Reciprocal Longitudinal Relationship Between Fitness, Fatness, and Metabolic Syndrome in Brazilian Children and Adolescents: A 3-Year Longitudinal Study

The Longitudinal Association of Cardiorespiratory Fitness and Adiposity With Clustered Cardiometabolic Risk: A Mediation Analysis

PURPOSE

Previous literature has demonstrated the mediating role of adiposity in the association between cardiorespiratory fitness (CRF) and cardiometabolic risk as well as the potential role of CRF in attenuating the adverse consequences associated with excess weight. This study aimed to evaluate the mediating role of CRF and adiposity in the possible association with cardiometabolic risk.

METHOD

Observational 3-year longitudinal study that included 420 children and adolescents (10.50 [2.05] y of age at baseline; 56.2% girls). Body mass index (BMI) was calculated, and CRF was evaluated using field assessments. A clustered cardiometabolic risk score (cMetS) was calculated from glucose, systolic blood pressure, total cholesterol/high-density lipoprotein cholesterol ratio, and triglycerides z scores. Analyses evaluated the mediating role of BMI in the association between CRF and cMetS as well as whether CRF mediated the association between BMI and cMetS.

RESULTS

BMI at baseline was directly associated with the cMetS at follow-up (0.102; 95% confidence interval, 0.020 to 0.181), independently of CRF, whereas CRF was only indirectly associated with cMetS at follow-up through BMI (-0.036; 95% confidence interval, -0.070 to -0.009), meaning that the association between CRF and cMetS was explained via the mediation role of BMI.

CONCLUSIONS

BMI presented direct association with cMetS, whereas CRF exhibited indirect association with cMetS mediated via BMI.

The stability of cardiometabolic risk factors clustering in children and adolescents: a 2-year longitudinal study

Objective

The present study aims to verify the odds of remaining with the clustering of 3 or more, 4 or more, and 5 or more risk factors across a 2-year time span.

Methods

Observational longitudinal study that included 358 children and adolescents (10.96 ± 2.28 years of age at baseline). Cardiorespiratory fitness, glucose, systolic blood pressure, total cholesterol/high-density lipoprotein cholesterol ratio, triglycerides, and waist circumference were assessed. The number of children in whom the risk factors were not independently distributed was analyzed. Odds ratios of presenting n risk factors clustered at follow-up according to the number of risk factors observed at baseline were calculated.

Results

More participants than expected were found presenting clustering of 4 or more and 5 or more risk factors at both baseline (11.7% and 5.6%, respectively) and follow-up (9.5% and 5.6%, respectively). The odds ratios calculated demonstrated that the odds of presenting the same number of risk factors clustered or more at follow-up increased according to the number of risk factors clustered at baseline.

Conclusion

The higher the number of risk factors a child had at baseline, the higher the odds of presenting the same number of risk factors or more after two years of follow-up.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-022-01174-1.

Body fat percentage, cardiorespiratory fitness and arterial blood pressure in children and adolescents: a longitudinal analysis

Background

A better understanding of how cardiorespiratory fitness (CRF) and adiposity interact to associate with arterial blood pressure over time remains inconclusive. Thus, the aim of the present study was to examine whether changes in CRF moderates the association between body fat percentage (BF%) and arterial blood pressure in children and adolescents.

Methods

This is an observational longitudinal study with 407 children and adolescents aged 8–17 years followed-up for three years from a city in Southern Brazil. Participants were evaluated in 2011 and 2014. CRF was measured by validated field-based tests following the Projeto Esporte Brazil protocols and peak oxygen uptake (VO_2peak) was estimated. BF% was determined by the measures of tricipital and subscapular skinfolds using equations according to sex. Systolic and diastolic blood pressure (SBP, DBP) were measured with a sphygmomanometer according to standard procedures. Moderation analyses included multiple linear regression models adjusted for sex, age, pubertal status, height, socioeconomic level, skin color, and the arterial blood pressure variable itself at baseline.

Results

It was observed a significant inverse association between VO_2peak at baseline with SBP (β = − 0.646 CI95% = − 0.976  − 0.316) and DBP (β = − 0.649 CI95% = − 0.923  − 0.375) at follow-up and a positive association between BF% at baseline with SBP (β = 0.274; CI95% = 0.094 0.455) and DBP (β = 0.301; CI95% = 0.150 0.453) at follow-up. In addition, results indicated a significant interaction term between changes in VO_2peak and BF% at baseline with both SBP (p = 0.034) and DBP at follow-up (p = 0.011), indicating that an increase of at least 0.35 mL/kg/min and 1.78 mL/kg/min in VO_2peak attenuated the positive relationship between BF% with SBP and DBP.

Conclusion

CRF moderates the relationship between BF% and SBP and DBP in children and adolescents.

Moderating Role of Physical Fitness in the Association Between TV Time and Adiposity Parameters in Adolescents

PURPOSE

To identify whether physical fitness (PF) components play a moderating role in the relationship between TV time and adiposity levels.

DESIGN

Cross-sectional study.

SETTING

Few studies have examined if different PF levels modify the association between TV time and adiposity in adolescents. Studies often focus on the isolated relationships between obesity and TV time, or obesity and PF levels.

SUBJECTS

1071 adolescents (617 girls), aged 12 to 17 years.

MEASURES

Cardiorespiratory fitness (CRF), abdominal muscular endurance, and lower limb strength were evaluated using the protocols of the Projeto Esporte Brasil fitness testing battery. TV time was obtained using a self-reported questionnaire. Body mass index (BMI) and waist circumference (WC) were also assessed. Moderation analyses were conducted through multiple linear regression models with the following associations tested in different models: PF components, TV time, and interaction (PF component x TV time) with adiposity parameters (BMI and WC).

