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Graffy P, Zimmerman L, Luo Y, Yu J, Choi Y, Zmora R, Lloyd-Jones D, Allen NB. Longitudinal clustering of Life's Essential 8 health metrics: application of a novel unsupervised learning method in the CARDIA study. J Am Med Inform Assoc 2024; 31:406-415. [PMID: 38070172 PMCID: PMC10797259 DOI: 10.1093/jamia/ocad240] [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: 06/20/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVE Changes in cardiovascular health (CVH) during the life course are associated with future cardiovascular disease (CVD). Longitudinal clustering analysis using subgraph augmented non-negative matrix factorization (SANMF) could create phenotypic risk profiles of clustered CVH metrics. MATERIALS AND METHODS Life's Essential 8 (LE8) variables, demographics, and CVD events were queried over 15 ears in 5060 CARDIA participants with 18 years of subsequent follow-up. LE8 subgraphs were mined and a SANMF algorithm was applied to cluster frequently occurring subgraphs. K-fold cross-validation and diagnostics were performed to determine cluster assignment. Cox proportional hazard models were fit for future CV event risk and logistic regression was performed for cluster phenotyping. RESULTS The cohort (54.6% female, 48.7% White) produced 3 clusters of CVH metrics: Healthy & Late Obesity (HLO) (29.0%), Healthy & Intermediate Sleep (HIS) (43.2%), and Unhealthy (27.8%). HLO had 5 ideal LE8 metrics between ages 18 and 39 years, until BMI increased at 40. HIS had 7 ideal LE8 metrics, except sleep. Unhealthy had poor levels of sleep, smoking, and diet but ideal glucose. Race and employment were significantly different by cluster (P < .001) but not sex (P = .734). For 301 incident CV events, multivariable hazard ratios (HRs) for HIS and Unhealthy were 0.73 (0.53-1.00, P = .052) and 2.00 (1.50-2.68, P < .001), respectively versus HLO. A 15-year event survival was 97.0% (HIS), 96.3% (HLO), and 90.4% (Unhealthy, P < .001). DISCUSSION AND CONCLUSION SANMF of LE8 metrics identified 3 unique clusters of CVH behavior patterns. Clustering of longitudinal LE8 variables via SANMF is a robust tool for phenotypic risk assessment for future adverse cardiovascular events.
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Affiliation(s)
- Peter Graffy
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Lindsay Zimmerman
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Yuan Luo
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Jingzhi Yu
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Yuni Choi
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55455, United States
| | - Rachel Zmora
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Norrina Bai Allen
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, United States
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Bacha AA, Din ZU, Khan I. Effect of Psyllium husk fiber and lifestyle modification on human body insulin resistance. Nutr Metab Insights 2022; 15:11786388221107797. [PMID: 35769394 PMCID: PMC9234916 DOI: 10.1177/11786388221107797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/31/2022] [Indexed: 11/16/2022] Open
Abstract
Insulin resistance is a metabolic disorder that is increasing worldwide and is associated with some of the most common diseases affecting modern societies including diabetes, hypertension, obesity, and coronary heart disease. Changes in diet and physical activity have a profound effect on lowering the risk and cost of managing insulin resistance compared to the pharmacological approach. An interventional study of 16 weeks explored the effect of Psyllium husk fiber in combination with lifestyle modification on insulin resistance among the centrally obese school teachers of district Malakand Khyber Pakhtunkhwa. One Hundred twenty school teachers with central obesity, aged 40-60 years, with no chronic disease history were divided into four subgroups (n = 30) with equal gender bifurcation; a control group, lifestyle modification (LSM) group, psyllium husk fiber (PSH) group, and the combined intervention of LSM & PSH group. Fasting serum was collected to analyze fasting blood glucose, and insulin resistance by using the HOMA-IR method at baseline and post-intervention. A significant effect of the intervention was observed on fasting blood glucose. The combined group of LSM&PSH showed the highest mean change of -7.5 ± 2.6 mg/dl (-9%), followed by the PSH group with a mean change of -6.3 ± 2.1 mg/dl, (-7%). Likewise a significant effect (P < 0.05) on HOMA-IR was observed in the combined group of LSM&PSH with a mean of 1.02 ± 0.14 molar units (-58%), followed by the PSH group with a mean of 1.55 ± 0.14 molar units (-33%). The current study was carried out to assess the effect of regular consumption of Psyllium husk fiber in combination with lifestyle modification on insulin resistance and fasting blood glucose.
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Affiliation(s)
- Amjad Ali Bacha
- Department of Human Nutrition, the University of Agriculture Peshawar, Peshawar, Pakistan
| | - Zia Ud Din
- Department of Human Nutrition, the University of Agriculture Peshawar, Peshawar, Pakistan
| | - Imran Khan
- Department of Human Nutrition, the University of Agriculture Peshawar, Peshawar, Pakistan
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Guo F, Bostean G, Berardi V, Velasquez AJ, Robinette JW. Obesogenic environments and cardiovascular disease: a path analysis using US nationally representative data. BMC Public Health 2022; 22:703. [PMID: 35399056 PMCID: PMC8994874 DOI: 10.1186/s12889-022-13100-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION People living in obesogenic environments, with limited access to healthful food outlets and exercise facilities, generally have poor health. Previous research suggests that behavioral risk factors and indicators of physiological functioning may mediate this link; however, no studies to date have had the requisite data to investigate multi-level behavioral and physiological risk factors simultaneously. The present study conducted serial and parallel mediation analyses to examine behavioral and physiological pathways explaining the association between environmental obesogenicity and cardiovascular disease (CVD). METHODS This cross-sectional observational study used data from the 2012-2016 Health and Retirement Study, a representative survey of US older adults (n = 12,482, mean age 65.9). Environmental obesogenicity was operationalized as a combined score consisting of nine environmental measures of food and physical activity. CVD and health-compromising behaviors (diet, alcohol consumption, smoking, and exercise) were self-reported. Physiological dysregulation was assessed with measured blood pressure, heart rate, HbA1c, cholesterol levels, BMI, and C-reactive protein. The Hayes Process Macro was used to examine serial and parallel paths through health-compromising behaviors and physiological dysregulation in the environmental obesogenicity-CVD link. RESULTS People living in more obesogenic environments had greater odds of self-reported CVD (odds ratio = 1.074, 95% confidence interval (CI): 1.028, 1.122), engaged in more health-compromising behaviors (β = 0.026, 95% CI: 0.008, 0.044), and had greater physiological dysregulation (β = 0.035, 95% CI: 0.017, 0.054). Combined, health-compromising behaviors and physiological dysregulation accounted for 7% of the total effects of environmental obesogenicity on CVD. CONCLUSION Behavioral and physiological pathways partially explain the environmental obesogenicity-CVD association. Obesogenic environments may stymie the success of cardiovascular health-promotion programs by reducing access to resources supporting healthy lifestyles.
