-5.64)] had a significant relationship with incident T2DM in the multivariable adjusted model. Among different confounders, being female and having family history of T2DM were consistently associated with higher risk of T2DM, in different combinations of MetS components. CONCLUSIONS Adolescence MetS and some combinations of MetS components predicted early adulthood T2DM. Thus, adolescents, particularly female ones, with combinations of MetS components as well as those with family history of T2DM could be targeted for lifestyle intervention.
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Affiliation(s)
- Golaleh Asghari
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra Hasheminia
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abolfazl Heidari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kamran Guity
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Karim Shahrzad
- Internal Medicine and Endocrinology, Shohada Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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16
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The prevalence of pediatric metabolic syndrome-a critical look on the discrepancies between definitions and its clinical importance. Int J Obes (Lond) 2020; 45:12-24. [PMID: 33208861 PMCID: PMC7752760 DOI: 10.1038/s41366-020-00713-1] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 10/16/2020] [Accepted: 11/02/2020] [Indexed: 02/06/2023]
Abstract
Introduction The Metabolic Syndrome (MetS) describes the clustering of cardio-metabolic risk factors—including abdominal obesity, insulin resistance, elevated blood pressure, high levels of triglycerides, and low levels of high-density lipoproteins—that increase the risk for developing cardiovascular diseases and type 2 diabetes mellitus. However, a generally accepted definition of MetS in pediatric patients is still lacking. Objectives The aim was to summarize current prevalence data of childhood MetS as well as to discuss the continuing disagreement between different pediatric definitions and the clinical importance of such diagnosis. Methodology A systematic literature search on the prevalence of pediatric MetS was conducted. Articles that were published during the past 5 years (2014–2019), using at least one of four predetermined classifications (International Diabetes Federation, Cook et al., Ford et al., and de Ferranti et al.), were included. Results The search resulted in 1167 articles, of which 31 publications met all inclusion criteria. Discussion The prevalence of MetS ranged between 0.3 and 26.4%, whereby the rising number of children and adolescents with MetS partly depended on the definition used. The IDF definition generally provided the lowest prevalences (0.3–9.5%), whereas the classification of de Ferranti et al. yielded the highest (4.0–26.4%). In order to develop a more valid definition, further research on long-term consequences of childhood risk factors such as abdominal obesity, insulin resistance, hypertension, and dyslipidemia is needed. There is also a temptation to suggest one valid, globally accepted definition of metabolic syndrome for pediatric populations but we believe that it is more appropriate to suggest definitions of MetS that are specific to males vs. females, as well as being specific to race/ethnicity or geographic region. Finally, while this notion of definitions of MetS specific to certain subgroups is important, it still needs to be tested in future research.
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Zhou T, Zhang Y, Wu C, Shen C, Li J, Liu Z. An Augmented Model with Inferred Blood Features for the Self-diagnosis of Metabolic Syndrome. Methods Inf Med 2020; 59:18-30. [DOI: 10.1055/s-0040-1710382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Abstract
Background and Objectives The penetration rate of physical examinations in China is substantially lower than that in developed countries. Therefore, an auxiliary approach that does not depend on hospital health checks for the diagnosis of metabolic syndrome (MetS) is needed.
Methods In this study, we proposed an augmented method with inferred blood features that uses self-care inputs available at home for the auxiliary diagnosis of MetS. The dataset used for modeling contained data on 91,420 individuals who had at least 2 consecutive years of health checks. We trained three separate models using a regularized gradient-boosted decision tree. The first model used only home-based features; additional blood test data (including triglyceride [TG] data, fasting blood glucose data, and high-density lipoprotein cholesterol [HDL-C] data) were included in the second model. However, in the augmented approach, the blood test data were manipulated using multivariate imputation by chained equations prior to inclusion in the third model. The performance of the three models for MetS auxiliary diagnosis was then quantitatively compared.
Results The results showed that the third model exhibited the highest classification accuracy for MetS in comparison with the other two models (area under the curve [AUC]: 3rd vs. 2nd vs. 1st = 0.971 vs. 0.950 vs. 0.905, p < 0.001). We further revealed that with full sets of the three measurements from earlier blood test data, the classification accuracy of MetS can be further improved (AUC: without vs. with = 0.971 vs. 0.993). However, the magnitude of improvement was not statistically significant at the 1% level of significance (p = 0.014).
Conclusion Our findings demonstrate the feasibility of the third model for MetS homecare applications and lend novel insights into innovative research on the health management of MetS. Further validation and implementation of our proposed model might improve quality of life and ultimately benefit the general population.
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Affiliation(s)
- Tianshu Zhou
- Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, People's Republic of China
- Connected Healthcare Big Data Research Center, Zhejiang Lab, Hangzhou, People's Republic of China
| | - Ying Zhang
- Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, People's Republic of China
- Connected Healthcare Big Data Research Center, Zhejiang Lab, Hangzhou, People's Republic of China
| | - Chengkai Wu
- Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, People's Republic of China
| | - Chao Shen
- Health Management Center, The First Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, People's Republic of China
| | - Jingsong Li
- Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, People's Republic of China
- Connected Healthcare Big Data Research Center, Zhejiang Lab, Hangzhou, People's Republic of China
| | - Zhong Liu
- Health Management Center, The First Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, People's Republic of China
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Serbis A, Giapros V, Galli-Tsinopoulou A, Siomou E. Metabolic Syndrome in Children and Adolescents: Is There a Universally Accepted Definition? Does it Matter? Metab Syndr Relat Disord 2020; 18:462-470. [PMID: 32795106 DOI: 10.1089/met.2020.0076] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The concept of metabolic syndrome (MetS) as a cluster of cardiovascular risk factors (obesity, altered glucose metabolism, dyslipidemia, and hypertension) has been around for more than 30 years. It is considered to be the result of complex interactions between centrally located fat, insulin resistance, subclinical inflammation, and other factors in genetically predisposed individuals. MetS diagnosis in adults has been linked to increased risk for cardiovascular disease (CVD) and type 2 diabetes mellitus (T2D). However, MetS in children and adolescents remains a controversial issue despite the extensive research in the field. It is still uncertain which definition should be used for its diagnosis in this age group, what is the clinical significance of such a diagnosis, and how reliably it can predict the future risk of developing CVD and T2D. Even if a child is diagnosed with MetS, management includes addressing each of the syndrome's components individually with weight loss and lifestyle modifications as the basic approach. Co-morbid conditions, such as nonalcoholic fatty liver disease, obstructive sleep apnea, and polycystic ovary syndrome should also be considered. It seems that MetS in children and adolescents should be used clinically as a conceptual framework for the identification of risk factors clustered around obesity and insulin resistance rather than a syndrome that needs to be diagnosed by measuring absolute "all-or-none" criteria.
