Diagnostic performance of BMI percentiles to identify adolescents with metabolic syndrome

Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Appraisal of Clinical Care Practices for Child Obesity Treatment. Part II: Comorbidities

The objective of this technical report is to provide clinicians with actionable evidence-based information upon which to make treatment decisions. In addition, this report will provide an evidence base on which to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) "What are effective clinically based treatments for obesity?" and (KQ2) "What is the risk of comorbidities among children with obesity?" See Appendix 1 for the conceptual framework and a priori Key Questions.

Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Safflower (Carthamus tinctorius L.) oil could improve abdominal obesity, blood pressure, and insulin resistance in patients with metabolic syndrome: A randomized, double-blind, placebo-controlled clinical trial

ETHNOPHARMACOLOGICAL RELEVANCE

Carthamus tinctorius L. (Safflower) has been widely recommended to treat metabolic disorders in traditional herbal medicine in Persia, China, Korea, Japan, and other East-Asian countries. The anti-hypercholesterolemic and antioxidant effects of this plant have been well documented, but its protective effects against Metabolic Syndrome (MetS) have not been fully illustrated.

AIM OF THE STUDY

The present study aimed to evaluate the effects of safflower oil on MetS risk factors.

MATERIALS AND METHODS

In this randomized, double-blind, placebo-controlled clinical trial, 67 patients with MetS were administered either divided 8 g safflower oil or placebo daily for 12 weeks. All patients were advised to follow their previous diets and physical activities.

RESULTS

Safflower oil resulted in a significant reduction in waist circumference (-2.42 ± 3.24 vs. 0.97 ± 2.53, p<0.001), systolic blood pressure (-8.80 ± 9.77 vs. -2.26 ± 8.56, p = 0.021), diastolic blood pressure (-3.53 ± 7.52 vs. -0.70 ± 6.21, p = 0.041), fasting blood sugar (-5.03 ± 10.62 vs. 2.94 ± 7.57, p = 0.003), and insulin resistance (-0.59 ± 1.43 vs. 0.50 ± 1, p = 0.012), but an increase in adiponectin level (0.38 ± 0.99 vs. -0.09 ± 0.81, p = 0.042) in the treatment group in comparison to the placebo group. The results revealed a direct relationship between leptin level and Body Mass Index (BMI) in both groups (p<0.001). In addition, increase in BMI resulted in a non-significant decrease in adiponectin level in both groups. Moreover, no significant difference was observed between the two groups regarding lipid profiles, leptin serum level, serum creatinine concentration, and other outcomes.

CONCLUSION

Safflower oil without lifestyle modification improved abdominal obesity, blood pressure, and insulin resistance in patients with MetS.

Association between Metabolic Syndrome Diagnosis and the Physical Activity-Sedentary Profile of Adolescents with Obesity: A Complementary Analysis of the Beta-JUDO Study

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.

Multifactorial causation of early onset colorectal cancer

The multiple-hit hypothesis of cancer, including colorectal cancer (CRC), states that neoplastic development requires a sequence of mutations and epigenetic changes in driver genes. We have previously proposed that obesity increases CRC risk by supporting neoplastic development through adipokine-induced signaling, and this proliferative signaling substitutes for specific driver gene mutations. In support of this hypothesis, analyses of The Cancer Genome Atlas (TCGA) mutation data have revealed that obese patients with microsatellite stable CRC exhibit fewer driver gene mutations than CRC patients with normal body mass index. The lower number of driver gene mutations required for cancer development may shorten the neoplastic process and lead to an early onset of CRC. Therefore, obesity could be one factor explaining the rise of CRC incidence among younger individuals (< 50 years of age); furthermore, early onset CRC has been associated with the increasing incidence of metabolic syndrome and obesity in this age group. However, CRC incidence among older individuals (> 50 years of age) is stable or declining, despite the high rates of metabolic syndrome and obesity in this age group. In search for explanations of this phenomenon, we discuss several factors that may contribute to the divergent CRC incidence trends in populations under, and above, the age of 50, despite the rising levels of metabolic syndrome and obesity across all ages. First, older individuals with metabolic dysregulation are more frequently on maintenance medications, such as aspirin, β-blockers, lipid-lowering drugs, ACE inhibitors, metformin, etc., compared to younger individuals. Such treatments may suppress specific adipokine-induced proliferative signaling pathways, and therefore counteract and slow down neoplastic development in medicated overweight/obese individuals. Second, in the past decades, the incidence of infectious diseases accompanied by febrile episodes has been decreasing and the use of antipyretics increasing. Compared to normal cells, neoplastic cells are more sensitive to high body temperature; therefore, the decreased number of febrile episodes in childhood and adolescence may contribute to increased cancer incidence before the age of 50. Third, obesity at younger age may expand the stem cell compartment. An increased number of intestinal stem cells and stem cell divisions translates into a higher probability of sporadic mutations in the stem cells, and therefore, a greater chance of neoplasia. In conclusion, we hypothesize that early onset CRC has multifactorial causation and the proposed associations could be examined through analyses of existing data.

The composite alliance of FTO locus with obesity-related genetic variants

Obesity has become a genuine global pandemic due to lifestyle and environmental modifications, and is associated with chronic lethal comorbidities. Various environmental factors such as lack of physical activity due to modernization and higher intake of energy-rich diets are primary obesogenic factors in pathogenesis of obesity. Genome-wide association study has identified the crucial role of FTO (fat mass and obesity) in human obesity. A bunch of SNPs in the first intron of FTO has been identified and subsequently correlated to body mass index and body composition. Findings of in silico, in vitro, and in vivo studies have manifested the robust role of FTO in regulation of energy expenditure and food consumption. Numerous studies have highlighted the mechanistic pathways behind the concomitant functions of FTO in adipogenesis and body size. Current investigation has also revealed the link of FTO neighbouring genes i.e., RPGRIP1L, IRX3 and IRX5 and epigenetic factors with obesity phenotypes. The motive behind this review is to cite the consequences of FTO on obesity vulnerability.

Low Muscular Strength, Weight Status, and Metabolic Syndrome in Adolescents: National Health and Nutrition Examination Survey 2011-2014

PURPOSE

To investigate the association between muscular strength and metabolic syndrome (MetS), with a specific focus on the role of weight status, using a nationally representative sample of US youth.