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Affiliation(s)
- Fangqi Guo
- Psychology Department, Crean College of Health and Behavioral Sciences, Chapman University, One University Drive, Orange, CA, 92866, USA.
| | - Georgiana Bostean
- Department of Sociology, Humanities, and Social Sciences, Wilkinson College of Arts, Chapman University, Orange, CA, USA
- Environmental Science & Policy Program, Schmid College of Science and Technology, Chapman University, Orange, CA, USA
| | - Vincent Berardi
- Psychology Department, Crean College of Health and Behavioral Sciences, Chapman University, One University Drive, Orange, CA, 92866, USA
| | - Alfredo J Velasquez
- Psychology Department, Crean College of Health and Behavioral Sciences, Chapman University, One University Drive, Orange, CA, 92866, USA
| | - Jennifer W Robinette
- Psychology Department, Crean College of Health and Behavioral Sciences, Chapman University, One University Drive, Orange, CA, 92866, USA
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García-Hermoso A, Ramírez-Vélez R, García-Alonso Y, Alonso-Martínez AM, Izquierdo M. Association of Cardiorespiratory Fitness Levels During Youth With Health Risk Later in Life: A Systematic Review and Meta-analysis. JAMA Pediatr 2020; 174:952-960. [PMID: 32870243 PMCID: PMC7489376 DOI: 10.1001/jamapediatrics.2020.2400] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
IMPORTANCE Although the associations between cardiorespiratory fitness (CRF) and health in adults are well understood, to date, no systematic review has quantitatively examined the association between CRF during youth and health parameters later in life. OBJECTIVES To examine the prospective association between CRF in childhood and adolescence and future health status and to assess whether changes in CRF are associated with future health status at least 1 year later. DATA SOURCES For this systematic review and meta-analysis, MEDLINE, Embase, and SPORTDiscus electronic databases were searched for relevant articles published from database inception to January 30, 2020. STUDY SELECTION The following inclusion criteria were used: CRF measured using a validated test and assessed at baseline and/or its change from baseline to the end of follow-up, healthy population with a mean age of 3 to 18 years at baseline, and prospective cohort design with a follow-up period of at least 1 year. DATA EXTRACTION AND SYNTHESIS Data were processed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Random-effects models were used to estimate the pooled effect size. MAIN OUTCOMES AND MEASURES Anthropometric and adiposity measurements and cardiometabolic health parameters. RESULTS Fifty-five studies were included with a total of 37 563 youths (46% female). Weak-moderate associations were found between CRF at baseline and body mass index (r = -0.11; 95% CI, -0.18 to -0.04; I2 = 59.03), waist circumference (r = -0.29; 95% CI, -0.42 to -0.14; I2 = 69.42), skinfold thickness (r = -0.34; 95% CI, -0.41 to -0.26; I2 = 83.87), obesity (r = -0.15; 95% CI, -0.23 to -0.06; I2 = 86.75), total cholesterol level (r = -0.12; 95% CI, -0.19 to -0.05; I2 = 75.81), high-density lipoprotein cholesterol (HDL-C) level (r = 0.11; 95% CI, 0.05-0.18; I2 = 69.06), total cholesterol to HDL-C ratio (r = -0.19; 95% CI, -0.26 to -0.13; I2 = 67.07), triglyceride levels (r = -0.10; 95% CI, -0.18 to -0.02; I2 = 73.43), homeostasis model assessment for insulin resistance (r = -0.12; 95% CI, -0.18 to -0.06; I2 = 68.26), fasting insulin level (r = -0.07; 95% CI, -0.11 to -0.03; I2 = 0), and cardiometabolic risk (r = -0.18; 95% CI, -0.29 to -0.07; I2 = 90.61) at follow-up. Meta-regression analyses found that early associations in waist circumference (β = 0.014; 95% CI, 0.002-0.026), skinfold thickness (β = 0.006; 95% CI, 0.002-0.011), HDL-C level (β = -0.006; 95% CI, -0.011 to -0.001), triglyceride levels (β = 0.009; 95% CI, 0.004-0.014), and cardiometabolic risk (β = 0.007; 95% CI, 0.003-0.011) from baseline to follow-up dissipated over time. Weak-moderate associations were found between change in CRF and body mass index (r = -0.17; 95% CI, -0.24 to -0.11; I2 = 39.65), skinfold thickness (r = -0.36; 95% CI, -0.58 to -0.09; I2 = 96.84), obesity (r = -0.21; 95% CI, -0.35 to -0.06; I2 = 91.08), HDL-C level (r = 0.05; 95% CI, 0.02-0.08; I2 = 0), low-density lipoprotein cholesterol level (r = -0.06; 95% CI, -0.11 to -0.01; I2 = 58.94), and cardiometabolic risk (r = -0.08; 95% CI, -0.15 to -0.02; I2 = 69.53) later in life. CONCLUSIONS AND RELEVANCE This study suggests that early intervention and prevention strategies that target youth CRF may be associated with maintaining health parameters in later life.
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Affiliation(s)
- Antonio García-Hermoso
- Navarrabiomed, Complejo Hospitalario de Navarra, Universidad Pública de Navarra, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain,Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago, Chile
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Complejo Hospitalario de Navarra, Universidad Pública de Navarra, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Yesenia García-Alonso
- Navarrabiomed, Complejo Hospitalario de Navarra, Universidad Pública de Navarra, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Alicia M. Alonso-Martínez
- Navarrabiomed, Complejo Hospitalario de Navarra, Universidad Pública de Navarra, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra, Universidad Pública de Navarra, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
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Musa DI, Toriola AL, Goon DT, Jonathan SU. Association of Fitness and Fatness with Clustered Cardiovascular Disease Risk Factors in Nigerian Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5861. [PMID: 32823494 PMCID: PMC7459652 DOI: 10.3390/ijerph17165861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 12/22/2022]
Abstract
Purpose: This study examinedthe independent and joint association of fitness and fatness with clustered cardiovascular disease risk (CVDrs) in 11-18 year-old Nigerian adolescents. Methods: A hundred and ninety seven adolescents (100 girls and 97 boys) were evaluated forfitness, fatness and CVDrs. Fitness was evaluated with the progressive aerobic cardiovascular endurance run test while fatness was assessed using body mass index. A clustered CVDrs was computed from the standardized residuals of total cholesterol, high density lipoprotein cholesterol, Low density lipoprotein cholesterol, triglycerides, plasma glucose, systolic blood pressure, and diastolic blood pressure. Regression models controlling for waist circumference assessed the association of fitness and fatness with CVDrs. Results: Prevalence of clustered CVD risk was 7.1% (girls = 3.0%; boys = 4.1%). Based on risk factor abnormalities, 52.8% of participants had one or more CVD risk factor abnormalities with more boys (27.4%) affected. Low fitness was associated with clustered CVDrs in both girls (R2 = 9.8%, β = -0.287, p = 0.05) and boys (R2 = 17%, β = -0.406, p < 0.0005). Fatness was not associated with the CVDrs in both sexes. After controlling for all the variables in the model, only fitness (R2 = 10.4%) and abdominal fat (R2 = 19.5%) were associated with CVDrs respectively. Unfit girls were 3.2 (95% CI = 1.31-7.91, p = 0.011) times likely to develop CVD risk abnormality compared to their fit counterparts. The likelihood of unfit boys developing CVD risk abnormality was 3.9 (95% CI = 1.15-10.08, p = 0.005) times compared to their fit peers. Conclusions: Fitness but not fatness was a better predictor of CVDrs in Nigerian boys and girls. The result of this study suggests that any public health strategies aimed at preventing or reversing the increasing trends of CVD risk in adolescents should emphasize promotion of aerobic fitness.