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Affiliation(s)
- Anastasios Serbis
- Child Health Department, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Vasileios Giapros
- Child Health Department, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Assimina Galli-Tsinopoulou
- 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Ekaterini Siomou
- Child Health Department, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
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Lycett K, Juonala M, Magnussen CG, Norrish D, Mensah FK, Liu R, Clifford SA, Carlin JB, Olds T, Saffery R, Kerr JA, Ranganathan S, Baur LA, Sabin MA, Cheung M, Dwyer T, Liu M, Burgner D, Wake M. Body Mass Index From Early to Late Childhood and Cardiometabolic Measurements at 11 to 12 Years. Pediatrics 2020; 146:peds.2019-3666. [PMID: 32632021 DOI: 10.1542/peds.2019-3666] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine how overweight and obesity at specific ages and overall BMI growth patterns throughout childhood predict cardiometabolic phenotypes at 11 to 12 years. METHODS In a population-based sample of 5107 infants, BMI was measured every 2 years between ages 2 to 3 and 10 to 11 years. We identified 5 BMI trajectories using growth curve models. At ages 11 to 12 years, 1811 children completed assessments for metabolic syndrome risk scores, carotid-femoral pulse wave velocity, and carotid intima-media thickness. Multivariable regression models were used to estimate associations, adjusted for potential confounders (eg, age, sex, smoking exposure, and small for gestational age). RESULTS Overweight and obesity from early childhood onward were strongly associated with higher cardiometabolic risk at 11 to 12 years of age. At age 6 to 7 years, compared with those with a healthy weight, children with overweight had higher metabolic syndrome risk scores by 0.23 SD units (95% confidence interval 0.05 to 0.41) and with obesity by 0.76 SD units (0.51-1.01), with associations almost doubling by age 10 to 11 years. Obese (but not overweight) children had higher outcome pulse wave velocity (0.64-0.73 SD units) from ages 6 to 7 years and slightly higher outcome carotid intima-media thickness (0.20-0.30 SD units) at all ages. Cumulative exposure to high BMI from 2 to 3 years of age carried the greatest cardiometabolic risk, with a gradient of risk across trajectories. CONCLUSIONS High early-childhood BMI is already silently associated with the development of cardiometabolic risk by 11 to 12 years, highlighting the urgent need for effective action to reduce overweight and obesity in early childhood.
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Affiliation(s)
- Kate Lycett
- Centre for Social & Early Emotional Development, Deakin University, Burwood, Victoria, Australia; .,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Markus Juonala
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Internal Medicine and.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Costan G Magnussen
- Research School of Computer Science, Australian National University, Canberra, Australian Capital Territory, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia
| | - David Norrish
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Research School of Computer Science, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Fiona K Mensah
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Richard Liu
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Susan A Clifford
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - John B Carlin
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Tim Olds
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Jessica A Kerr
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Sarath Ranganathan
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Louise A Baur
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Matthew A Sabin
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Michael Cheung
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Terence Dwyer
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Mengjiao Liu
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - David Burgner
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; and
| | - Melissa Wake
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
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20
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Shenassa ED, Williams AD. Concomitant exposure to area-level poverty, ambient air volatile organic compounds, and cardiometabolic dysfunction: a cross-sectional study of U.S. adolescents. Ann Epidemiol 2020; 48:15-22. [PMID: 32778227 DOI: 10.1016/j.annepidem.2020.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/09/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE A key to better understanding the influence of the place of residence on cardiometabolic function is the effect of concomitant exposure to both air pollution and residence in economically marginalized areas. We hypothesized that, among adolescents, the association between air pollution and cardiometabolic function is exacerbated among residents of economically marginalized areas. METHODS In this cross-sectional study, individual-level data on cardiometabolic function collected from a representative sample of U.S. adolescents in the National Health and Nutrition Examination Survey (n = 10,415) were merged with data on area-level poverty (U.S. decennial survey and American Community Survey) and air pollution levels (National-Scale Air Toxics Assessment ) using contemporary census-tract identifiers. We excluded respondents who were pregnant, had hypertension or diabetes or using medication for hypertension or diabetes, or with missing data on outcome variables. RESULTS We observed a significant interaction between area-level poverty and air pollution. Among residents of high-poverty areas, exposure to high levels of air pollution predicted a 30% elevated odds of cardiometabolic dysfunction (OR = 1.30; 95% CI: 1.04, 1.61), whereas in low-poverty areas, exposure to high levels of air pollution was not associated with elevated odds of cardiometabolic dysfunction (OR = 1.04; 95% CI: 0.85, 1.28). CONCLUSIONS Our findings suggest that the cardiometabolic consequences of air pollution are more readily realized among residents of economically marginalized areas. Structural remedies are discussed.
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Affiliation(s)
- Edmond D Shenassa
- Maternal and Child Health Program, Department of Family Science, University of Maryland, College Park; Department of Epidemiology and Biostatistics, University of Maryland, College Park, MD; Department of Epidemiology and Biostatistics, School of Public Health, Brown University, Providence, RI; Department of Epidemiology and Biostatistics, School of Medicine, University of Maryland Baltimore, Baltimore, MD.
| | - Andrew D Williams
- Public Health Program, School of Medicine & Health Sciences, University of North Dakota, Grand Forks
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21
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Eny KM, Jeyakumar N, Dai DWH, Maguire JL, Parkin PC, Birken CS. Sugar-containing beverage consumption and cardiometabolic risk in preschool children. Prev Med Rep 2020; 17:101054. [PMID: 32021763 PMCID: PMC6994294 DOI: 10.1016/j.pmedr.2020.101054] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 12/19/2019] [Accepted: 01/11/2020] [Indexed: 02/07/2023] Open
Abstract
Objective Sugar-containing beverages (SCBs) including 100% fruit juice, fruit drinks and soda substantially contribute to total caloric intake in young children. The objective of this study was to examine whether consumption of SCB is associated with cardiometabolic risk (CMR) in preschool children, along with whether 100% fruit juice and sugar sweetened beverage (SSB) is associated with CMR. Study Design We used a repeated measures study design examining SCB consumption and CMR outcomes measured concurrently in children 3-6 years of age participating in TARGet Kids!, a primary-care, practice-based research network in Canada (2008-2017). To account for within-person variability, multivariable linear regression models using generalized estimating equation was used to examine the association between SCB consumption and CMR score and the individual CMR score components including systolic blood pressure, waist circumference, high-density lipoprotein cholesterol (HDL-c), triglycerides, and glucose. Results After adjusting for sociodemographic, familial and child-related covariates, higher SCB consumption was associated with elevated CMR score [0.05 (95% CI -0.0001 to 0.09), p = 0.05], including lower HDL-c [-0.02 mmol/L (95% CI -0.03 to -0.01), p = 0.01] and higher triglycerides [0.02 mmol/L (95% CI 0.004 to 0.04), p = 0.02]. When examined separately, higher 100% fruit juice [-0.02 mmol/L (95% CI -0.03 to -0.003), p = 0.02] and SSB[-0.03 mmol/L (95% CI -0.06 to -0.001), p = 0.04] consumption were each associated with lower HDL-c. Conclusion Higher SCB consumption was associated with small elevations of CMR in preschool children. Our findings support recommendations to limit overall intake of SCBs in early childhood, in effort to reduce the potential long-term burden of CMR.