METHODS

The analysis included 409 boys and 415 girls from the 2011 to 2014 National Health and Nutrition Examination Survey between 12 and 18 years of age. The prevalence of MetS was defined using age- and sex-specific criteria for abdominal obesity, elevated triglycerides, blood pressure, fasting glucose, and low high-density lipoprotein (HDL) cholesterol. Strength was assessed via handgrip dynamometer and expressed as age- and sex-specific z scores of relative strength. Low strength was defined as a relative strength below the 25th percentile. Analyses controlled for age, sex, race/ethnicity, physical activity, and weight status.

RESULTS

The sample prevalence of MetS was approximately 5.3%. However, MetS prevalence was 18.5% in overweight/obese youth with low strength. The adjusted odds of MetS were 3.1 (95% confidence interval, 1.5-6.3, P < .001) times higher for overweight/obese youth with low strength versus sufficient strength.

CONCLUSION

Muscular strength is predictive of adolescent MetS, specifically in those with unhealthy weight status. Approximately one in 5 overweight/obese youth with low strength had MetS. These findings highlight the relevance of muscular strength in youth cardiometabolic morbidities.

Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease.

RESULTS

Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Metabolic Syndrome in Obese Children-Clinical Prevalence and Risk Factors

The prevalence of childhood obesity is increasing worldwide. Some obese children can go on to develop metabolic syndrome (MetS), but exactly who among them remains to be determined. The aim of this study was to indicate predisposing factors for metabolic syndrome, especially those that can be modified. The study comprised 591 obese children aged 10–12 years. They were all Caucasian residents of Gdańsk, Poland, with similar demographic backgrounds. Clinical examination, anthropometry, biometric impedance analysis, blood tests (including oral glucose tolerance tests (OGTT) and insulinemia), and dietary and physical activity evaluation were conducted. The results of our study show that the risk factors for MetS or any of its components include male sex, parental (especially paternal) obesity, low body mass at birth, as well as omitting breakfast or dinner. There are few risk factors for metabolic syndrome both in obese adults and children. Some of these predictors can be modified, especially those in relation to lifestyle. Identifying and then influencing these factors may help to reduce the development of metabolic syndrome and consequently improve health and quality of life.

Prevalence of Metabolic Syndrome and Impaired Glucose Metabolism among 10- to 17-Year-Old Overweight and Obese Lithuanian Children and Adolescents

BACKGROUND

Overweight (Ow) and obesity among adults and children increases the risk of metabolic consequences. Metabolic syndrome (MS) and impaired glucose metabolism are well-known risk factors for cardiovascular diseases and type 2 diabetes. The aim of this study was to evaluate the prevalence of MS and impaired glucose metabolism among Ow and obese (Ob) children and adolescents (aged 10-17 years) in Lithuania, and to evaluate the associations between insulin resistance (IR) indices and anthropometric parameters as well as metabolic disturbances.

METHODS

The study population consisted of 344 OwOb children and adolescents of all pubertal stages. Oral glucose tolerance tests (OGTTs), IR and β cell function indices, lipid profile, and anthropometric parameters of all subjects were analyzed. MS was defined according to the International Diabetes Federation consensus guidelines.

RESULTS

MS was found in 21.3% of the OwOb children and adolescents, and 12.1% had impaired glucose metabolism (6.9% with impaired fasting glucose, 4.5% with impaired glucose tolerance, and 0.6% with type 2 diabetes). IR was directly related to body mass index and waist circumference, waist-to-height and waist-to-hip ratios, and sum of skin-fold thicknesses. Children with MS were more insulin-resistant, had higher odds ratio for prediabetes and had a more disturbed lipid profile than subjects without MS. Moreover, total cholesterol and low-density lipoprotein cholesterol levels were significantly lower in the more mature OwOb adolescents.

CONCLUSION

MS and lipid profile disturbances are common in OwOb children and adolescents. MS is directly associated with IR. Therefore, OwOb children and adolescents should be carefully followed up for metabolic abnormalities during late childhood as these can persist into adulthood.

Longitudinal Associations between Physical Fitness and Academic Achievement in Youth

INTRODUCTION

Data from clinical trials have justified the promotion of fitness as a means to enhance facets of cognitive control and academic achievement in youth. However, such associations, when tested under real-world conditions, are equivocal. The purpose of this study, therefore, was to evaluate longitudinal associations between aerobic capacity (AC), weight status, and academic achievement within a large urban county.

METHODS

Longitudinal data were obtained from a sample of third, fifth, and seventh grade students in schools within an urban county in Georgia. Data on body mass index (BMI) were available from 11,639 students; AC data from 5735 students. Data on both indicators were obtained through the established FitnessGram assessment battery with 2-yr changes calculated using standardized Z scores. Academic achievement data were available from three subjects (math, science, and reading) for third, fifth, and seventh grade students, and 2-yr changes were computed using changes in Z scores for each test. Data were analyzed using generalized logistic models to test associations between change in BMI and AC in relation to changes in academic achievement.

RESULTS

Positive associations were observed between improvements in weight status and academic achievement for the fifth grade boys and girls ([reading] odds ratio [OR], 1.47; 95% confidence interval [CI], 1.25-1.72; [science] OR, 1.22; 95% CI, 1.04-1.42). Maintaining weight status was associated with improved scores in the third grade ([math] OR, 1.16; 95% CI, 1.012-1.327; [reading] OR, 1.47; 95% CI, 1.25-1.72) and fifth grade cohorts (math OR, 1.20; 95% CI, 1.00.1.43). For AC, no significant associations were found for any age cohort.

CONCLUSIONS

Modest associations between improvements in weight status, AC, and academic achievement are noteworthy, despite the lack of statistical significance for AC. The results provide a robust evaluation of associations between fitness and academic achievement.