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Affiliation(s)
- Danladi I. Musa
- Department of Human Kinetics and Health Education, Kogi State University, Anyigba 272102, Nigeria
| | - Abel L. Toriola
- Department of Sport, Rehabilitation and Dental Sciences, Tshwane University of Technology, Pretoria 0001, South Africa;
| | - Daniel T. Goon
- Faculty of Health Sciences, University of forte Hare, East London 5201, South Africa;
| | - Sunday U. Jonathan
- Department of Human Kinetics and Health Education, Ibrahim BadamasiBabangida University, Lapai 911101, Nigeria;
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Akinbodewa AA, Adejumo AO, Lamidi OA, Adeyemi O. Clustering of Cardiometabolic Risk Factors among Children and Adolescents in a Rural Community in Ondo, Southwest Nigeria. J Trop Pediatr 2020; 66:366-376. [PMID: 31665517 DOI: 10.1093/tropej/fmz075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Clustering of cardiometabolic risk factors is rapidly becoming prevalent among children and adolescents with grave implications for their cardiovascular health. We set out to determine prevalence and pattern of clustering of risk factors and, identify factors (if any) that determine their clustering. METHODS A cross-sectional study of children (3-9 years) and adolescents (10-17 years) in a rural, agrarian community. Their blood pressure, body mass index and lipids were measured. Data was analyzed with SPSS 20. RESULTS A total of 114 (M : F, 1 : 1.1) subjects were studied. The mean age of children and adolescents were 5.6 ± 2.1 and 12.9 ± 2.2 years respectively. The most prevalent cardiometabolic risk factors were elevated non-high density lipoprotein-cholesterol (HDL-c; 39.5%), low HDL-c (33.3%), prehypertension (12.3%) and overweight (9.6%). The prevalence of hypertension was higher among females (11.9% vs. 1.8%, p = 0.024) and adolescents (13.2% vs. 1.6%, p = 0.037). Serum levels of non-HDL-c was higher among adolescents than children (50.9% vs. 29.5%, p = 0.013). At least one risk factor was present in 68.4% of the subjects. Clustering of two and three risk factors were present in 18.4% and 6.1%. The presence of prehypertension (χ2 23.93, p < .001), hypertension (χ2 12.19, p = 0.002), high serum non-HDL-c (χ2 6.336, p = 0.011) and high serum total cholesterol (TC; χ2 8.810, p < 0.001) were associated with clustering of cardiometabolic risk factors. CONCLUSION The burden of cardiometabolic risk factors among children and adolescents is high. Identified determinants of risk factor clustering were prehypertension, hypertension, non-HDL-c and TC.
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Affiliation(s)
- Akinwumi Ayodeji Akinbodewa
- Department of Medicine, Kidney Care Centre, University of Medical Sciences Teaching Hospital, PMB 542, Ondo City, Nigeria
| | - Ademola Oluseyi Adejumo
- Department of Medicine, Kidney Care Centre, University of Medical Sciences Teaching Hospital, PMB 542, Ondo City, Nigeria
| | - Oluwakemi Abiola Lamidi
- Department of Dietetics and Nutrition, University of Medical Sciences Teaching Hospital, PMB 542, Ondo City, Nigeria
| | - Ogunleye Adeyemi
- Chemical Pathology Major, Medical Laboratory Science Department, University of Medical Sciences Teaching Hospital, PMB 542, Ondo City, Nigeria
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Thangiah N, Chinna K, Su TT, Jalaludin MY, Al-Sadat N, Majid HA. Clustering and Tracking the Stability of Biological CVD Risk Factors in Adolescents: The Malaysian Health and Adolescents Longitudinal Research Team Study (MyHeARTs). Front Public Health 2020; 8:69. [PMID: 32257989 PMCID: PMC7090141 DOI: 10.3389/fpubh.2020.00069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/21/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Cardiovascular disease (CVD) risk factors tend to cluster and progress from adolescence to young adulthood. Reliable and meaningful clustering of CVD risk factors is essential to circumvent loss of information. Tracking adverse and high-risk profiles of adolescents is hoped to curb CVD progression later in life. The study aims to investigate the clustering of biological CVD risk factor among adolescents in Malaysia and the transitions between clusters over time. Method: The Malaysian Health and Adolescents Longitudinal Research Team study (MyHeARTs) examined school students aged 13 in 2012 and re-examined them in 2014 and 2016. In a two-stage stratified cluster sampling, 1,361 students were recruited, of which, 1,320 had complete data. In the follow-up, there were 881 and 637 students in 2014 and in 2016, respectively. Pearson's correlation coefficients were used to identify and remove highly correlated CVD risk factors. All risk factors were standardized into z-scores. The hierarchical and non-hierarchical (k-means) cluster analyses were used to classify students into high, medium and low risk clusters in each screening year. The tracking and stability of cluster transitions through cross-classification were enumerated with Pearson's inter-age correlations and percentages. Results: Three significant clusters of high, medium and low risk groups were derived from the clustering of eight biological CVD risk factors. The transitions between risk clusters from one screening year to the other were categorized as either stagnant, improved or adverse. The number of students who had adverse transitions increased from 15.5% (13–15 year) to 19.5% (15–17 year), 13.8 to 18.2% among the girls and 19.9 to 22.8% among the boys. For girls, the number of them who remained at high risk over the two transition periods were about the same (13.6 vs. 13.8%) whereas for boys, the percentage reduced from 14.6 to 12.3%. Conclusion: Over time, more than 12% of adolescents remained in the high risk cluster. There were sizable adverse transitions over time as more adolescents appear to be shifting toward an increased risk of having CVD. Collaborative and constant measures should be taken by parents, school, health promotion boards and policy makers to curb the multiplicative effect of clustering CVD risk factors among adolescents.