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Key Words
- 100% fruit juice
- AAP, American Academy of Pediatrics
- CMR, cardiometabolic risk
- CVD, Cardiovascular disease
- GEE, Generalized estimating equations
- HDL-c, high density lipoprotein-cholesterol
- HDL-cholesterol
- NHANES, National Health and Nutrition Examination Survey
- SBP, Systolic blood pressure
- SCB, Sugar-containing beverage
- SSB, Sugar-sweetened beverage
- Sugar-sweetened beverages
- TG, triglycerides
- Triglycerides
- WC, waist circumference
- zBMI, Body mass index z-score
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Affiliation(s)
- Karen M Eny
- Nutrigenomix Inc, Toronto, Ontario, Canada.,ICES, Ontario, Canada
| | | | | | - Jonathon L Maguire
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Pediatrics, St. Michael's Hospital, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Patricia C Parkin
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Pediatric Medicine and the Pediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Catherine S Birken
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Canada.,Division of Pediatric Medicine and the Pediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, Ontario, Canada
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22
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Renninger M, Hansen BH, Steene-Johannessen J, Kriemler S, Froberg K, Northstone K, Sardinha L, Anderssen SA, Andersen LB, Ekelund U. Associations between accelerometry measured physical activity and sedentary time and the metabolic syndrome: A meta-analysis of more than 6000 children and adolescents. Pediatr Obes 2020; 15:e12578. [PMID: 31709781 PMCID: PMC7003500 DOI: 10.1111/ijpo.12578] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/13/2019] [Accepted: 08/24/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Metabolic syndrome is increasingly prevalent in the pediatric population. To prevent an early onset, knowledge about its association with modifiable lifestyle factors is needed. OBJECTIVES To estimate the prevalence of the metabolic syndrome and examine its cross-sectional associations with physical activity and sedentary time. METHODS Participants were 6009 children and adolescents from 8 studies of the International Children's Accelerometry Database. Physical activity and sedentary time were measured by accelerometer. Metabolic syndrome was defined based on International Diabetes Federation criteria. Logistic regression models adjusted for sex, age and monitor wear time were used to examine the associations between physical activity, sedentary time and the metabolic syndrome in each study and effect estimates were combined using random-effects meta-analysis. RESULTS The overall prevalence of the metabolic syndrome was 2.9%. In crude models, a 10 min increase in moderate-to-vigorous intensity physical activity and vigorous-intensity physical activity were inversely associated with the metabolic syndrome [OR 0.88, 95% CI 0.82-0.94, OR 0.80, 95% CI 0.70-0.92]. One hour increase in sedentary time was positively associated with the metabolic syndrome [OR 1.28, 95% CI 1.13-1.45]. After adjustment for sedentary time, the association between moderate-to-vigorous-intensity physical activity and the metabolic syndrome remained significant [OR 0.91, 95% CI 0.84-0.99]. Sedentary time was not associated with the metabolic syndrome after adjustment for moderate-to-vigorous intensity physical activity [OR 1.14 95% CI 0.96-1.36]. CONCLUSIONS Physical activity of at least moderate intensity but not sedentary time is independently associated with the metabolic syndrome.
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Affiliation(s)
- Marius Renninger
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität München, Munich, Germany
| | - Bjørge H Hansen
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Susi Kriemler
- Epidemiology, Biostatistics and Public Health Institute, University of Zürich, Zurich, Switzerland
| | - Karsten Froberg
- Center of Research in Childhood Health (RICH), University of Southern Denmark, Odense, Denmark
| | - Kate Northstone
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Luis Sardinha
- Exercise and Health Laboratory, CIPER, Fac Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Sigmund A Anderssen
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Lars B Andersen
- Faculty of Education, Arts and Sport, Western Norway University of Applied Sciences, Sogndal, Norway
| | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Norwegian Institute for Public Health, Oslo, Norway
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23
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Williams AD, Shenassa ED. Sex-Specific Associations Between Area-Level Poverty and Cardiometabolic Dysfunction Among US Adolescents. Public Health Rep 2019; 135:47-55. [PMID: 31725345 DOI: 10.1177/0033354919884303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Cardiometabolic disease is the leading cause of mortality in the United States. Cardiometabolic function during adolescence predicts future cardiometabolic disease, yet few studies have examined early determinants of cardiometabolic function. Informed by evidence of sex differences in the prevalence and severity of cardiometabolic disorders and evidence of sexual dimorphism in the stress response, we examined sex differences in the association between living in poverty and cardiometabolic function during adolescence, a precursor of later cardiometabolic disorders. METHODS We linked data from 10 415 adolescents aged 12-19 in the National Health and Nutrition Examination Survey (1999-2012) with US Census-tract data on area-level poverty (percentage of the population living in poverty, grouped into quartiles). We parameterized cardiometabolic dysfunction by summing the z scores of 6 cardiometabolic biomarkers, grouped into quintiles. Hierarchical ordinal models estimated associations. RESULTS Compared with residents in low-poverty areas, residents in high-poverty areas had elevated odds of cardiometabolic dysfunction (highest quartile of poverty odds ratio [OR] = 1.27; 95% confidence interval [CI], 1.08-1.50). This association was more pronounced among boys than girls (highest quartile of poverty for boys: OR = 1.36; 95% CI, 1.10-1.70; highest quartile of poverty for girls: OR = 1.17; 95% CI, 0.94-1.47). CONCLUSION Our study supports the existence of sex-specific associations. These results highlight the potential for community-based programs, such as housing assistance, to improve population health.
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Affiliation(s)
- Andrew D Williams
- Department of Family Science, Maternal and Child Health Program, University of Maryland College Park, College Park, MD, USA
| | - Edmond D Shenassa
- Department of Family Science, Maternal and Child Health Program, University of Maryland College Park, College Park, MD, USA.,Department of Epidemiology and Biostatistics, University of Maryland College Park, College Park, MD, USA.,Department of Epidemiology and Biostatistics, School of Public Health, Brown University, Providence, RI, USA.,Department of Epidemiology and Biostatistics, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA
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24
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Sharma R. Continuous Metabolic Syndrome Score in Children: How Useful is it? Indian J Pediatr 2019; 86:881-882. [PMID: 31378001 DOI: 10.1007/s12098-019-03047-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Rajni Sharma
- Division of Pediatric Endocrinology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
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25
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Sawant SP, Amin AS. Use of Continuous Metabolic Syndrome Score in Overweight and Obese Children. Indian J Pediatr 2019; 86:909-914. [PMID: 31300954 DOI: 10.1007/s12098-019-02994-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/22/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To assess the utility of continuous metabolic syndrome score (cMetS) for predicting metabolic syndrome (MS) and determine the cut-off values in overweight and obese children. METHODS This study was conducted among 104 children (7-14 y) attending obesity clinics of a tertiary care hospital in Mumbai, India. The cMetS was computed by standardizing the residuals of waist circumference (WC), mean arterial blood pressure (MAP), high density lipoprotein cholesterol (HDL-C), triglycerides (TG), and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) by regressing them according to age and sex and aggregating them. The optimal cut-off of cMetS for predicting MS was determined by the receiver operation characteristic (ROC) curve analysis. RESULTS The cMetS increased significantly with increase in the number of MS risk factors. It was significantly high in children with MS than those without it (boys: 1.070 + 1.834 vs. -1.478 + 2.262; girls: 2.092 + 1.963 vs. -2.253 + 2.140; combined children group: 1.572 + 1.950 vs. -1.907+ 2.374; p < 0.001). The score predicted MS with high accuracy in girls; (AUC of 0.95, 95% CI: 0.90-1.00), moderate accuracy in boys (AUC of 0.79, 95% CI: 0.65-0.92) and in the combined group (AUC of 0.87, 95% CI 0.80-0.94) respectively. The cut-off of cMetS yielding maximal sensitivity and specificity for predicting the MS was -1.009 in boys (sensitivity 93% and specificity 62%); -0.652 in girls (sensitivity 96.4% and specificity 77%) and - 0.6881 in the combined group (sensitivity 91.2% and specificity 70.2%). CONCLUSIONS cMetS predicted MS with moderate to high accuracy. It had high sensitivity and specificity in predicting MS in overweight and obese children.
