Clustering of Metabolic Risk Components and Associated Lifestyle Factors: A Nationwide Adolescent Study in Taiwan

Hyperlipidemia in Children and Adolescents

While coronary artery disease (CAD) is thought to be a disease of adulthood, atherosclerosis can originate in childhood and adolescence. There is a paucity of randomized controlled treatment trials regarding dyslipidemia among the younger population. However, it is apparent that childhood dyslipidemia is associated with an earlier onset of CAD. Most recent guidelines by the American College of Cardiology (ACC) and American Heart Association (AHA) focus on lifestyle modification and lifetime risk of atherosclerotic disease, as well as adequate screening measures. Genetic factors, environmental contributors such as pollution, obesity linked to poor nutrition, and sedentary lifestyles are shown to be associated with increased lipid levels and early CAD among children and adolescents. Familial hyperlipidemia is one of the most prevalent genetic diseases and can affect 1 in 250 individuals. A multimodal treatment plan is most effective for children and adolescents with dyslipidemia including lifestyle changes (a modified diet and moderate physical activity) and pharmacologic intervention. The mainstay of pharmacologic treatment for childhood dyslipidemia is similar to that of adults. Statins are the most widely used medications. Newer medications have proven integral in treatment for genetic dyslipidemias including evolocumab and evinacumab.

Association of the consumption of common drinks with early puberty in both sexes

Background

We examined the effect of sugar-sweetened beverages (SSB) and common drink intake on pubertal development in both sexes.

Methods

Data were retrieved from Taiwan Children Health Study, which involved detailed pubertal stage assessments of 2,819 schoolchildren aged 11 years in 2011-2012. Drawings of secondary sexual characteristics and self-reported age at menarche or voice breaking were used to assess pubertal stages. Dietary intake was assessed using a detailed semi-quantitative food frequency questionnaire. Generalized estimating equation modeling was applied to obtain odds ratios (ORs) and 95% confidence intervals (CIs) to represent the effects of each drink on early pubertal development outcomes.

Results

In boys, an one cup/day increment of a SSB was associated with earlier voice breaking (β = -0.12; 95% CI = -0.20, -0.04), whereas consuming yogurt (≥2 cups/day) was a protective factor against early puberty (OR = 0.78; 95% CI = 0.73, 0.83). In girls, SSB consumption was associated with increased risk of early puberty in a dose-response manner, and a similar protective effect of yogurt consumption and fermented probiotic drink (≥2 cups/day) against early puberty was observed (OR = 0.96; 95% CI = 0.94, 0.99). Furthermore, the intake of both total sugar and added sugar within SSBs increased risk of early puberty in girls but not in boys.

Conclusions

Sugar-sweetened beverages were associated with early puberty, and probiotic drinks appeared to mitigate this link. These findings indicate that the gut-brain axis could play a crucial role in sexual maturation.

Metabolic Syndrome Prevalence among High School First-Year Students: A Cross-Sectional Study in Taiwan

Different types of high schools in Taiwan have the same physical education curriculum. In this cross-sectional study, we investigated the difference in the prevalence of metabolic syndrome between senior and vocational high school students. We retrospectively collected health check-up data from 81,076 first-year senior and 68,863 vocational high school students in Taipei City from 2011 to 2014, including their blood pressure, height, weight, waist circumference, fasting blood glucose, total cholesterol, triglyceride, and HDL-c levels. The prevalence of metabolic syndrome was determined using definitions from the Taiwan Pediatric Association (TPA), International Diabetes Federation (IDF), and de Ferranti et al. The prevalence of metabolic syndrome was 1.73% (senior and vocational high school students: 1.22% and 2.33%, respectively) using TPA criteria, 1.02% (0.69% and 1.40%, respectively) using IDF criteria, and 5.11% (3.92% and 6.51%, respectively) using de Ferranti et al. criteria. The most prevalent risk factors overall were increased blood pressure and central obesity. Given the significantly higher prevalence of metabolic syndrome in vocational school students regardless of the criteria, and that metabolic syndrome causes future adult health risks, the physical education curriculum and health education program in vocational schools should be strengthened to decrease the risk and prevalence of metabolic syndrome.

Sex differences in the association between sugar-sweetened beverages consumption and metabolic risks among the working-age population in Taiwan

OBJECTIVE

Sugar-sweetened beverages (SSBs) are linked to increased metabolic risk. However, the sex differences in the relationship between SSB intake and adverse health effects remain unclear. Therefore, the present study examined the association between SSB consumption and metabolic risks among working-age males and females from Taiwanese communities.

DESIGN

A community-based study utilized data from a comprehensive health screening project conducted by the Public Health Bureau in Changhua County, Taiwan. Metabolic risks included waist circumference, systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL), and fasting glucose level using serum tests.

SETTING

Participants were recruited in Changhua County, Taiwan.

PARTICIPANTS

Between 2005 and 2014, 92,724 citizens participated in the health screening; our data analysis included 75,278 respondents between 30 and 64.