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Affiliation(s)
- Nithiah Thangiah
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre for Population Health (CePH), University of Malaya, Kuala Lumpur, Malaysia
| | - Karuthan Chinna
- Faculty of Health and Medical Sciences, School of Medicine, Taylor's University, Selangor, Malaysia
| | - Tin Tin Su
- Jeffery Cheah School of Medicine and Health Sciences, Monash University, Selangor, Malaysia
| | | | - Nabilla Al-Sadat
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre for Population Health (CePH), University of Malaya, Kuala Lumpur, Malaysia
| | - Hazreen Abdul Majid
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre for Population Health (CePH), University of Malaya, Kuala Lumpur, Malaysia.,T.H. Chan School of Public Health, Harvard University, Boston, MA, United States.,Department of Nutrition, Faculty of Public Health, Airlangga University, Surabaya, Indonesia
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Mintjens S, Menting MD, Daams JG, van Poppel MNM, Roseboom TJ, Gemke RJBJ. Cardiorespiratory Fitness in Childhood and Adolescence Affects Future Cardiovascular Risk Factors: A Systematic Review of Longitudinal Studies. Sports Med 2019; 48:2577-2605. [PMID: 30144022 PMCID: PMC6182463 DOI: 10.1007/s40279-018-0974-5] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although cardiorespiratory fitness (CRF) in childhood and adolescence may be linked to future cardiovascular health, there is currently limited evidence for a longitudinal association. OBJECTIVES To provide a systematic review on the prospective association between CRF in childhood and adolescence and cardiovascular disease (CVD) risk factors at least 2 years later. METHODS Using a systematic search of Medline, Embase, and SPORTDiscus, relevant articles were identified by the following criteria: generally healthy children and adolescents between 3 and 18 years of age with CRF assessed at baseline, and a follow-up period of ≥ 2 years. The outcome measures were CVD risk factors. We appraised quality of the included articles with STROBE and QUIPS checklists. RESULTS After screening 7524 titles and abstracts, we included 38 articles, assessing 44,169 children and adolescents followed up for a median of 6 years. Eleven articles were of high quality. There was considerable heterogeneity in methodology, measurement of CRF, and outcomes, which hampered meta-analysis. In approximately half of the included articles higher CRF in childhood and adolescence was associated with lower body mass index (BMI), waist circumference, body fatness and lower prevalence of metabolic syndrome in later life. No associations between CRF in childhood and adolescence and future waist-to-hip ratio, blood pressure, lipid profile, and glucose homeostasis were observed. CONCLUSION Although about half of the included articles reported inverse associations between CRF in childhood and adolescence and future BMI, body fatness, and metabolic syndrome, evidence for other CVD risk factors was unconvincing. Many articles did not account for important confounding factors such as adiposity. Recommendations for future research include standardizing the measurement of CRF, i.e. by reporting VO2max, using standardized outcome assessments, and performing individual patient data meta-analyses.
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Affiliation(s)
- Stijn Mintjens
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Reproduction and Development, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, Room KTC 4-021, 1081 HZ, Amsterdam, The Netherlands. .,Department of Gynecology and Obstetrics, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Reproduction and Development, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.
| | - Malou D Menting
- Department of Gynecology and Obstetrics, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Reproduction and Development, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
| | - Joost G Daams
- Medical Library AMC, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
| | - Mireille N M van Poppel
- Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.,Institute of Sport Science, University of Graz, Mozartgasse 14, 8010, Graz, Austria
| | - Tessa J Roseboom
- Department of Gynecology and Obstetrics, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Reproduction and Development, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
| | - Reinoud J B J Gemke
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Reproduction and Development, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, Room KTC 4-021, 1081 HZ, Amsterdam, The Netherlands
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Lang JJ, Tremblay MS, Léger L, Olds T, Tomkinson GR. International variability in 20 m shuttle run performance in children and youth: who are the fittest from a 50-country comparison? A systematic literature review with pooling of aggregate results. Br J Sports Med 2016; 52:276. [PMID: 27650256 DOI: 10.1136/bjsports-2016-096224] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2016] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To describe and compare 20 m shuttle run test (20mSRT) performance among children and youth across 50 countries; to explore broad socioeconomic indicators that correlate with 20mSRT performance in children and youth across countries and to evaluate the utility of the 20mSRT as an international population health indicator for children and youth. METHODS A systematic review was undertaken to identify papers that explicitly reported descriptive 20mSRT (with 1-min stages) data on apparently healthy 9-17 year-olds. Descriptive data were standardised to running speed (km/h) at the last completed stage. Country-specific 20mSRT performance indices were calculated as population-weighted mean z-scores relative to all children of the same age and sex from all countries. Countries were categorised into developed and developing groups based on the Human Development Index, and a correlational analysis was performed to describe the association between country-specific performance indices and broad socioeconomic indicators using Spearman's rank correlation coefficient. RESULTS Performance indices were calculated for 50 countries using collated data on 1 142 026 children and youth aged 9-17 years. The best performing countries were from Africa and Central-Northern Europe. Countries from South America were consistently among the worst performing countries. Country-specific income inequality (Gini index) was a strong negative correlate of the performance index across all 50 countries. CONCLUSIONS The pattern of variability in the performance index broadly supports the theory of a physical activity transition and income inequality as the strongest structural determinant of health in children and youth. This simple and cost-effective assessment would be a powerful tool for international population health surveillance.