Adapting a Prediction Rule for Metabolic Syndrome Risk Assessment Suitable for Developing Countries

Background: Metabolic syndrome (MetS) is a cluster of cardiometabolic disturbances that increases the risk of cardiovascular diseases (CVD) and type 2 diabetes mellitus (DM). The early identification of high-risk individuals is the key for halting these conditions. The world is facing a growing epidemic MetS although the magnitude in Egypt is unknown. Objectives: To describe MetS and its determinants among apparently healthy individuals residing in urban and rural communities in Egypt and to establish a model for MetS prediction. Methods: A cross-sectional study was conducted with 270 adults from rural and urban districts in Alexandria, Egypt. Participants were clinically evaluated and interviewed for sociodemographic and lifestyle factors and dietary habits. MetS was defined according to the harmonized criteria set by the AHA/NHLBI. The risk of ischemic heart diseases (IHDs), DM and fatty liver were assessed using validated risk prediction charts. A multiple risk model for predicting MetS was developed, and its performance was compared. Results: In total, 57.8% of the study population met the criteria for MetS and were at high risk for developing IHD, DM, and fatty liver. Silent CVD risk factors were identified in 20.4% of the participants. In our proposed multivariate logistic regression model, the predictors of MetS were obesity [OR (95% CI) = 16.3 (6.03-44.0)], morbid obesity [OR (95% CI) = 21.7 (5.3-88.0)], not working [OR (95% CI) = 2.05 (1.1-3.8)], and having a family history of chronic diseases [OR (95% CI) = 4.38 (2.23-8.61)]. Consumption of caffeine once per week protected against MetS by 27.8-fold. The derived prediction rule was accurate in predicting MetS, fatty liver, high risk of DM, and, to a lesser extent, a 10-year lifetime risk of IHD. Conclusion: Central obesity and sedentary lifestyles are accountable for the rising rates of MetS in our society. Interventions are needed to minimize the potential predisposition of the Egyptian population to cardiometabolic diseases.

Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals.

RESULTS

Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Development of a Computational Model to Predict Excess Body Fat in Adolescents through Low Cost Variables

BACKGROUND

Excess body fat has been growing alarmingly among adolescents, especially in low income and middle income countries where access to health services is scarce. Currently, the main method for assessing overweight in adolescents is the body mass index, but its use is criticized for its low sensitivity and high specificity, which may lead to a late diagnosis of comorbidities associated with excess body fat, such as cardiovascular diseases. Thus, the aim of this study was to develop a computational model using linear regression to predict obesity in adolescents and compare it with commonly used anthropometric methods. To improve the performance of our model, we estimated the percentage of fat and then classified the nutritional status of these adolescents.

METHODS

The model was developed using easily measurable socio-demographic and clinical variables from a database of 772 adolescents of both genders, aged 10-19 years. The predictive performance was evaluated by the following metrics: accuracy, sensitivity, specificity, and area under ROC curve. The performance of the method was compared to the anthropometric parameters: body mass index and waist-to-height ratio.

RESULTS

Our model showed a high correlation (R = 0.80) with the body fat percentage value obtained through bioimpedance. In addition, regarding discrimination, our model obtained better results compared to BMI and WHtR: AUROC = 0.80, 0.64, and 0.55, respectively. It also presented a high sensitivity of 92% and low false negative rate (6%), while BMI and WHtR showed low sensitivity (27% and 9.9%) and a high false negative rate (65% and 53%), respectively.

CONCLUSIONS

The computational model of this study obtained a better performance in the evaluation of excess body fat in adolescents, compared to the usual anthropometric indicators presenting itself as a low cost alternative for screening obesity in adolescents living in Brazilian regions where financial resources are scarce.

Adiposity Criteria in Assessing Increased Cardiometabolic Risk in Prepubertal Children

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.

At what age do normal weight Canadian children become overweight adults? Differences according to sex and metric

BACKGROUND

The prevalence of overweight and obesity doubles between adolescence and young adulthood; however, the exact age, and appropriate metric to use to identify when overweight develops is still debated.

AIM

To examine the age of onset of overweight by sex and four metrics: body mass index (BMI), fat mass (%FM), waist circumference (WC) and waist-to-height ratio (WHtR).

SUBJECTS AND METHODS

Between 1991 and 2017, serial measures of body composition were taken on 237 (108 males) individuals (aged 8-40 years of age). Hierarchical random effects models were used to develop growth curves. Curves were compared to BMI, %FM and WC overweight age- and sex-specific cut-points.

RESULTS

In males, the BMI growth curve crossed the cut-point at 22.0 years, compared to 23.5 and 26.5 years for WHtR and %FM, respectively; WC cut-off was not reached until 36 years. In females, the BMI growth curve crossed the overweight cut-point at 21.5 years, compared to 14.2 years for %FM and 21.9 and 27.5 years for WC and WHtR, respectively.

CONCLUSION

In summary, overweight onset occurs during young adulthood with the exception of WC in males. BMI in males and %FM in females were the metrics identifying overweight the earliest.

Associations between Liver Enzyme Levels and Parameters of the Metabolic Syndrome in Obese Children

BACKGROUND

Obesity is strongly associated with insulin resistance, hypertension, dyslipidemia, and therefore risk for metabolic syndrome (MetS), which is an increasing problem in youth. The potential role of elevated liver enzyme levels in this context needs to be further investigated.

METHODS

This paper provides a post hoc analysis of a cross-sectional study of 77 obese nondiabetic children (51% female; median age 11.7 years; BMI >97th percentile) enrolled at the University of Bonn, Bonn, Germany. Anthropometric parameters, lipid profiles, glycemic control, and liver enzyme levels were evaluated. Glucose and insulin levels were determined during an oral glucose tolerance test (OGTT). Gender- and age-specific cutoff values were used to assess MetS.

RESULTS

A high prevalence of hypertension (51%), dyslipidemia (52%), elevated liver enzyme levels (51%), and hyperglycemia (24%) was found. There was considerable overlap between the presence of different MetS risk factors in individuals, and 40% of the participants had ≥3 of a maximum of 5 MetS risk factors. Elevated liver enzyme levels were significantly associated with reduced insulin sensitivity, as the OGTT-insulin response was significantly higher in participants with elevated transaminases (p = 0.01). This association was independent of hyperglycemia and dyslipidemia (p = 0.03).

CONCLUSIONS

We conclude that liver enzyme levels are related to insulin sensitivity in obese children and could therefore be an indirect indicator for MetS. Testing for disturbed glucose metabolism should be considered for obese children with elevated liver enzymes.