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Affiliation(s)
- Sangeeta P Sawant
- Department of Pediatrics, Bhabha Atomic Research Centre Hospital, Anushakti Nagar, Mumbai, Maharashtra, 400094, India.
| | - Alpa S Amin
- Department of Pediatrics, Bhabha Atomic Research Centre Hospital, Anushakti Nagar, Mumbai, Maharashtra, 400094, India
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26
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Low S, Khoo KCJ, Wang J, Irwan B, Sum CF, Subramaniam T, Lim SC, Wong TKM. Development of a metabolic syndrome severity score and its association with incident diabetes in an Asian population-results from a longitudinal cohort in Singapore. Endocrine 2019; 65:73-80. [PMID: 31161560 DOI: 10.1007/s12020-019-01970-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/24/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Metabolic syndrome (MetS) is a constellation of clinical factors that indicates elevated risk of diabetes. It is diagnosed based on three or more abnormalities in its components. This does not take into account that MetS can likely present as a continuum of risk. We aim to develop a MetS severity score and assess its association with incident diabetes. METHODS In total, 4149 subjects without baseline diabetes participated in a community screening programme in 2013-2017. MetS was defined according to International Diabetes Federation criteria. A MetS severity z-score was derived from standardised loading coefficients of a confirmatory factor analysis for waist circumference, triglycerides, HDL-cholesterol, blood pressure and fasting plasma glucose (FPG). Multivariable cox proportional hazards regression model was used to assess the risk of diabetes by the score with adjustment for demographics and MetS components. RESULTS Diabetes occurred in 130 subjects. Quintile 5 of the baseline MetS severity z-score was significantly associated with development of diabetes even in fully adjusted model with HR 2.63 (95% CI: 1.04-6.64; p = 0.040). The relationship between MetS and incident diabetes became attenuated and non-significant in fully adjusted model with HR 0.67 (95% CI: 0.34-1.29; p = 0.228). Mediation analysis showed that MetS severity z-score accounted 61.0% of the association between increasing body mass index and development of diabetes (p < 0.001). CONCLUSIONS The MetS severity z-score is an inexpensive and clinically-available continuous measure of MetS to identify individuals at high risk of diabetes.
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Affiliation(s)
- Serena Low
- Diabetes Centre, Admiralty Medical Centre, Singapore, Singapore
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | | | - Jiexun Wang
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Bastari Irwan
- Transformation Office, Hospital Administration, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Chee Fang Sum
- Diabetes Centre, Admiralty Medical Centre, Singapore, Singapore
| | | | - Su Chi Lim
- Diabetes Centre, Admiralty Medical Centre, Singapore, Singapore.
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
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Tompuri TT, Jääskeläinen J, Lindi V, Laaksonen DE, Eloranta AM, Viitasalo A, Laitinen T, Lakka TA. Adiposity Criteria in Assessing Increased Cardiometabolic Risk in Prepubertal Children. Front Endocrinol (Lausanne) 2019; 10:410. [PMID: 31293520 PMCID: PMC6606693 DOI: 10.3389/fendo.2019.00410] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/07/2019] [Indexed: 01/08/2023] Open
Abstract
Objective: Adiposity induces the clustering of cardiometabolic risk factors, and pediatric adiposity is a better indicator for adulthood cardiometabolic diseases than pediatric metabolic syndrome. However, the observed prevalence of pediatric adiposity depends on the methods and cut-points used. Therefore, we aimed to define diagnostic criteria for adiposity which enable more valid identification of prepubertal children at increased cardiometabolic risk. Methods: The participants were 470 prepubertal children (249 boys) aged 6-8 years. The measures of adiposity included body mass index-standard deviation score (BMI-SDS), waist-to-height ratio (WHtR) and body fat percentage (BF%) assessed by bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA). Criteria for adiposity were determined by increased cardiometabolic risk. Cardiometabolic risk factors which correlated with BF% assessed by DXA in the upper but not lower half of BF% (serum insulin and plasma high-density lipoprotein cholesterol, triglycerides, gamma-glutamyl transferase, high-sensitivity C-reactive protein and uric acid) were included in the cardiometabolic risk score (CMS). We computed receiver operating characteristics curves for the measures of adiposity using the ≥90th percentile of CMS as a measure of increased cardiometabolic risk, and local regression curves were graphed to demonstrate the associations of the measures of adiposity with CMS. Results: In girls, WHtR of 0.445 (area under curve 0.778, its 95% confidence interval 0.65-0.91, sensitivity and specificity 0.73) and BF% of 19.5% assessed by BIA (0.801, 0.70-0.90, 0.73) were the best overall criteria for increased cardiometabolic risk. In boys, BMI-SDS of 0.48 (0.833, 0.75-0.92, 0.76) was the best overall criterion for increased cardiometabolic risk. While local regression curves in girls showed that WHtR of 0.445 corresponds well to a point where CMS began to increase, in boys local regression curves suggest that CMS began to increase even at a lower level of BMI-SDS than 0.48. Moreover, the diagnostic ability of the measures of adiposity to exclude increased cardiometabolic risk was poorer than the ability to detect it. Conclusions: In general, the measures of adiposity have sufficient diagnostic accuracy to be utilized as the screening tool for increased cardiometabolic risk. The observed cut-points for adiposity were lower than the traditional cut-points for adiposity.