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Affiliation(s)
- Justin J Lang
- Healthy Active Living and Obesity (HALO) Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Mark S Tremblay
- Healthy Active Living and Obesity (HALO) Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Luc Léger
- Département de kinésiologie, Université de Montréal, Montreal, Quebec, Canada
| | - Tim Olds
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences & Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Grant R Tomkinson
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences & Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia.,Department of Kinesiology and Public Health Education, University of North Dakota, Grand Forks, North Dakota, USA
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Tomkinson GR, Lang JJ, Tremblay MS, Dale M, LeBlanc AG, Belanger K, Ortega FB, Léger L. International normative 20 m shuttle run values from 1 142 026 children and youth representing 50 countries. Br J Sports Med 2016; 51:1545-1554. [PMID: 27208067 DOI: 10.1136/bjsports-2016-095987] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To develop sex-specific and age-specific international norms for the 20 m shuttle run test (20mSRT) in children and youth (aged 9-17 years), and to estimate the prevalence meeting the FITNESSGRAM criterion-referenced standards for healthy cardiorespiratory endurance (CRE). METHODS A systematic review was undertaken to identify papers explicitly reporting descriptive 20mSRT (with 1 min stages) data on children and youth since 1981. Data were included on apparently healthy (free from known disease/injury) 9-17 years old. Following standardisation to a common metric and for protocol differences, pseudo data were generated using Monte Carlo simulation, with population-weighted sex-specific and age-specific normative centiles generated using the Lambda Mu and Sigma (LMS) method. Sex-related and age-related differences were expressed as per cent and standardised differences in means. The prevalence with healthy CRE was estimated using the sex-specific and age-specific FITNESSGRAM criterion-referenced standards for [Formula: see text]. RESULTS Norms were displayed as tabulated centiles and as smoothed centile curves for the 20mSRT using 4 common metrics (speed at the last completed stage, completed stages/minutes, laps and relative [Formula: see text]). The final data set included 1 142 026 children and youth from 50 countries, extracted from 177 studies. Boys consistently outperformed girls at each age group (mean difference±95% CI: 0.86±0.28 km/h or 0.79±0.20 standardised units), with the magnitude of age-related increase larger for boys than for girls. A higher proportion of boys (mean±95% CI: 67±14%) had healthy CRE than girls (mean±95% CI: 54±17%), with the prevalence of healthy CRE decreasing systematically with age. CONCLUSIONS This study provides the most comprehensive and up-to-date set of international sex-specific and age-specific 20mSRT norms for children and youth, which have utility for health and fitness screening, profiling, monitoring and surveillance.
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Affiliation(s)
- Grant R Tomkinson
- Department of Kinesiology and Public Health Education, University of North Dakota, Grand Forks, North Dakota, USA
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences & Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Justin J Lang
- Healthy Active Living and Obesity (HALO) Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Mark S Tremblay
- Healthy Active Living and Obesity (HALO) Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Michael Dale
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | | | - Kevin Belanger
- Healthy Active Living and Obesity (HALO) Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Francisco B Ortega
- University of Granada, Granada, Spain
- Karolinska Institute, Huddinge, Sweden
| | - Luc Léger
- Département de kinésiologie, Université de Montréal, Montréal, Quebec, Canada
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11
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Dietary patterns and cardiovascular risk factors in adolescents and young adults: the Northern Ireland Young Hearts Project. Br J Nutr 2014; 112:1685-98. [DOI: 10.1017/s0007114514002682] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Dietary pattern (DP) analysis allows examination of the combined effects of nutrients and foods on the markers of CVD. Very few studies have examined these relationships during adolescence or young adulthood. Traditional CVD risk biomarkers were analysed in 12–15-year-olds (n487; Young Hearts (YH)1) and again in the same individuals at 20–25 years of age (n487; YH3). Based on 7 d diet histories, in the present study, DP analysis was performed usinga posterioriprincipal component analysis for the YH3 cohort and thea prioriMediterranean Diet Score (MDS) was calculated for both YH1 and YH3 cohorts. In thea posterioriDP analysis, YH3 participants adhering most closely to the ‘healthy’ DP were found to have lower pulse wave velocity (PWV) and homocysteine concentrations, the ‘sweet tooth’ DP were found to have increased LDL concentrations, systolic blood pressure, and diastolic blood pressure and decreased HDL concentrations, the ‘drinker/social’ DP were found to have lower LDL and homocysteine concentrations, but exhibited a trend towards a higher TAG concentration, and finally the ‘Western’ DP were found to have elevated homocysteine and HDL concentrations. In thea prioridietary score analysis, YH3 participants adhering most closely to the Mediterranean diet were found to exhibit a trend towards a lower PWV. MDS did not track between YH1 and YH3, and nor was there a longitudinal relationship between the change in the MDS and the change in CVD risk biomarkers. In conclusion, cross-sectional analysis revealed that some associations between DP and CVD risk biomarkers were already evident in the young adult population, namely the association between the healthy DP (and the MDS) and PWV; however, no longitudinal associations were observed between these relatively short time periods.
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12
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Area-level socioeconomic characteristics, prevalence and trajectories of cardiometabolic risk. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:830-48. [PMID: 24406665 PMCID: PMC3924477 DOI: 10.3390/ijerph110100830] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 12/10/2013] [Accepted: 12/20/2013] [Indexed: 01/04/2023]
Abstract
This study examines the relationships between area-level socioeconomic position (SEP) and the prevalence and trajectories of metabolic syndrome (MetS) and the count of its constituents (i.e., disturbed glucose and insulin metabolism, abdominal obesity, dyslipidemia, and hypertension). A cohort of 4,056 men and women aged 18+ living in Adelaide, Australia was established in 2000–2003. MetS was ascertained at baseline, four and eight years via clinical examinations. Baseline area-level median household income, percentage of residents with a high school education, and unemployment rate were derived from the 2001 population Census. Three-level random-intercepts logistic and Poisson regression models were performed to estimate the standardized odds ratio (SOR), prevalence risk ratio (SRR), ratio of SORs/SRRs, and (95% confidence interval (CI)). Interaction between area- and individual-level SEP variables was also tested. The odds of having MetS and the count of its constituents increased over time. This increase did not vary according to baseline area-level SEP (ratios of SORs/SRRs ≈ 1; p ≥ 0.42). However, at baseline, after adjustment for individual SEP and health behaviours, median household income (inversely) and unemployment rate (positively) were significantly associated with MetS prevalence (SOR (95%CI) = 0.76 (0.63–0.90), and 1.48 (1.26–1.74), respectively), and the count of its constituents (SRR (95%CI) = 0.96 (0.93–0.99), and 1.06 (1.04–1.09), respectively). The inverse association with area-level education was statistically significant only in participants with less than post high school education (SOR (95%CI) = 0.58 (0.45–0.73), and SRR (95%CI) = 0.91 (0.88–0.94)). Area-level SEP does not predict an elevated trajectory to developing MetS or an elevated count of its constituents. However, at baseline, area-level SEP was inversely associated with prevalence of MetS and the count of its constituents, with the association of area-level education being modified by individual-level education. Population-level interventions for communities defined by area-level socioeconomic disadvantage are needed to reduce cardiometabolic risks.