Clinical study on the prevalence and comparative analysis of metabolic syndrome and its components among Chinese breast cancer women and control population

Metabolic syndrome has been previously identified as a risk factor for breast cancer and is increasingly a public health concern. This study aims to investigate the prevalence of metabolic syndrome and its components among primary breast cancer and control population. The clinical data of metabolic syndrome and its components in the breast cancer (605 cases) and control population (3212 cases), from Breast Cancer Center and Physical Examination Center of Chongqing, China, from July 2015 to February 2017, were collected for comparative analysis. This study was prospectively registered in Chinese Clinical Trial Registry (http://www.chictr.org.cn/, number: ChiCTR-OOB-15007543). The prevalence of metabolic syndrome in breast cancer (32.6%) was obviously higher than that in control population (18.2%) (p<0.001; OR: 2.173, 95%CI: 1.793 to 2.633). With age stratification, the prevalence of metabolic syndrome in breast cancer group aged below 60 years (24.9%, p<0.001; OR: 2.216, 95%CI: 1.744 to 2.816) and equal/above 60 years (58.3%, p<0.001; OR: 2.291, 95%CI: 1.580 to 3.322) were also statistically higher than those (13.0% & 37.9%) in control population, respectively. Breast cancer women were more likely to have preobese (BMI 25.0-29.9) or obesity (BMI ≥30.0), broader waist circumference, lower HDL-C level, higher systolic and/or diastolic blood pressure and higher fasting blood glucose level compared to the control population, corresponding prevalence were 31.7%vs.19.4%, 76.0%vs.29.6%, 37.4%vs.30.4%, 34.2%/27.3%vs.27.6%/14.2% and 25.0%vs.20.1%, respectively (p<0.01). In summary, there is high prevalence of metabolic syndrome and its components in Chinese breast cancer women, and metabolic syndrome is closely related with breast cancer. Therefore, screening and prevention strategy of metabolic syndrome should be carried out in the management of breast cancer.

The Healthy Fitness Zone Continuum Score as a Measure of Change in Body Mass Index of School-Aged Children and Adolescents, Georgia, 2012-2014

OBJECTIVES

The FitnessGram Healthy Fitness Zone continuum (HFZc) score reflects the relative difference of a person's body mass index (BMI) from the established FitnessGram standard. As such, it may provide added utility for public health programming and research on obesity among school-aged children and adolescents. We used the standard BMI Z (BMIz) score and the alternative HFZc score to describe changes in BMI of school-aged children and adolescents in Georgia over time.

METHODS

We compiled 2012-2014 BMI data from the Georgia FitnessGram database. The sample included 162 992 boys and 141 711 girls enrolled in 239 schools from a large urban district in Georgia. We analyzed trends in BMIz and HFZc scores separately for normal-weight, overweight, and obese categories for school-aged children and adolescents using hierarchical linear models.

RESULTS

From 2012 to 2014, the BMIz score shifted favorably in up to 40.7% (2052/5047) of normal-weight, 51.0% (758/1485) of overweight, and 52.8% (5430/10 279) of obese students. We also found favorable shifts in HFZc score in up to 69.8% (105 831/151 739) of normal-weight, 78.3% (3605/4603) of overweight, and 80.8% (8305/10 279) of obese students.

CONCLUSIONS

Compared with the BMIz score, the HFZc score may be a better indicator of favorable changes in BMI over time among school-aged children and adolescents with different baseline BMI levels, making it potentially valuable for use in individualized assessments, school programs, obesity research, and public health curriculum and policy development.

Metabolic syndrome is associated with exposure to organochlorine pesticides in Anniston, AL, United States

The Anniston Community Health Survey, a cross-sectional study, was undertaken in 2005-2007 to study environmental exposure to polychlorinated biphenyl (PCB) and organochlorine (OC) pesticides and health outcomes among residents of Anniston, AL, United States. The examination of potential risks between these pollutants and metabolic syndrome, a cluster of cardiovascular risk factors (i.e., hypertension, central obesity, dyslipidemia and dysglycemia) was the focus of this analysis. Participants were 548 adults who completed the survey and a clinic visit, were free of diabetes, and had a serum sample for clinical laboratory parameters as well as PCB and OC pesticide concentrations. Associations between summed concentrations of 35 PCB congeners and 9 individual pesticides and metabolic syndrome were examined using generalized linear modeling and logistic regression; odds ratios (OR) and 95% confidence intervals (CI) are reported. Pollutants were evaluated as quintiles and as log transformations of continuous serum concentrations. Participants were mostly female (68%) with a mean age (SD) of 53.6 (16.2) years. The racial distribution was 56% white and 44% African American; 49% met the criteria for metabolic syndrome. In unadjusted logistic regression, statistically significant and positive associations across the majority of quintiles were noted for seven individually modeled pesticides (p,p'-DDT, p,p'-DDE, HCB, β-HCCH, oxychlor, tNONA, Mirex). Following adjustment for covariables (i.e., age, sex, race, education, marital status, current smoking, alcohol consumption, positive family history of diabetes or cardiovascular disease, liver disease, BMI), significant elevations in risk were noted for p,p'-DDT across multiple quintiles (range of ORs 1.61 to 2.36), for tNONA (range of ORs 1.62-2.80) and for p,p'-DDE [OR (95% CI)] of 2.73 (1.09-6.88) in the highest quintile relative to the first. Significant trends were observed in adjusted logistic models for log10 HCB [OR=6.15 (1.66-22.88)], log10 oxychlor [OR=2.09 (1.07-4.07)] and log10 tNONA [3.19 (1.45-7.00)]. Summed PCB concentrations were significantly and positively associated with metabolic syndrome only in unadjusted models; adjustment resulted in attenuation of the ORs in both the quintile and log-transformed models. In conclusion, several OC pesticides were found to have significant associations with metabolic syndrome in the Anniston study population while no association was observed for PCBs.

Impact of NFL PLAY 60 Programming on Elementary School Children's Body Mass Index and Aerobic Capacity: The NFL PLAY 60 FitnessGram Partnership Project

BACKGROUND

We examined the impact of the Fuel Up to Play 60 (FUTP60) program on children's body mass index (BMI) and aerobic capacity (AC).

METHODS

Participation in the FUTP60 and both BMI and AC profiles were collected through the NFL PLAY 60 FitnessGram Partnership Project involving over 100 schools from 22 US states. We specifically examined the distributions of BMI and AC among participating versus nonparticipating schools in the 2012-2013 school year. Hierarchical linear models tested the impact of participation and availability of additional funding for program implementation on the proportions of youth meeting FitnessGram health-related fitness standards (ie, Needs Improvement-Health Risk [NIHR] and Healthy Fitness Zone [HFZ] categories).