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Affiliation(s)
- Tuomo Tapani Tompuri
- Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
- Institute of Biomedicine/Physiology, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Sense4Health Ltd., Kontio, Finland
| | - Jarmo Jääskeläinen
- Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Virpi Lindi
- Institute of Biomedicine/Physiology, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | | | - Aino-Maija Eloranta
- Institute of Biomedicine/Physiology, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Anna Viitasalo
- Institute of Biomedicine/Physiology, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tomi Laitinen
- Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Timo Antero Lakka
- Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
- Institute of Biomedicine/Physiology, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
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28
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Khoshhali M, Heshmat R, Esmaeil Motlagh M, Ziaodini H, Hadian M, Aminaei T, Qorbani M, Kelishadi R. Comparing the validity of continuous metabolic syndrome risk scores for predicting pediatric metabolic syndrome: the CASPIAN-V study. J Pediatr Endocrinol Metab 2019; 32:383-389. [PMID: 30862761 DOI: 10.1515/jpem-2018-0384] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/30/2019] [Indexed: 12/28/2022]
Abstract
Background The aim of this study was to compare the validity of various approaches to pediatric continuous metabolic syndrome (cMetS) scores including siMS scores (2 waist/height + fasting blood glucose [FBG]/5.6 + triglycerides [TG]/1.7 + systolic blood pressure [BP]/130 + high-density lipoprotein [HDL]/1.02), Z-scores, principal component analysis (PCA) and confirmatory factor analysis (CFA) for predicting metabolic syndrome (MetS). Methods This nationwide cross-sectional study was conducted on 4200 Iranian children and adolescents aged 7-18 years. The cMetS was computed using data on HDL, cholesterol, TGs, FBG, mean arterial pressure (MAP) and waist circumference (WC). The areas under the receiver operating characteristic curves (AUCs) were used to compare the performances of different cMetS scores. Results Data of 3843 participants (52.4% boys) were available for the current study. The mean (standard deviation [SD]) age was 12.6 (3) and 12.3 (3.1) years for boys and girls, respectively. The differences in AUC values of cMetS scores were significant based on the Delong method. The AUCs (95% confidence interval [CI]) were for Z-scores, 0.94 (0.93, 0.95); first PCA, 0.91 (0.89, 0.93); sum PCA, 0.90 (0.88, 0.92), CFA, 0.79 (0.76, 0.3) and also for siMS scores 1 to 3 as 0.93 (0.91, 0.94), 0.92 (0.90, 0.93), and 0.91 (0.90, 0.93), respectively. Conclusions The results of our study indicated that the validity of all approaches for cMetS scores for predicting MetS was high. Given that the siMS scores are simple and practical, it might be used in clinical and research practice.
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Affiliation(s)
- Mehri Khoshhali
- Child Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hasan Ziaodini
- Health Psychology Research Center, Education Ministry, Tehran, Iran
| | - Mahdi Hadian
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Tahereh Aminaei
- Office of Adolescents and School Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Mostafa Qorbani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Kelishadi
- Child Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran, Phone: +983137925281
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Abstract
The metabolic syndrome (MetS) concept gathers in a single entity a set of metabolic abnormalities that have in common a close relationship with ectopic deposit of lipids, insulin resistance, and chronic low-grade inflammation. It is a valuable teaching tool to help health professionals to understand and integrate the consequences of lipotoxicity and the adverse metabolic consequences of insulin resistance. Also, it is useful to identify subjects with a high risk for having incident type 2 diabetes. Systems biology studies have gained a prominent role in understanding the interaction between adipose tissue dysfunction, insulin action, and the MetS traits and co-morbidities (that is, non-alcoholic steatohepatitis, or NASH). This approach may allow the identification of new therapeutic targets (that is,
de novo lipogenesis inhibitors for NASH). Treatment targets on MetS are the adoption of a healthy lifestyle, weight loss, and the control of the co-morbidities (hyperglycemia, dyslipidemia, arterial hypertension, among others). The long-term goals are the prevention of type 2 diabetes, cardiovascular events, and other MetS-related outcomes. In the last few decades, new drugs derived from the identification of innovative treatment targets have come on the market. These drugs have positive effects on more than one MetS component (that is, hyperglycemia and weight control). New potential treatment targets are under study.
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Affiliation(s)
- Carlos A Aguilar-Salinas
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, 14008, Mexico.,Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, 14008, Mexico.,Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, Nuevo Leon, 64710, Mexico
| | - Tannia Viveros-Ruiz
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, 14008, Mexico.,Doctorado de Epidemiología Clínica, Universidad Nacional Autónoma de México, Mexico City, 04510, Mexico
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Muscle Fitness Changes During Childhood Associates With Improvements in Cardiometabolic Risk Factors: A Prospective Study. J Phys Act Health 2019; 16:108-115. [DOI: 10.1123/jpah.2017-0678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Williams AD, Shenassa E, Slopen N, Rossen L. Cardiometabolic Dysfunction Among U.S. Adolescents and Area-Level Poverty: Race/Ethnicity-Specific Associations. J Adolesc Health 2018; 63:546-553. [PMID: 30348278 PMCID: PMC6318802 DOI: 10.1016/j.jadohealth.2018.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/03/2018] [Accepted: 07/04/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine race/ethnicity-specific associations between area-level poverty and cardiometabolic dysfunction among U.S. adolescents. METHODS Data were from 10,415 adolescents aged 12-19 in the National Health and Nutrition Examination Survey (1999-2012), linked with census tract data on area-level poverty (the percent population living in poverty, grouped into race/ethnicity-specific quartiles). Cardiometabolic dysfunction was parameterized by summing z-scores of six cardiometabolic biomarkers, grouped into quintiles. Hierarchical ordinal models estimated overall and race/ethnicity specific associations. Posthoc analysis explored associations between area-level poverty and family poverty-to-income ratio. RESULTS Overall, compared to adolescents residing in areas with the lowest area-level poverty (i.e., first quartile), residents in third (OR 1.32, 95% CI 1.13, 1.53) and fourth (OR 1.27, 95% CI 1.08, 1.50) quartiles of area-level poverty experienced elevated odds of cardiometabolic dysfunction. Area-level poverty predicted cardiometabolic dysfunction between non-Hispanic white and Mexican American adolescents, but not between non-Hispanic black adolescents. CONCLUSIONS We found race/ethnicity-specific associations between area-level poverty and cardiometabolic dysfunction among U.S. adolescents, highlighting the moderating effect of race-ethnicity. Among non-Hispanic black adolescents, neither higher area-level nor family-level socioeconomic status is associated with cardiometabolic health, in contrast to non-Hispanic white adolescents. Similar associations among non-Hispanic white and Mexican American groups aligns with evidence of the Hispanic Paradox. Future studies of effect of area-level determinants of cardiometabolic dysfunction may consider race/ethnicity-specific associations.
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Affiliation(s)
- Andrew D. Williams
- Maternal and Child Health Program, Department of Family Science, University of Maryland College Park, College Park, Maryland
| | - Edmond Shenassa
- Maternal and Child Health Program, Department of Family Science, University of Maryland College Park, College Park, Maryland; Department of Epidemiology and Biostatistics, University of Maryland, College Park, Maryland; Department of Epidemiology and Biostatistics, School of Public Health, Brown University, Providence, Rhode Island; Department of Epidemiology and Biostatistics, School of Medicine, University of Maryland Baltimore, Baltimore, Maryland.