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Shang X, Li Y, Liu A, Zhang Q, Hu X, Du S, Ma J, Xu G, Li Y, Guo H, Du L, Ma G. Dietary pattern and its association with the prevalence of obesity and related cardiometabolic risk factors among Chinese children. PLoS One 2012; 7:e43183. [PMID: 22905228 PMCID: PMC3419173 DOI: 10.1371/journal.pone.0043183] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 07/19/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The association of dietary pattern with chronic diseases has been investigated widely in western countries. However, information is quite limited among children in China. Our study is aimed to identify the dietary patterns of Chinese children and examine their association with obesity and related cardiometabolic risk factors. METHODS A total of 5267 children were selected using multistage random sampling from 30 primary schools of 5 provincial capital cities in China. Dietary intake was derived from 24 hour dietary recall for three consecutive days. Anthropometric measurements, glucose and lipid profiles were obtained. Factor analysis combined with cluster analysis was used for identifying major dietary patterns. The associations of dietary patterns with obesity and related cardiometabolic risk factors were examined by logistic regression analysis. RESULTS Three mutually exclusive dietary patterns were identified, which were labeled as the healthy dietary pattern, the transitive dietary pattern, and the Western dietary pattern. Compared with children of the healthy dietary pattern, the multiple-adjusted odds ratios (95% confidence interval (CI)) of obesity were 1.11 (0.89-1.38) for children with the transitive dietary pattern and 1.80 (1.15-2.81) for children with the Western dietary pattern, which was 1.31 (95%CI 1.09-1.56) and 1.71 (95%CI: 1.13-2.56), respectively, for abdominal obesity. The Western dietary pattern was associated with significantly higher concentrations of low-density lipoprotein cholesterol (P<.001), triglycerides (P<.001), systolic blood pressure (P = 0.0435) and fasting glucose (P = 0.0082) and a lower concentration of high-density lipoprotein cholesterol (P = 0.0023), as compared with the healthy dietary pattern. CONCLUSIONS The Western dietary pattern characterized by red meat, eggs, refined grain and products, was positively associated with odds of obesity, the levels of plasma glucose, low-density lipoprotein cholesterol and triglycerides, and was inversely associated with the level of high-density lipoprotein cholesterol.
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Affiliation(s)
- Xianwen Shang
- National Institute for Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, Beijing, China
- China Oxford Centre for International Health Research, Cardiovascular Institute & Fu Wai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, Beijing, China
| | - Yanping Li
- National Institute for Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, Beijing, China
| | - Ailing Liu
- National Institute for Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, Beijing, China
| | - Qian Zhang
- National Institute for Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, Beijing, China
| | - Xiaoqi Hu
- National Institute for Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, Beijing, China
| | - Songming Du
- National Institute for Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, Beijing, China
| | - Jun Ma
- Health Science Center, Beijing University, Beijing, Beijing, China
| | - Guifa Xu
- Shandong University, Jinan, Shandong, China
| | - Ying Li
- Public Health College, Haerbin Medical University, Haerbin, Heilongjiang, China
| | | | - Lin Du
- Guangzhou Center for Diseases Prevention and Control, Guangzhou, Guangdong, China
| | - Guansheng Ma
- National Institute for Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, Beijing, China
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Olds T, Tomkinson G, Léger L, Cazorla G. Worldwide variation in the performance of children and adolescents: an analysis of 109 studies of the 20-m shuttle run test in 37 countries. J Sports Sci 2007; 24:1025-38. [PMID: 17115514 DOI: 10.1080/02640410500432193] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study is a meta-analysis of 109 reports of the performance of children and adolescents on the 20-m shuttle run test (20-mSRT). The studies were performed in 37 countries and included data on 418,026 children, tested between 1981 and 2003. Results were expressed as running speed (km x h(-1)) at the final completed stage of the 20-mSRT. Raw data were combined with pseudodata using Monte Carlo simulation. The 20-mSRT performances were expressed as z-scores relative to all children of the same age and sex from all countries. An overall "performance index" was derived for each country as the average of the age- and sex-specific z-scores for all children from that country. Factorial analysis of variance was used to compare scores among countries and regions, and between boys and girls of the same age. There was wide and significant (P < 0.0001) global variability in the performance of children. The best performing children were from the Northern European countries Estonia, Iceland, Lithuania, and Finland (0.6 - 0.9 standard deviations above the global average). The worst performing children were from Singapore, Brazil, USA, Italy, Portugal, and Greece (0.4 - 0.9 standard deviations below the global average). There is evidence that performance was negatively related to being overweight, as well as to a country's average temperature.
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Affiliation(s)
- Tim Olds
- Centre for Applied Anthropometry, University of South Australia, Adelaide, SA, Australia.
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15
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Lawlor DA, O'Callaghan MJ, Mamun AA, Williams GM, Bor W, Najman JM. Socioeconomic position, cognitive function, and clustering of cardiovascular risk factors in adolescence: findings from the Mater University Study of Pregnancy and its outcomes. Psychosom Med 2005; 67:862-8. [PMID: 16314590 DOI: 10.1097/01.psy.0000188576.54698.36] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives of this study were to examine the extent of clustering of smoking, high levels of television watching, overweight, and high blood pressure among adolescents and whether this clustering varies by socioeconomic position and cognitive function. METHODS This study was a cross-sectional analysis of 3613 (1742 females) participants of an Australian birth cohort who were examined at age 14. RESULTS Three hundred fifty-three (9.8%) of the participants had co-occurrence of three or four risk factors. Risk factors clustered in these adolescents with a greater number of participants than would be predicted by assumptions of independence having no risk factors and three or four risk factors. The extent of clustering tended to be greater in those from lower-income families and among those with lower cognitive function. The age-adjusted ratio of observed to expected co-occurrence of three or four risk factors was 2.70 (95% confidence interval [CI], 1.80-4.06) among those from low-income families and 1.70 (95% CI, 1.34-2.16) among those from more affluent families. The ratio among those with low Raven's scores (nonverbal reasoning) was 2.36 (95% CI, 1.69-3.30) and among those with higher scores was 1.51 (95% CI, 1.19-1.92); similar results for the WRAT 3 score (reading ability) were 2.69 (95% CI, 1.85-3.94) and 1.68 (95% CI, 1.34-2.11). Clustering did not differ by sex. CONCLUSION Among adolescents, coronary heart disease risk factors cluster, and there is some evidence that this clustering is greater among those from families with low income and those who have lower cognitive function.
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Affiliation(s)
- Debbie A Lawlor
- Department of Social Medicine, University of Bristol, Bristol, UK.