RESULTS

After 1 year implementing the program, participating schools had lower proportions of boys (-4.1 ± 2.0%, p = .04) and girls (-4.5 ± 2.0%, p = .03) in the NIHR for BMI, and lower proportion of girls (-9.7 ± 4.0%, p = .02) in the NIHR for AC. There were no differences in the distributions for the HFZ and the availability of additional funding did not alter the relationships (p > .05).

CONCLUSIONS

This study provides preliminary evidence that participation in the FUTP60 is associated with improved profiles of health-related fitness.

Validation of surrogate markers for metabolic syndrome and cardiometabolic risk factor clustering in children and adolescents: A nationwide population-based study

Prevalence of metabolic syndrome (MetS) in children is increasing and identifying the risk factors for MetS during childhood is an important first step to prevent chronic diseases later in life. The aim of the present study was to evaluate the prevalence of MetS and cardiometabolic risk factor (CMRF) clustering among Korean children and adolescents and to validate the associated anthropometric and laboratory surrogate markers. We used data from the 2011–2014 Korean National Health and Nutrition Examination Survey. In total, data for 2,935 subjects (1539 boys, 52.6%) aged 10–19 years were assessed. MetS was defined by central obesity plus any two or more of CMRFs such as abdominal obesity, hypertension, hyperglycemia, hypertriglyceridemia, and decreased high density lipoprotein cholesterol (HDL-C) using the International Diabetes Federation criteria for children and adolescents. The presence of two or more CMRFs was classified as CMRF clustering. The prevalence of MetS and CMRF clustering in this group was found to be 1.8% and 8.9%, respectively. The receiver operating characteristic analysis of MetS and CMRF clustering, and the area under the curve (95% confidence interval) of surrogate markers revealed that the waist circumference to height ratio [0.960 (95% CI 0.959–0.960), cut-off 0.491] showed the highest predictability for MetS whereas triglyceride to HDL-C ratio [0.891 (95% CI 0.891–0.892), cut-off 2.63] showed the highest predictability for CMRF clustering. Long-term follow-up is needed for further validation.

Early Onset Obesity and Risk of Metabolic Syndrome Among Chilean Adolescents

INTRODUCTION

Obesity and metabolic syndrome (MetS) indicators have increased globally among the pediatric population. MetS indicators in the young elevate their risk of cardiovascular disease and metabolic disorders later in life. This study examined early onset obesity as a risk factor for MetS risk in adolescence.

METHODS

A cohort of Chilean participants (N = 673) followed from infancy was assessed at age 5 years and in adolescence (mean age, 16.8 y). Adiposity was measured at both time points; blood pressure and fasting blood samples were assessed in adolescence only. Early onset obesity was defined as a World Health Organization z score of 2 standard deviations (SDs) or more for body mass index (BMI) at age 5 years. We used linear regression to examine the association between early onset obesity and adolescent MetS risk z score, adjusting for covariates.

RESULTS

Eighteen percent of participants had early onset obesity, and 50% of these remained obese in adolescence. Mean MetS risk z score in adolescence was significantly higher among those with early onset obesity than among those without (1.0; SD, 0.8 vs 0.2; SD, 0.8 [P < .001]). In the multivariable model, early onset obesity independently contributed to a higher MetS risk score in adolescence (β = 0.27, P < .001), controlling for obesity status at adolescence and sex, and explained 39% of the variance in MetS risk.

CONCLUSION

Early onset obesity as young as age 5 years relates to higher MetS risk.

ANTHROPOMETRY AND CLUSTERED CARDIOMETABOLIC RISK FACTORS IN YOUNG PEOPLE: A SYSTEMATIC REVIEW

OBJECTIVE

To conduct a systematic review of the literature on the ability of anthropometric indicators to predict clustered cardiometabolic risk factors (CMRF) in children and adolescents.

DATA SOURCE

Studies published from June 1st, 2011 to May 31st, 2016 in the PubMed, SciELO and LILACS databases were analyzed. The research was based on keywords derived from the terms "anthropometric indicators" AND "cardiometabolic risk factors". Observational studies on the ability of anthropometric indicators as predictors of clustered CMRF in children and adolescents in Portuguese, English and Spanish languages were included. Studies with a specific group of obese patients or with other diseases were not included.

DATA SYNTHESIS

Of the 2,755 articles retrieved, 31 were selected for systematic review. Twenty-eight studies analyzed body mass index (BMI) as a predictor of clustered CMRF. Only 3 of the 25 cross-sectional studies found no association between anthropometric indicators and clustered CMRF. The results of six studies that compared the predictive ability of different anthropometric measures for clustered CMRF were divergent, and it was not possible to define a single indicator as the best predictor of clustered CMRF. Only six articles were cohort studies, and the findings suggested that changes in adiposity during childhood predict alterations in the clustered CMRF in adolescence.

CONCLUSIONS

BMI, waist circumference and waist-to-height ratio were predictors of clustered CMRF in childhood and adolescence and exhibited a similar predictive ability for these outcomes. These findings suggest anthropometric indicators as an interesting screening tool of clustered CMRF at early ages.

Performance of different diagnostic criteria of overweight and obesity as predictors of metabolic syndrome in adolescents

OBJECTIVE

To analyze the performance of three different diagnostic criteria of overweight and obesity (WHO, IOTF and Conde and Monteiro) using body mass index (BMI) as predictors of metabolic syndrome (MetS) in a representative sample of adolescents.

METHODS

A sample of 1035 adolescents aged 12-20 years (565 girls and 470 boys) was used in the study. BMI was calculated through the quotient of weight (kg)/height squared (m)², and MetS was defined according to the criteria of the International Diabetes Federation. Sensitivity, specificity, and overall accuracy (area under the curve) were estimated using the receiver operating characteristic (ROC) curves method and used to describe the predictive performance.

RESULTS

The three diagnostic criteria showed higher absolute values of sensitivity and specificity for predicting MetS in boys and older adolescents. The highest sensitivity to identify MetS was found using the IOTF criterion (60-85%), while specificity values ≥ 90% were found for the three criteria. The Conde and Monteiro diagnostic criterion pointed to a significantly lower overall accuracy (0.52-0.64) than that of the WHO (0.70-0.84) and IOTF (0.75-0.89) diagnostic criterion.