RESULTS

A significant interaction term was found for CRF and TV time in the association with both WC (β: -.005; 95% CI: -.009; -.001; P = .012) and BMI (β: -.002; 95% CI: -.004; -.001; P = .009).

CONCLUSION

CRF moderates the relationship between TV time and adiposity measures in this cross-sectional analysis. These data support strategies looking at increasing physical activity levels to improve CRF and avoid the development of excess abdominal obesity and excess weight.

Changes in Physical Fitness during COVID-19 Pandemic Lockdown among Adolescents: A Longitudinal Study

The negative impact of COVID-19 on physical activity has been improved, while the research on changes in physical fitness that may be caused by physical inactivity is still scarce. This study aims to explore the impact of the COVID-19 pandemic lockdown on physical fitness, and the impact of initial physical fitness indicators on their changes during the lockdown in adolescents. A longitudinal study including 265 adolescents aged 14.1 ± 0.4 years old was conducted in China. Physical fitness measurement at baseline and follow-up were respectively measured before (November 2019) and after the lockdown (July 2020). Several physical fitness indicators including aerobic fitness (i.e., 800-m or 1000-m run) and explosive force (i.e., 50-m sprint) deteriorated during the lockdown. Whereas the performances of vital capacity, flexibility (i.e., sit and reach), and muscular strength (i.e., pull-ups) were significantly improved during the lockdown. Furthermore, the reduction in physical fitness for adolescents with higher physical fitness before the lockdown was greater than that for others. These findings may contribute to the development of targeted intervention strategies for physical fitness promotion during the lockdown caused by the public health emergency.

The association between fat-to-muscle ratio and metabolic disorders in type 2 diabetes

BACKGROUND

Altered body composition is known to be related to abnormal metabolism. The aim of this study was to determine the association between the fat-to-muscle ratio (FMR) and metabolic disorders in type 2 diabetes (T2DM) population.

METHOD

In total, 361 T2DM participants aged ≥ 18 years were included in our research. A bioelectrical impedance analyzer was applied to measure fat mass and muscle mass. FMR was calculated as body fat mass (kg) divided by muscle mass (kg). The performance of FMR to assess metabolic disorders in T2DM was conducted using ROC curves. The independent association between FMR and metabolic syndrome (MS) was tested by logistic regression analysis.

RESULTS

The FMR was significantly higher in patients with MS than in those without MS (p < 0.001). The optimal FMR cutoff point for identifying MS was higher in females than in males (0.465 vs. 0.296, respectively). In addition, the areas under the ROC curve (AUCs) for the evaluation of MS by FMR, fat mass, muscle mass, BMI and waist circumference were further compared, indicating that the AUC of FMR (0.843) was the largest among the five variables in females, but the AUC of waist circumference (0.837) was still the largest among other variables in males. Based on the derived FMR cutoff point, patients with a high FMR exhibited more cardiometabolic risk indicators (all p < 0.05). Using a low FMR as a reference, the relative risk of a high FMR for MS was 2.861 (95% CI 1.111-7.368, p = 0.029) in males and 9.518 (95% CI 2.615-34.638, p = 0.001) in females following adjustment for confounding factors.

CONCLUSIONS

The fat-to-muscle ratio is independently and positively associated with metabolic disorders in T2DM. FMR may serve as an optimal method for screening T2DM patients coupled with a high risk of abnormal metabolism, especially in females, providing a new perspective for the prevention and treatment of cardiovascular complications in Chinese type 2 diabetes.

Mediation Role of Physical Fitness and Its Components on the Association Between Distribution-Related Fat Indicators and Adolescents' Cognitive Performance: Exploring the Influence of School Vulnerability. The Cogni-Action Project

Background: Physical fitness and fatness converge simultaneously modulating cognitive skills, which in turn, are associated with children and adolescents’ socioeconomic background. However, both fitness components and fat mass localization are crucial for understanding its implication at the cognitive level.

Objective: This study aimed to determine the mediation role of a global physical fitness score and its components on the association between different fatness indicators related to fat distribution and adolescents’ cognitive performance, and simultaneously explore the influence of school vulnerability.

Methods: In this study, 1,196 Chilean adolescents participated (aged 10–14; 50.7% boys). Cardiorespiratory fitness (CRF), muscular fitness (MF), and speed-agility fitness (SAF) were evaluated, and a global fitness score (GFS) was computed adjusted for age and sex (CRF + MF + SAF z-scores). Body mass index z-score (BMIz), sum-of-4-skinfolds (4SKF), and waist-to-height ratio (WHtR) were used as non-specific, peripheral, and central adiposity indicators, respectively. A global cognitive score was computed based on eight tasks, and the school vulnerability index (SVI) was registered as high, mid or low. A total of 24 mediation analyses were performed according to two models, adjusted for sex and peak high velocity (Model 1), and adding the school vulnerability index (SVI) in Model 2. The significance level was set at p < 0.05.

Results: The fitness mediation role was different concerning the fatness indicators related to fat distribution analyzed. Even after controlling for SVI, CRF (22%), and SAF (29%), but not MF, mediated the association between BMIz and cognitive performance. Likewise, CRF, SAF and GFS, but not MF, mediated the association between WHtR and cognitive performance (38.6%, 31.9%, and 54.8%, respectively). No mediations were observed for 4SKF.

Conclusion: The negative association between fatness and cognitive performance is mitigated by the level of adolescents’ physical fitness, mainly CRF and SAF. This mediation role seems to be more consistent with a central fat indicator even in the presence of school vulnerability. Strategies promoting physical fitness would reduce the cognitive gap in children and adolescents related to obesity and school vulnerability.