| | - Natalie Slopen
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, Maryland
| | - Lauren Rossen
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
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Stavnsbo M, Resaland GK, Anderssen SA, Steene-Johannessen J, Domazet SL, Skrede T, Sardinha LB, Kriemler S, Ekelund U, Andersen LB, Aadland E. Reference values for cardiometabolic risk scores in children and adolescents: Suggesting a common standard. Atherosclerosis 2018; 278:299-306. [PMID: 30477756 DOI: 10.1016/j.atherosclerosis.2018.10.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/12/2018] [Accepted: 10/04/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS International reference values for cardiometabolic risk variables, to allow for standardization of continuous risk scores in children, are not currently available. The aim of this study was to provide international age- and gender-specific reference values for cardiometabolic risk factors in children and adolescents. METHODS Cohorts of children sampled from different parts of Europe (North, South, Mid and Eastern) and from the United States were pooled. In total, 22,479 observations (48.7% European vs. 51.3% American), 11,234 from girls and 11,245 from boys, aged 6-18 years were included in the study. Linear mixed-model regression analysis was used to analyze the associations between age and each cardiometabolic risk factor. RESULTS Reference values for 14 of the most commonly used cardiometabolic risk variables in clustered risk scores were calculated and presented by age and gender: systolic blood pressure (SBP), diastolic blood pressure (DBP), waist circumference (WC), body mass index (BMI), sum of 4 skinfolds (sum4skin), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), TC:HDL-C ratio, glucose, insulin, homeostatic model assessment-score (HOMA-score), and cardiorespiratory fitness (CRF). CONCLUSIONS This study suggests a common standard to define cardiometabolic risk in children. Adapting this approach makes single risk factors and clustered cardiometabolic disease risk scores comparable to the reference material itself and comparable to cardiometabolic risk values in studies using the same strategy. This unified approach therefore increases the prospect to estimate and compare prevalence and trends of cardiometabolic risk in children when using continuous cardiometabolic risk scores.
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Affiliation(s)
- Mette Stavnsbo
- Western Norway University of Applied Sciences, Department of Sport, Food and Natural Sciences, PO BOX 133, N-6856, Sogndal, Norway; Norwegian School of Sport Sciences, Department of Sports Medicine, PO Box 4014, Sognsveien 220, Ullevaal Stadion, Oslo, Norway.
| | - Geir K Resaland
- Western Norway University of Applied Sciences, Department of Sport, Food and Natural Sciences, PO BOX 133, N-6856, Sogndal, Norway
| | - Sigmund A Anderssen
- Western Norway University of Applied Sciences, Department of Sport, Food and Natural Sciences, PO BOX 133, N-6856, Sogndal, Norway; Norwegian School of Sport Sciences, Department of Sports Medicine, PO Box 4014, Sognsveien 220, Ullevaal Stadion, Oslo, Norway
| | - Jostein Steene-Johannessen
- Norwegian School of Sport Sciences, Department of Sports Medicine, PO Box 4014, Sognsveien 220, Ullevaal Stadion, Oslo, Norway; Kristiania University College, Faculty of Health Sciences, PO Box 1155, Sentrum, 0107, Oslo, Norway
| | - Sidsel L Domazet
- University of Southern Denmark, Department of Sports Science and Clinical Biomechanics, Center of Research in Childhood Health, Campusvej 55, 5230, Odense M, Denmark
| | - Turid Skrede
- Western Norway University of Applied Sciences, Department of Sport, Food and Natural Sciences, PO BOX 133, N-6856, Sogndal, Norway; Norwegian School of Sport Sciences, Department of Sports Medicine, PO Box 4014, Sognsveien 220, Ullevaal Stadion, Oslo, Norway
| | - Luis B Sardinha
- Universidade de Lisboa, Fac Motricidade Humana, CIPER, Exercise and Health Laboratory, Estrada Dacosth, Cruz-Quebrada, 1499, Lisbon, Portugal
| | - Susi Kriemler
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Hirschengraben 84, 8001, Zürich, Switzerland
| | - Ulf Ekelund
- Norwegian School of Sport Sciences, Department of Sports Medicine, PO Box 4014, Sognsveien 220, Ullevaal Stadion, Oslo, Norway
| | - Lars B Andersen
- Western Norway University of Applied Sciences, Department of Sport, Food and Natural Sciences, PO BOX 133, N-6856, Sogndal, Norway; Norwegian School of Sport Sciences, Department of Sports Medicine, PO Box 4014, Sognsveien 220, Ullevaal Stadion, Oslo, Norway
| | - Eivind Aadland
- Western Norway University of Applied Sciences, Department of Sport, Food and Natural Sciences, PO BOX 133, N-6856, Sogndal, Norway
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Abstract
The continued rise of pediatric obesity globally has raised concerns for related sequalae. One marker of risk is the metabolic syndrome, a cluster of cardiovascular risk factors that is associated with future cardiovascular disease and type 2 diabetes. MetS has at its core visceral adipocytes exhibiting dysfunction as a result of excess fat content. MetS in children and adolescents is linked to unhealthy lifestyle practices such as sedentary lifestyles and excess consumption calories. As such, the optimal means of addressing MetS is targeting a decrease in adiposity through lifestyle modification, a decrease in MetS following increases in physical activity and improvements in the quality and content of food intake. Efforts remain needed in increasing motivation to these changes and maintaining adherence to avoid long-term sequelae.
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Affiliation(s)
- Linda X Wang
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Mark D Deboer
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA -
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Vikram NK. Cardiovascular and Metabolic Complications - Diagnosis and Management in Obese Children. Indian J Pediatr 2018; 85:535-545. [PMID: 29218646 DOI: 10.1007/s12098-017-2504-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/20/2017] [Indexed: 02/06/2023]
Abstract
The world at present is facing a burden of rising prevalence of obesity in children and adolescents. The developing countries are particularly facing the dual burden on under-nutrition and obesity. This is associated with appearance and clustering of cardiometabolic abnormalities at an early age with development of chronic complications early and possible decrease in life span of these children and adolescents. In adults this clustering has been termed as 'metabolic syndrome' with definitions that can be used universally. However, in children and adolescents there is no consensus on a uniform definition of metabolic syndrome that can be applicable across the age groups and various ethnicities. Further, as childhood is a period of growth and development, changes in body composition and insulin sensitivity that occur with puberty may influence the thresholds of components used to define metabolic syndrome. Children of South Asian ethnicity appear to be more predisposed to develop abnormalities of metabolic syndrome, possible due to their adverse body fat patterning and genetic influences. The definition of pediatric metabolic syndrome proposed by International Diabetes Federation is useful across different ethnicities. Presence of at least one component of metabolic syndrome should lead to detailed screening for other components and complications. A multimodality approach including therapeutic lifestyle changes targeted at the individual, family and community is essential for management. Pharmacotherapy for individual components may be required if initial management strategies fail to achieve the goals.
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Affiliation(s)
- Naval K Vikram
- Department of Medicine, Metabolic Research Group, All India Institute of Medical Sciences, New Delhi, 110029, India.