CONCLUSIONS

Overweight and obesity using BMI showed a moderate association with MetS, regardless of the diagnostic criteria used. However, the IOTF criterion showed better predictive capacity for the presence of MetS than the WHO and the Conde and Monteiro criteria.

Prevalence of Metabolically Healthy but Overweight/Obese Phenotype and Its Association With Sedentary Time, Physical Activity, and Fitness

PURPOSE

Childhood obesity is one of the major concerns in the last years due to the association with future health problems and all-cause mortality. However, there is a subset of adolescents with overweight/obesity who present a metabolic healthy profile. Therefore, the aim of this study was to examine the prevalence of metabolically healthy but overweight/obese adolescents and whether sedentary time, physical activity, and fitness differ between metabolically healthy and nonmetabolically healthy phenotypes.

METHODS

A subsample of 237 European adolescents from the HEalthy Lifestyle in Europe by Nutrition in Adolescence study (n = 3,528, participation rate: 61.3%) with overweight/obesity were included. The study sample was not fully representative for the European adolescent population. Based on sex- and age-specific metabolic syndrome cutoff points for triglycerides, glucose, blood pressure, and high-density cholesterol participants were classified as metabolically healthy or nonmetabolically healthy. Sedentary time, physical activity, and fitness were assessed by accelerometry and the Alpha battery, respectively.

RESULTS

The prevalence of metabolically healthy status in adolescents with overweight and obesity was higher in girls (87%) than in boys (74%, p = .019), being similar when only obesity was considered. Sedentary time was lower in metabolically healthy overweight/obese than in nonmetabolically healthy participants (mean difference = 48.0 minutes, p = .012). Moderate and moderate-to-vigorous physical activity were higher (p's < .05) in metabolically healthy than in nonmetabolically healthy adolescents with overweight/obesity (mean difference = 7.9 min/day and 10.9 min/day, respectively). No significant differences were found in fitness. Overall, these results persisted when only adolescents with obesity were included in the analyses.

CONCLUSIONS

Metabolically healthy adolescents with overweight/obesity are less sedentary and more active than their nonmetabolically healthy peers with overweight/obesity, yet consistent differences in fitness were not observed.

Complex Relationship between Obesity and the Fat Mass and Obesity Locus

In the 21st century, obesity has become a serious problem because of increasing obese patients and numerous metabolic complications. The primary reasons for this situation are environmental and genetic factors. In 2007, FTO (fat mass and obesity associated) was the first gene identified through a genome-wide association study (GWAS) associated with obesity in humans. Subsequently, a cluster of single nucleotide polymorphisms (SNPs) in the first intron of the FTO gene was discovered to be associated with BMI and body composition. Various studies have explored the mechanistic basis behind this association. Thus, emerging evidence showed that FTO plays a key role regulating adipose tissue development and functions in body size and composition. Recent prevalent research topic concentrated in the three neighboring genes of FTO: RPGRIP1L, IRX3 and IRX5, as having a functional link between obesity-associated common variants within FTO and the observed human phenotypes. The purpose of this review is to present a comprehensive picture of the impact of FTO on obesity susceptibility and to illuminate these new studies of FTO function in adipose tissue.

School and County Correlates Associated with Youth Body Mass Index

PURPOSE

The purpose of the study was to explore the utility of school- and county-level variables in explaining variability in children and adolescent body mass index (BMI).

METHODS

BMI data from nearly 2.5 million of children and adolescents were aggregated at the school level from more than 5000 schools in Texas. School-level predictors included enrollment and the percentage of students qualifying for free and reduced lunch. Seven county-level variables were obtained from the County Health Rankings website, including adult obesity, food environment index, adult physical inactivity, access to exercise, college completion, childhood poverty, and income inequality. Multilevel modeling was used to examine school- and county-level predictors that may explain the variability in group level youth BMI.

RESULTS

School-level socioeconomic status, school enrollment, and age-group were identified as significant predictors in youth BMI for both boy and girls. In girls, county-level adult obesity, food environment index, college completion, and income inequality were also significantly associated with youth BMI. In boys, the significant county-level predictors were food environment index and income inequality. Approximately 11%-16% of the variations in BMI Healthy Fitness Zone achievement were attributable to the differences between counties. The predictors included in the present study collectively explained approximately 50%-60% of between-county variation and 24%-47% of within-county variation.

CONCLUSIONS

The results of the current study advance research on the correlates that are associated with youth obesity at both school and county levels. These factors should be taken into account by policy makers and researchers interested in childhood obesity research.

ERICA: prevalence of metabolic syndrome in Brazilian adolescents

OBJECTIVE

To determine the prevalence of metabolic syndrome and its components in Brazilian adolescents.

METHODS

We evaluated 37,504 adolescents who were participants in the Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional, school-based, national study. The adolescents, aged from 12 to 17 years, lived in cities with populations greater than 100,000 inhabitants. The sample was stratified and clustered into schools and classes. The criteria set out by the International Diabetes Federation were used to define metabolic syndrome. Prevalences of metabolic syndrome were estimated according to sex, age group, school type and nutritional status.

RESULTS

Of the 37,504 adolescents who were evaluated: 50.2% were female; 54.3% were aged from 15 to 17 years, and 73.3% were from public schools. The prevalence of metabolic syndrome was 2.6% (95%CI 2.3-2.9), slightly higher in males and in those aged from 15 to 17 years in most macro-regions. The prevalence was the highest in residents from the South macro-region, in the younger female adolescents and in the older male adolescents. The prevalence was higher in public schools (2.8% [95%CI 2.4-3.2]), when compared with private schools (1.9% [95%CI 1.4-2.4]) and higher in obese adolescents when compared with nonobese ones. The most common combinations of components, referring to 3/4 of combinations, were: enlarged waist circumference (WC), low HDL-cholesterol (HDL-c) and high blood pressure; followed by enlarged WC, low HDL-c and high triglycerides; and enlarged WC, low HDL-c, high triglycerides and blood pressure. Low HDL was the second most frequent component, but the highest prevalence of metabolic syndrome (26.8%) was observed in the presence of high triglycerides.