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Ribeiro JC, Guerra S, Oliveira J, Andersen LB, Duarte JA, Mota J. Body fatness and clustering of cardiovascular disease risk factors in Portuguese children and adolescents. Am J Hum Biol 2004; 16:556-62. [PMID: 15368603 DOI: 10.1002/ajhb.20056] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Modifiable cardiovascular risk factors that increase the risk for cardiovascular diseases (CVD) in adult populations have also been observed in pediatric populations. Childhood and adolescence obesity has been strongly implicated in the clustering of risk factors. The aims of the present study were 1) to examine whether clustering of CVD risk factors, either biological risk factors (high blood pressure (HBP), percentage of high fat mass (%HBF), and high total cholesterol (HTC)) and one behavioral/lifestyle risk factor (low physical activity index (LPAI)) exist, and 2) to analyze the relationship between body fatness and the clustering of other risk factors. The cluster of CVD risk factors was determined in 1,533 (8-15 years of age) children, 731 males (age 10.8 +/- 2.3 years; weight, 40.6 +/- 12.7 kg; height, 143.1 +/- 14.1 cm; BMI, 19.4 +/- 3.4 kg(-2)) and 802 females (age, 11.0 +/- 2.4; weight, 41.0 +/- 12.4; height, 142.8 +/- 13.2; BMI, 19.7 +/- 3.5). Sex- and age-specific "high risk" quartiles were formed for each of the biological risk factors and the lifestyle factor. Thus, for blood pressure (high blood pressure, HBP), cholesterol (high cholesterol, HTC), and obesity (high percent of body fat, HBF), the sex- and age-adjusted 4th quartile (4Q) was defined as the "high risk" quartile, while for physical activity the 1st quartile (1Q) was defined as the "high risk" quartile. The majority of children (62% of boys and 62% of girls) at risk of obesity are at risk of another risk factor. In our sample, estimated ORs indicated that, compared with 1Q, the "risk of obesity" children and adolescents were two times as likely (P < 0.001) to have two or three risk factors. Our results suggest that children 8-15 years old in the highest quartile of body fatness are an increased risk of having a cluster of other risk factors, namely HBP, HTC, and LPAI. These data provide further evidence that juvenile obesity warrants early intervention because the patterns of unhealthy behavior are formed in adolescence and young adulthood.
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Affiliation(s)
- José Carlos Ribeiro
- Research Center in Physical Activity, Health and Leisure, Faculty of Sports Science and Physical Education, University of Porto, Portugal
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17
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Kremers SPJ, De Bruijn GJ, Schaalma H, Brug J. Clustering of energy balance-related behaviours and their intrapersonal determinants. Psychol Health 2004. [DOI: 10.1080/08870440412331279630] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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18
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Ribeiro JC, Guerra S, Oliveira J, Teixeira-Pinto A, Twisk JWR, Duarte JA, Mota J. Physical activity and biological risk factors clustering in pediatric population. Prev Med 2004; 39:596-601. [PMID: 15313100 DOI: 10.1016/j.ypmed.2004.02.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND From a preventive point of view, it is especially important to investigate the life style risk factors connected to cardiovascular disease (CVD) biological risk factors clustering. The purposes of this study were (I) to determine in pediatric population the coexistence of biological cardiovascular disease risk factors (high blood pressure (HBP), percentage of high fat mass (%HFM), and high total cholesterol (HTC)) and (II) to study the relationship between low physical activity, a lifestyle risk factor, with those biological risk factors. METHODS This study comprised 1461 children (699 males and 762 females) aged between 8 and 15 years old. The following measurements were carried out: blood pressure, percentage of fat mass, total cholesterol (TC), and physical activity. The quartiles, adjusted for age and gender, were the criterion used to classify the subjects at risk. Odds ratios and confidence intervals at 95% were used to study HBP, HTC, and %HFM clustering in both genders. Multinomial logistic regression was used to investigate the relationship between clustering and physical activity index (PAI). RESULTS The findings of this study indicated that there is clustering for the biological risk factors, specially between HBP and %HFM for females. It can be observed that about half of the subjects had at least one biological risk factor. CONCLUSIONS The results of the present study suggest that children and adolescents with higher PAI have a lower number of biological risk factors for CVD.
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Affiliation(s)
- José C Ribeiro
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sports Science and Physical Education, University of Porto, Porto 4200 450, Portugal
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Darnton-Hill I, Nishida C, James WPT. A life course approach to diet, nutrition and the prevention of chronic diseases. Public Health Nutr 2004; 7:101-21. [PMID: 14972056 DOI: 10.1079/phn2003584] [Citation(s) in RCA: 211] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To briefly review the current understanding of the aetiology and prevention of chronic diseases using a life course approach, demonstrating the life-long influences on the development of disease. DESIGN A computer search of the relevant literature was done using Medline-'life cycle' and 'nutrition' and reviewing the articles for relevance in addressing the above objective. Articles from references dated before 1990 were followed up separately. A subsequent search using Clio updated the search and extended it by using 'life cycle', 'nutrition' and 'noncommunicable disease' (NCD), and 'life course'. Several published and unpublished WHO reports were key in developing the background and arguments. SETTING International and national public health and nutrition policy development in light of the global epidemic in chronic diseases, and the continuing nutrition, demographic and epidemiological transitions happening in an increasingly globalized world. RESULTS OF REVIEW: There is a global epidemic of increasing obesity, diabetes and other chronic NCDs, especially in developing and transitional economies, and in the less affluent within these, and in the developed countries. At the same time, there has been an increase in communities and households that have coincident under- and over-nutrition. CONCLUSIONS The epidemic will continue to increase and is due to a lifetime of exposures and influences. Genetic predisposition plays an unspecified role, and with programming during fetal life for adult disease contributing to an unknown degree. A global rise in obesity levels is contributing to a particular epidemic of type 2 diabetes as well as other NCDs. Prevention will be the most cost-effective and feasible approach for many countries and should involve three mutually reinforcing strategies throughout life, starting in the antenatal period.
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Affiliation(s)
- I Darnton-Hill
- Institute of Human Nutrition, Columbia University, New York, USA.