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35
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Gooty VD, Sinaiko AR, Ryder JR, Dengel DR, Jacobs DR, Steinberger J. Association Between Carotid Intima Media Thickness, Age, and Cardiovascular Risk Factors in Children and Adolescents. Metab Syndr Relat Disord 2018; 16:122-126. [PMID: 29412763 DOI: 10.1089/met.2017.0149] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Measures of carotid intima media thickness (cIMT) in adults are correlated with adiposity and the metabolic syndrome (MetS) and predict cardiovascular (CV) events. Relations in children are not as well studied. Our objective was to determine the relations of cIMT with body mass index (BMI) and CV risk score in children. METHODS The study included 291 children (158 M/133 F) 6-18 years of age (140 aged 6-11/151 aged 12-18) with measurements of height, weight, waist circumference; fasting lipids, glucose, insulin, and cIMT. A CV risk cluster score was developed from sum of the z-scores of the five MetS components (waist circumference, blood pressure, serum triglycerides, high-density lipoprotein cholesterol, and insulin). Partial Pearson correlation coefficients were adjusted for age, sex, and race. RESULTS There was no significant age difference in cIMT from 6 to 18 years of age. BMI and CV risk score were significantly correlated (P < 0.0001), and both were correlated with cIMT (r = 0.14, P = 0.02 and r = 0.16, P = 0.006, respectively). Slight age-related differences in associations of cIMT with CV risk score and BMI were explained by unusual values in a few children. CONCLUSIONS These cross-sectional data in normal children show that cIMT was stable from childhood into adolescence. However, both BMI and CV risk score had small, but significant positive correlations with cIMT. Therefore, maintaining normal levels of adiposity and other risk variables may be useful in preventing early changes associated with preclinical atherosclerosis.
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Affiliation(s)
- Vasu D Gooty
- 1 Department of Pediatrics, University of Minnesota Medical School , Minneapolis, Minnesota
| | - Alan R Sinaiko
- 1 Department of Pediatrics, University of Minnesota Medical School , Minneapolis, Minnesota
| | - Justin R Ryder
- 1 Department of Pediatrics, University of Minnesota Medical School , Minneapolis, Minnesota
| | - Donald R Dengel
- 2 Laboratory of Integrative Human Physiology, School of Kinesiology, University of Minnesota , Minneapolis, Minnesota
| | - David R Jacobs
- 3 Division of Epidemiology and Community Health, School of Public Health, University of Minnesota , Minneapolis, Minnesota
| | - Julia Steinberger
- 1 Department of Pediatrics, University of Minnesota Medical School , Minneapolis, Minnesota
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The 23-year tracking of blood lipids from adolescence to adulthood in Korea: the Kangwha study. Lipids Health Dis 2017; 16:221. [PMID: 29166949 PMCID: PMC5700514 DOI: 10.1186/s12944-017-0615-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022] Open
Abstract
Background Several studies have examined tracking pattern of blood lipids level during long follow-up periods in Western countries. However, there have been few such studies in Asian populations. Methods The Kangwha Study is a community-based prospective cohort study that started in 1986 on Kangwha Island, South Korea. A total of 432 participants (47% men) were enrolled in the study, during which serum total cholesterol, triglycerides, and high-density lipoprotein (HDL) cholesterol levels were measured for each participant at least once during adolescence (12–16 years of age) and again at least once during adulthood (25–35 years of age). The tracking patterns of the blood lipid levels were determined using Spearman correlation coefficients and tracking coefficients from generalized estimating equations. Results The Spearman correlation coefficients between lipid measurements ranged from 0.12 to 0.73 depending on the lipid profile and measurement time interval; all were significant (p < 0.05). The magnitude of the coefficients tended to decrease as the time interval increased. When adjusted for age, sex, body mass index, and blood pressure, the tracking coefficients were 0.58 (95% confidence interval [CI]: 0.54–0.63) for total cholesterol, 0.39 (95% CI: 0.31–0.48) for triglycerides, and 0.51 (95% CI: 0.47–0.56) for HDL cholesterol. In a subgroup analysis by sex, the tracking coefficients were higher for women than for men, except for HDL cholesterol. Conclusions The tracking patterns of blood lipids from adolescence to adulthood were notable. This study supports the importance of measuring lipids during adolescence for identifying high-risk individuals. Electronic supplementary material The online version of this article (10.1186/s12944-017-0615-2) contains supplementary material, which is available to authorized users.
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Tarp J, Bugge A, Andersen LB, Sardinha LB, Ekelund U, Brage S, Møller NC. Does adiposity mediate the relationship between physical activity and biological risk factors in youth?: a cross-sectional study from the International Children's Accelerometry Database (ICAD). Int J Obes (Lond) 2017; 42:ijo2017241. [PMID: 29087387 PMCID: PMC6952275 DOI: 10.1038/ijo.2017.241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/14/2017] [Accepted: 09/05/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES To model the association between accumulating 60 daily minutes of moderate-to-vigorous physical activity and a composite score of biological risk factors into a direct and an indirect effect, using abdominal obesity as the mediator. SUBJECTS/METHODS Cross-sectional data from the International Children's Accelerometry Database (ICAD) including 6-18-year-old children and adolescents (N=3412) from 4 countries providing at least 3 days of accelerometry-assessed physical activity. A standardized composite risk score was calculated from systolic blood pressure and fasting blood samples of insulin, glucose, triacylglycerol and inverse HDL-cholesterol. Abdominal obesity was assessed by the waist-circumference:height ratio. Two-stage regression analysis, allowing for exposure-mediator interaction, was used for the effect decomposition. RESULTS Participants achieving 60 daily minutes of moderate-to-vigorous physical activity had a 0.31 (95% CI: -0.39, -0.23) standard deviations lower composite risk score than those achieving less than 60 min. Modelling the associations suggested that 0.24 standard deviations (95% CI: -0.32, -0.16) was attributed to the direct effect and -0.07 (95% CI: -0.11, -0.02) to the indirect effect indicating that 22% of the total effect was mediated by central adiposity. Modelling 30 and 90 min of moderate-to-vigorous physical activity per day resulted in changes in the direct but not the indirect effect. CONCLUSIONS One hour of daily moderate-to-vigorous physical activity was associated with clinically relevant differences in metabolic control compared to engagement in less than this minimally recommended amount. The majority of the difference was explained by the direct effect of physical activity.International Journal of Obesity advance online publication, 31 October 2017; doi:10.1038/ijo.2017.241.
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Affiliation(s)
- Jakob Tarp
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anna Bugge
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lars Bo Andersen
- Department of Teacher Education and Sport, Western Norway University of Applied Sciences, Sogndal, Norway
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Luis B. Sardinha
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada, Portugal
| | - Ulf Ekelund
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Soren Brage
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Niels Christian Møller
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Koskinen J, Magnussen CG, Sinaiko A, Woo J, Urbina E, Jacobs DR, Steinberger J, Prineas R, Sabin MA, Burns T, Berenson G, Bazzano L, Venn A, Viikari JSA, Hutri-Kähönen N, Raitakari O, Dwyer T, Juonala M. Childhood Age and Associations Between Childhood Metabolic Syndrome and Adult Risk for Metabolic Syndrome, Type 2 Diabetes Mellitus and Carotid Intima Media Thickness: The International Childhood Cardiovascular Cohort Consortium. J Am Heart Assoc 2017; 6:JAHA.117.005632. [PMID: 28862940 PMCID: PMC5586423 DOI: 10.1161/jaha.117.005632] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background There is paucity of knowledge concerning the specific age in youth when the associations of metabolic syndrome (MetS) begin to be operative. Thus, we investigated the relation of age to the associations of childhood MetS with adult MetS, type 2 diabetes mellitus and high carotid intima‐media thickness. Methods and Results Five thousand eight‐hundred three participants were analyzed in 4 cohort studies (Cardiovascular Risk in Young Finns, Bogalusa Heart Study, Princeton Lipid Research Study, Insulin Study). International cutoffs and previously used 75th percentile cutoffs were used for children to define MetS and its components. Mean follow‐up period was 22.3 years. Logistic regression was used to calculate risk ratios and 95% confidence intervals. Childhood MetS and overweight were associated with over 2.4‐fold risk for adult MetS from the age of 5 years onward. Risk for type 2 diabetes mellitus was increased from the age of 8 (risk ratio, 2.6–4.1; 95% confidence interval, 1.35–6.76 and 1.12–7.24, respectively) onward for the 2 childhood MetS criteria based on international cut‐off values and for childhood overweight. Risk for high carotid intima‐media thickness was significant at ages 11 to 18 years in relation to childhood MetS or overweight (risk ratio, 2.44–4.22; 95% confidence interval, 1.55–3.55 and 2.55–5.66, respectively). Continuous childhood MetS score was associated with adult MetS from the age of 5, with type 2 diabetes mellitus from the age of 14 and with high carotid intima‐media thickness from the age of 11 years onward. Conclusions Adult MetS was predicted by MetS in childhood beginning at age 5. However, adult type 2 diabetes mellitus and subclinical atherosclerosis were not predicted by childhood data until after age 8. Body mass index measurement alone at the same age points provided similar findings.