CONCLUSIONS

ERICA is the first Brazilian nation-wide study to present the prevalence of metabolic syndrome and describe the role of its components. Despite the prevalence of Metabolic Syndrome being low, the high prevalences of some components and participation of others in the syndrome composition shows the importance of early diagnosis of this changes, even if not grouped within the metabolic syndrome.

Establishing Waist-to-Height Ratio Standards from Criterion-Referenced BMI Using ROC Curves in Low-Income Children

The purpose of this study was to establish health-related waist-to-height ratio (WHtR) cut-points associating with FITNESSGRAM's body mass index (BMI) criterion-referenced standards in low-income children. A secondary aim was to examine the classification agreement between the derived WHtR cut-points and various cardiometabolic blood markers using current recommendations. Participants were 219 children from low-income schools (mean age = 10.5 ± 0.6 years). Waist circumference, height, weight, and cardiometabolic blood markers were collected in a fasting state before school hours. Receiver operating characteristic (ROC) curves were used to determine WHtR cut-points that associated with a child meeting FITNESSGRAM's age- and sex-specific criterion-referenced standards for BMI. The derived WHtR cut-point was 0.50 (AUC = 0.89, p < 0.001; sensitivity = 0.86, specificity = 0.82, and accuracy = 84.3%). Classification agreement using the derived WHtR cut-point with various blood marker standards was statistically significant but considered weak to fair (kappa 0.14-0.34, agreement = 59%-67%, and p < 0.01). The WHtR cut-point of 0.50 can be used with strong accuracy to distinguish low-income children who met FITNESSGRAM's criterion-referenced standards for body composition; however, the evidence was weaker for its use in distinguishing low-income children meeting specific cardiometabolic blood marker recommendations.

Docosahexaenoic Acid Levels in Blood and Metabolic Syndrome in Obese Children: Is There a Link?

Prevalence of metabolic syndrome is increasing in the pediatric population. Considering the different existing criteria to define metabolic syndrome, the use of the International Diabetes Federation (IDF) criteria has been suggested in children. Docosahexaenoic acid (DHA) has been associated with beneficial effects on health. The evidence about the relationship of DHA status in blood and components of the metabolic syndrome is unclear. This review discusses the possible association between DHA content in plasma and erythrocytes and components of the metabolic syndrome included in the IDF criteria (obesity, alteration of glucose metabolism, blood lipid profile, and blood pressure) and non-alcoholic fatty liver disease in obese children. The current evidence is inconsistent and no definitive conclusion can be drawn in the pediatric population. Well-designed longitudinal and powered trials need to clarify the possible association between blood DHA status and metabolic syndrome.

The Relationship Between Physical Activity and the Metabolic Syndrome Score in Children

The relationship between physical activity levels and the metabolic syndrome (MetSyn) score was examined in 72 boys and girls (9.5 ± 1.2 years). A fasting blood draw was obtained; waist circumference and blood pressure measured, and an accelerometer was worn for 5 days. Established cut points were used to estimate time spent in moderate, vigorous, moderate-to-vigorous (MVPA), and total physical activity. A continuous MetSyn score was created from blood pressure, waist circumference, high-density-lipoprotein, triglyceride, and glucose values. Regression analysis was used to examine the relationship between physical activity levels, the MetSyn score, and its related components. Logistic regression was used to examine the association between meeting physical activity recommendations, the MetSyn score, and its related components. All analyses were controlled for body mass index group, age, sex, and race. Time spent in different physical activity levels or meeting physical activity recommendations (OR: 0.87, 95%CI: 0.69-1.09) was not related with the MetSyn score after controlling for potential confounders (p > .05). Moderate physical activity, MVPA, and meeting physical activity recommendations were related to a lower diastolic blood pressure (p < .05). No other relationships were observed (p > .05). While physical activity participation was not related with the MetSyn, lower diastolic blood pressure values were related to higher physical activity levels.

Metabolic syndrome is common and persistent in youth-onset type 2 diabetes: Results from the TODAY clinical trial

OBJECTIVE

To examine the prevalence of metabolic syndrome (MetS) in youth-onset type 2 diabetes in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study.

METHODS

Prevalence of MetS (ATP III definition) was compared at baseline (n = 679) and at 6 (n = 625) and 24 months (n = 545) using chi-square tests. Laboratory data were examined between MetS classifications at each time point using ANOVA.

RESULTS

Baseline prevalence of MetS was 75.8% and did not differ by treatment group or change over time. MetS was more common in females (83.1%) than males (62.3%; P < 0.0001) at baseline; this difference persisted over 24 months. Prevalence of MetS was similar between ethnic groups at baseline but greater in Hispanics (82.7%) vs. non-Hispanic Whites (67.5%; P = 0.0017) and non-Hispanic Blacks (72.7%; P = 0.0164) at 24 months. Although MetS was common in participants with hemoglobin A1c < 7.0% (74.4% at baseline; no significant change over 24 months), it was more common in those who did not maintain glycemic control at 6 months (80.3%; P = 0.0081). Elevated C-reactive protein, ALT, IL-6, and PAI-1 levels were more frequent with MetS.

CONCLUSIONS

Persistent high prevalence of MetS in youth-onset diabetes, even with excellent glycemic control, is of concern given the associated increased cardiovascular risk.

Cross-Validation of FITNESSGRAM® Health-Related Fitness Standards in Hungarian Youth

PURPOSE

The purpose of this study was to cross-validate FITNESSGRAM® aerobic and body composition standards in a representative sample of Hungarian youth.

METHOD

A nationally representative sample (N = 405) of Hungarian adolescents from the Hungarian National Youth Fitness Study (ages 12-18.9 years) participated in an aerobic capacity assessment via treadmill test to maximum to determine peak oxygen consumption (VO2peak) and a bioelectrical impedance assessment to estimate percent body fat (%BF). Additionally, metabolic syndrome status was assessed via finger-stick blood sample. Youth were categorized into Healthy Fitness Zone (HFZ) and Needs Improvement (NI) groups based on Fitnessgram standards. Prevalence of metabolic syndrome was calculated and logistic regression was used to estimate odds of metabolic syndrome.