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20
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Thomas NE, Baker JS, Davies B. Established and recently identified coronary heart disease risk factors in young people: the influence of physical activity and physical fitness. Sports Med 2003; 33:633-50. [PMID: 12846588 DOI: 10.2165/00007256-200333090-00001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Epidemiological studies have identified several risk factors for coronary heart disease (CHD), many of which are present in young people. [For the purpose of this review, the phrase "young people" embraces both children and adolescents.] One such risk factor is hypertension. In adults, exercise is thought to have a positive effect on blood pressure levels; however, findings are inconclusive for young people. Despite its association with CHD, obesity is on the increase in Western society's young population; prevention and intervention during early years is needed. An active lifestyle is considered to have a beneficial effect on body fatness. Lipoprotein profiles are directly associated with CHD status. In adults, there is some evidence that physical activity and/or fitness have a favourable effect on lipoprotein levels. Although information regarding the younger population is more ambiguous, it tends to concur with these findings. High levels of lipoprotein(a), are considered an independent risk factor for CHD. Relatively little has been written on young people, although some studies have postulated a favourable relationship with physical activity. An inverse relationship between aerobic fitness and CHD has been confirmed in adults; an association is not as easily verified for young people. Physical activity is similarly deemed to have a beneficial effect on health status. A high-fat diet has been linked to CHD in adults, and evidence to date reports similar findings for young people. Smoking increases the risk of CHD and even moderate smoking during youth could have damaging long-term consequences. There is some evidence that smoking is related to physical activity and fitness levels in young people. In adults, high levels of homocyst(e)ine have been associated with CHD. As yet, little has been written on the relationship between physical activity or physical fitness and homocysteine status in young people. High levels of plasma fibrinogen have been linked to CHD. Several studies have explored the relationship between plasma fibrinogen and physical activity and/or fitness in adults, but findings are inconclusive; for young people, the ambiguity is even greater. C-reactive protein is a molecular marker for CHD but, to date, little attention has been given to this aspect, especially amongst young people. The link between high levels of plasminogen activator inhibitor-1 and CHD has been confirmed, although the essence of this relationship is not established. There is a paucity of data on the younger population and the relevance of collating such information is questionable. For the younger population, most research is limited to the established CHD risk factors and further investigations of recently identified CHD risk factors are needed.
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Affiliation(s)
- Non Eleri Thomas
- School of Sport Physical Education and Recreation, University of Wales Institute Cardiff, Cyncoed, Cardiff CF12 6XD, Wales
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Tomkinson GR, Léger LA, Olds TS, Cazorla G. Secular trends in the performance of children and adolescents (1980-2000): an analysis of 55 studies of the 20m shuttle run test in 11 countries. Sports Med 2003; 33:285-300. [PMID: 12688827 DOI: 10.2165/00007256-200333040-00003] [Citation(s) in RCA: 253] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
It is widely believed that the performance of children and adolescents on aerobic fitness tests is declining. To test this hypothesis, this meta-analysis compared the results of 55 reports of the performance of children and adolescents aged 6-19 years who have used the 20m shuttle run test (20mSRT). All data were collected in the period 1981-2000. Following corrections for methodological variation, the results of all studies were expressed using the common metric of running speed (km/h) at the last completed stage. Raw data were combined with pseudodata generated from reported means and standard deviations using Monte Carlo simulation. Where data were available on children and adolescents from the same country of the same age and sex, but tested at different times, linear regression was used to calculate rates of change. This was possible for 11 (mainly developed) countries, representing a total of 129,882 children and adolescents in 151 age x sex x country slices. There has been a significant decline in performance in the 11 countries where data were available, and in most age x sex groups, with a sample-weighted mean decline of 0.43% of mean values per year. The decline was most marked in older age groups and the rate of decline was similar for boys and girls. There has been a very rapid secular decline in the 20mSRT performance of children and adolescents over the last 20 years, at least in developed countries. The rate of decline is not related to the change in the country's relative wealth, as quantified by per capita gross domestic product (GDP).
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Affiliation(s)
- Grant R Tomkinson
- Computer Simulation Laboratory, School of Health Sciences, University of South Australia, Underdale, South Australia, Australia.
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Guerra S, Oliveira J, Ribeiro JC, Teixeira-Pinto A, Duarte JA, Mota J. Relação entre a atividade física regular e a agregação de fatores de risco biológicos das doenças cardiovasculares em crianças e adolescentes. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2003. [DOI: 10.1590/s1519-38292003000100003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Com o presente trabalho pretende-se analisar os estudos referenciados na literatura que abordam o tema da agregação de fatores de risco biológicos e ainda analisar a hipotética relação entre a atividade física (AF) e essa agregação. O hábito de prática regular de AF tem sido associado a um estilo de vida saudável. Uma vez que os fatores de risco das doenças cardiovasculares (DCV) estão já presentes na infância e adolescência e porque os níveis de AF habitual parecem exercer alguma influência nesses fatores, índices mais elevados de AF nesses períodos de vida poderão repercutir-se na redução da morbidade e mortalidade das DCV em idades adultas. Através da análise da literatura parece existir agregação de fatores de risco biológicos para as DCV, para rapazes e moças, contudo não existe ainda consenso quanto ao sexo que registra o "risco" mais elevado de agregação. Deste modo, os resultados parecem sugerir que as crianças ou adolescentes identificados com um fator de risco, devem efetuar um rastreio no sentido de verificar se possuem mais fatores de risco agregados. De acordo com os estudos referenciados na literatura não existe unanimidade quanto à relação entre a AF e a agregação de fatores de risco biológicos para as DCV.
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Abstract
BACKGROUND The objective of the study was to evaluate the degree of clustering of common lifestyle risk factors in a general adult population and to define subgroups with elevated clustering. METHODS Data on lifestyle risk factors (smoking, low vegetable and fruit consumption, excessive alcohol intake, and low physical activity), sociodemographics, and health perception were collected by questionnaire from 16,789 men and women aged 20 to 59. RESULTS About 20% of the subjects had at least three lifestyle risk factors. Prevalence of risk factors was higher among unemployed, low-educated subjects and those who had experienced health deterioration. All lifestyle risk factors showed significant clustering, except for low physical activity and excessive alcohol consumption. The strongest association was observed for alcohol and smoking (prevalence odds ratio (POR): 2.38; 95% confidence interval: 2.18-2.61). Clustering of smoking and alcohol consumption was strongest among the young subjects (POR: 3.78) and, although moderately, clustering of lifestyle risk factors was elevated in subjects who had experienced a deterioration in health. CONCLUSIONS These findings suggest that common lifestyle risk factors cluster among adult subjects. The tendency for risk factors to aggregate has important implications for health promotion. Information on high-risk groups will help in planning future preventive strategies.
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Affiliation(s)
- A Jantine Schuit
- Department of Chronic Diseases Epidemiology, National Institute of Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands.
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van Lenthe FJ, Boreham CA, Twisk JW, Savage MJ, Murray L, Smith GD. What determines drop out in prospective studies of coronary heart disease risk factors between youth and young adulthood: the Young Hearts Study. J Epidemiol Community Health 2001; 55:681-2. [PMID: 11511649 PMCID: PMC1731986 DOI: 10.1136/jech.55.9.681] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- F J van Lenthe
- Department of Public Health, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
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