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Affiliation(s)
- Juha Koskinen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland .,Heart Center, Turku University Hospital, Turku, Finland
| | - Costan G Magnussen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Alan Sinaiko
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Jessica Woo
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| | - Elaine Urbina
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Ronald Prineas
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Matthew A Sabin
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Pediatrics, University of Melbourne, Parkville, Australia
| | - Trudy Burns
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Gerald Berenson
- Department of Epidemiology, Tulane Center for Cardiovascular Health, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Lydia Bazzano
- Departments of Epidemiology and Biostatistics and Bioinformatics, Tulane University Health Sciences Center, Tulane University, New Orleans, LA
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Jorma S A Viikari
- Department of Medicine, University of Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Nina Hutri-Kähönen
- Department of Pediatrics, University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland
| | - Olli Raitakari
- Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Terence Dwyer
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Pediatrics, University of Melbourne, Parkville, Australia
| | - Markus Juonala
- Department of Medicine, University of Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
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Skrede T, Stavnsbo M, Aadland E, Aadland KN, Anderssen SA, Resaland GK, Ekelund U. Moderate-to-vigorous physical activity, but not sedentary time, predicts changes in cardiometabolic risk factors in 10-y-old children: the Active Smarter Kids Study. Am J Clin Nutr 2017; 105:1391-1398. [PMID: 28381476 DOI: 10.3945/ajcn.116.150540] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/15/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Cross-sectional data have suggested an inverse relation between physical activity and cardiometabolic risk factors that is independent of sedentary time. However, little is known about which subcomponent of physical activity may predict cardiometabolic risk factors in youths.Objective: We examined the independent prospective associations between objectively measured sedentary time and subcomponents of physical activity with individual and clustered cardiometabolic risk factors in healthy children aged 10 y.Design: We included 700 children (49.1% males; 50.9% females) in which sedentary time and physical activity were measured with the use of accelerometry. Systolic blood pressure, waist circumference (WC), and fasting blood sample (total cholesterol, high-density lipoprotein cholesterol, triglycerides, glucose, fasting insulin) were measured with the use of standard clinical methods and analyzed individually and as a clustered cardiometabolic risk score standardized by age and sex (z score). Exposure and outcome variables were measured at baseline and at follow-up 7 mo later.Results: Sedentary time was not associated with any of the individual cardiometabolic risk factors or clustered cardiometabolic risk in prospective analyses. Moderate physical activity at baseline predicted lower concentrations of triglycerides (P = 0.021) and homeostatic model assessment for insulin resistance (P = 0.027) at follow-up independent of sex, socioeconomic status, Tanner stage, monitor wear time, or WC. Moderate-to-vigorous physical activity (P = 0.043) and vigorous physical activity (P = 0.028) predicted clustered cardiometabolic risk at follow-up, but these associations were attenuated after adjusting for WC.Conclusions: Physical activity, but not sedentary time, is prospectively associated with cardiometabolic risk in healthy children. Public health strategies aimed at improving children's cardiometabolic profile should strive for increasing physical activity of at least moderate intensity rather than reducing sedentary time. This trial was registered at clinicaltrials.gov as NCT02132494.
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Affiliation(s)
- Turid Skrede
- Department of Teacher Education and Sports, Sogn og Fjordane University College, Sogndal, Norway; and
| | - Mette Stavnsbo
- Department of Teacher Education and Sports, Sogn og Fjordane University College, Sogndal, Norway; and
| | - Eivind Aadland
- Department of Teacher Education and Sports, Sogn og Fjordane University College, Sogndal, Norway; and
| | - Katrine N Aadland
- Department of Teacher Education and Sports, Sogn og Fjordane University College, Sogndal, Norway; and
| | - Sigmund A Anderssen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Geir K Resaland
- Department of Teacher Education and Sports, Sogn og Fjordane University College, Sogndal, Norway; and
| | - Ulf Ekelund
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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40
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DeBoer MD, Gurka MJ. Clinical utility of metabolic syndrome severity scores: considerations for practitioners. Diabetes Metab Syndr Obes 2017; 10:65-72. [PMID: 28255250 PMCID: PMC5325095 DOI: 10.2147/dmso.s101624] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The metabolic syndrome (MetS) is marked by abnormalities in central obesity, high blood pressure, high triglycerides, low high-density lipoprotein-cholesterol, and high fasting glucose and appears to be produced by underlying processes of inflammation, oxidative stress, and adipocyte dysfunction. MetS has traditionally been classified based on dichotomous criteria that deny that MetS-related risk likely exists as a spectrum. Continuous MetS scores provide a way to track MetS-related risk over time. We generated MetS severity scores that are sex- and race/ethnicity-specific, acknowledging that the way MetS is manifested may be different by sex and racial/ethnic subgroup. These scores are correlated with long-term risk for type 2 diabetes mellitus and cardiovascular disease. Clinical use of scores like these provide a potential opportunity to identify patients at highest risk, motivate patients toward lifestyle change, and follow treatment progress over time.
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Affiliation(s)
- Mark D DeBoer
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA
- Correspondence: Mark D DeBoer, Division of Pediatric Endocrinology, Department of Pediatrics, University of Virginia School of Medicine, 409 Lane Road, Room 2017, PO Box 800386, Charlottesville, VA 22908, USA, Tel +1 434 924 9833, Fax +1 434 924 9181, Email
| | - Matthew J Gurka
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA
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Steinberger J, Urbina EM. Childhood Metabolic Syndrome is a Poor Predictor of Adult Cardiovascular Outcomes. J Pediatr 2016; 171:14-5. [PMID: 26795681 DOI: 10.1016/j.jpeds.2015.12.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Julia Steinberger
- Department of Pediatric Cardiology, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota.
| | - Elaine M Urbina
- Department of Preventive Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Cardiology, University of Cincinnati, Cincinnati, Ohio
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