RESULTS

Hungarian youth were generally fit with a low prevalence of metabolic syndrome. Approximately 69% to 77% of boys and 55% to 57% of girls were classified into the HFZ based on %BF and VO2peak. Youth in the NI health risk zones for VO2peak and %BF were 4 times to 5 and 2 times to 3 times more likely to have metabolic syndrome than children in the lower-risk groups, respectively.

CONCLUSIONS

Fitnessgram standards for aerobic capacity and body composition were associated with metabolic syndrome status, though odds ratios were larger for VO2peak than for %BF and varied by sex. Even though these standards were developed in U.S. youth, they can be applied in Hungary and still provide a criterion-referenced indication of fitness.

Establishing Normative Reference Values for Handgrip Among Hungarian Youth

PURPOSE

The purpose of this study was to examine age- and sex-related variation in handgrip strength and to determine reference values for the Hungarian population.

METHOD

A sample of 1,086 Hungary youth (aged 11-18 years old; 654 boys and 432 girls) completed a handgrip strength assessment using a handheld dynamometer. Quantile regression was used to compute separate models for boys and girls and included a linear, cubic, and quadratic term for age to account for nonlinear patterns. These terms were tested for statistical significance using the Wald statistical test with p < .05. Age- and sex-specific centiles were generated and the 50th percentile was used to describe the overall patterns in handgrip strength.

RESULTS

The linear, cubic, and quadratic terms for age fitted the data well for boys (p < .05), while both linear and quadratic terms for age were statistically significant for girls (p < .05). The 50th percentile values resulted in 21.4 kg, 21.7 kg, 25.0 kg, 30.0 kg, 35.4 kg, 40.0 kg, 42.6 kg, and 42.0 kg for boys aged 11 to 18 years old, respectively. The same percentile resulted in 20.0 kg, 19.5 kg, 19.6 kg, 20.3 kg, 21.6 kg, 23.5 kg, 26.1 kg, and 29.2 kg for girls aged 11 to 18 years old, respectively.

CONCLUSIONS

Muscle strength as determined by handgrip has distinct age-related patterns in boys and girls. We have accounted for biological age differences and developed norm-referenced values that can be used to interpret handgrip assessment scores obtained from school-aged children in Hungary.

Agreement and Diagnostic Performance of FITNESSGRAM®, International Obesity Task Force, and Hungarian National BMI Standards

PURPOSE

This study examined agreement between all 3 standards (as well as relative diagnostic associations with metabolic syndrome) using a representative sample of youth from the Hungarian National Youth Fitness Study.

METHOD

Body mass index (BMI) was assessed in a field sample of 2,352 adolescents (ages 10-18.5 years) and metabolic syndrome status was assessed in a laboratory subsample of 373 youth. All youth were categorized into weight status groups based on the FITNESSGRAM®, International Obesity Task Force (IOTF), and Hungarian growth standards. Classification agreement was compared between all pairs of standards via cross-tabulation. Logistic regression was used to estimate the odds of metabolic syndrome by weight status.

RESULTS

The 3 BMI standards agreed on ≥  88% of cases, with better agreement on girls' standards than boys' standards. Kappa values ranged from .65 to .89. Using the Hungarian standards over the Fitnessgram or IOTF standards resulted in 5% to 10% more youth being classified as normal weight. The overweight/obesity groups were 4 times to 6 times more likely to have metabolic syndrome than those classified as normal weight regardless of the classification standards. These odds ratios increased to 8 times to 17 times when comparing the normal-weight/overweight groups to the obesity category. Odds ratios for boys tended to be slightly larger than those for girls.

CONCLUSIONS

All 3 standards provide similar information about weight status and metabolic syndrome classification. To more easily facilitate international comparisons, it may be of greater benefit to use the IOTF standards, which also had better agreement with the U.S. Fitnessgram thresholds.

Cardiometabolic and Fitness Improvements in Obese Girls Who Either Gained or Lost Weight during Treatment

OBJECTIVE

To evaluate the quality of weight change (change in fat mass vs fat-free mass [FFM]), changes in cardiorespiratory fitness (CRF), and frequencies of metabolic risk factors in adolescent females with obesity who either lost or gained weight following lifestyle treatment.

STUDY DESIGN

Fifty-eight girls (mean age = 13.0 ± 1.6 years; 77% black; mean body mass index = 36.5 ± 4.5 kg/m(2)) completed a 6-month lifestyle intervention combining dietary and behavioral counseling with aerobic and resistance exercise training. We examined baseline to 6-month differences in weight (kg), body composition, CRF, and frequencies of metabolic risk factors between weight loss and weight gain groups.

RESULTS

In the weight loss group, body weight (-4.50 ± 3.53 kg, P < .001), fat mass (-4.50 ± 2.20 kg, P < .001), and body fat percentage (-2.97% ± 1.45%, P < .001) decreased, and FFM was unchanged at 6 months. In the weight gain group, body weight (4.50 ± 2.20 kg, P < .001), fat mass (1.52 ± 3.16 kg, P < .024), and FFM (2.99 ± 2.45 kg, P < .001) increased, and body fat percentage was unchanged. Both groups improved CRF (P < .05). Frequencies of metabolic risk factors were reduced across all participants after the 6-month treatment.

CONCLUSIONS

Participation in a weight management program might elicit health improvements in obese adolescent females who increase weight and fat mass, provided that FFM gains are sufficient to negate increases in body fat percentage.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT00167830.

Top 10 research questions related to musculoskeletal physical fitness testing in children and adolescents

The purpose of this article is to bring attention to the 10 most pressing questions relevant to musculoskeletal physical fitness testing in children and adolescents. The goal is to stimulate research to answer these questions. The most pressing needs include establishing definitive links between valid, reliable, and feasible field test measures of muscular strength, endurance, power, and flexibility and health risk factors/markers in children and adolescents; determining the effects of exercise training on these relationships; and documenting the tracking of these relationships. The role of flexibility in health-related physical fitness (HRPF) needs to be carefully and specifically examined. Although body weight/composition is a separate component of health-related fitness, it is also a factor that can influence the performance of musculoskeletal test items. The role of body weight, body fat, and central adiposity and the possibility of adjustment of tests results are important research questions. Several questions relate to which field tests are best for use in schools. Finally, actual health-related criterion-referenced cutoff values need to be developed. In conclusion, more quality research is needed to firmly establish the musculoskeletal area for HRPF in youth.