RESULTS

The results showed that the frequency of SSB consumption was associated with abnormal waist circumference and elevated total cholesterol, triglycerides, LDL, and glucose in both men and women. Increased SSB consumption frequency was associated with elevated glucose and hypertension in women. Even a slight increase in SSB intake frequency was related to raising the metabolic risks. Similar patterns were evident when models included body mass index (BMI); however, the associations were attenuated. In the BMI-stratified subgroup analysis, the relationship between SSB consumption and metabolic risks was more pronounced in participants without obesity.

CONCLUSION

The present study suggests that SSB consumption carries metabolic risk among working-age Taiwanese, particularly women and those without obesity. Health promotion programs should raise awareness of the health hazards associated with SSBs.

Multilevel Understanding of the Impact of Individual- and School-Level Determinants on Lipid Profiles in Adolescents: The Cross-Level Interaction of Food Environment and Body Mass Index

Adolescents with comparable personal risk factors may have different lipid profiles because of the school’s context. Lipid determinants in adolescents should be considered using a multilevel perspective. This multilevel study investigated the effects of individual-level and school-level factors on lipid profiles in adolescents and evaluated the cross-level influence of lipid determinants. A representative adolescent cohort (n = 2727) was randomly selected from 36 schools in three diverse economic areas in Taiwan and assessed for their personal dietary patterns, physical parameters, and lipid profiles. For individual-level factors, both low physical activity and high body mass index (BMI) were associated with elevated triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and total cholesterol (TC) levels, and a sugar-sweetened beverage intake of >500 mL/day was associated with increases of 5.97 and 6.12 mg/dL in LDL-C and TC levels, respectively, compared with abstinence. Regarding school-level factors, students in schools with ≥2 health promotion programs per year had a 5.27 mg/dL lower level of LDL-C than those in schools with 0−1 program, and students in schools with ≥46 food outlets within 600 m of the school had 6.90 and 13.3 mg/dL higher levels of TG and TC, respectively, than those in schools with <46 food outlets. School context modified the individual-level positive correlation between BMI and TG level (the p-value for the random-slope effect was 0.003). In conclusion, individual-level and school-level factors exert a multilevel effect on adolescent lipid profiles. The food environment near the school has a stronger cross-level impact on individual TG levels in adolescents with a high BMI than in those with a normal BMI.

Stability and Transformation of Metabolic Syndrome in Adolescents: A Prospective Assessment in Relation to the Change of Cardiometabolic Risk Factors

Underlying pathophysiological mechanisms drive excessive clustering of cardiometabolic risk factors, causing metabolic syndrome (MetS). MetS status may transform as adolescents transition to young adulthood. This study investigated the latent clustering structure and its stability for MetS during adolescence, and assessed the anthropometric and clinical metabolic determinants for MetS transformation. A community-based representative adolescent cohort (n = 1516) was evaluated for MetS using four diagnostic criteria, and was followed for 2.2 years to identify new-onset MetS. The clustering structure underlying cardiometabolic parameters was stable across adolescence; both comprised a fat—blood pressure (BP)—glucose three-factor structure (total variance explained: 68.8% and 69.7% at baseline and follow-up, respectively). Among adolescents with MetS-negative at baseline, 3.2–4.4% had incident MetS after 2.2 years. Among adolescents with MetS-positive at baseline, 52.0–61.9% experienced MetS remission, and 38.1–48.0% experienced MetS persistence. Increased systolic BP (SBP) was associated with a high MetS incidence risk, while decreased levels of SBP and glucose were associated with MetS remission. Compared with adolescents with a normal metabolic status at baseline, those with an initial abdominal obesity and increased triglycerides level had a 15.0- and 5.7-fold greater risk for persistent abnormality, respectively. Abdominal obesity and low high-density lipoprotein cholesterol are two abnormal MetS components that highly persist during adolescence, and are the intervention targets for reducing the future risk of cardiometabolic disorders.

Lifestyle school-based intervention to increase the proportion of adolescents free of components of the metabolic syndrome in an andean region of Peru

OBJECTIVE.

To estimate the impact of a school-based nutritional and healthy lifestyle intervention to increase the proportions of adolescents free of components of the metabolic syndrome.

MATERIALS AND METHODS.

We conducted a pre-experimental study in a representative sample of adolescents from two schools in a high Andean district of Peru (Cajamarca city); 388 students completed the intervention and the baseline and post-intervention measurement. The intervention had nine thematic modules; each module was developed in an educational session of 45 minutes every two weeks. We used the National Cholesterol Education Program Expert Panel and Adult Treatment Panel III criteria for metabolic syndrome. We used paired proportions comparison (McNemar test) to determine the impact of the intervention.

RESULTS.

At baseline, 20.4% (95% CI: 16.2 to 24.5) students had no metabolic syndrome components, post-intervention this proportion increased to 32,5% (95% CI: 27.7 to 37.3), the difference in proportions was 12.1% (95% CI: 7.5 to 16.8; p<0.001). The prevalence of metabolic syndrome was 4.6% (95% CI: 2.4 to 6.9) at baseline, while post-intervention was 2.3% (95%CI: 0.7 to 3.9). During the analysis of components, the greatest reduction was observed in the proportion of hypertriglyceridemia (difference in proportions: 21.9%, 95%CI: 16.9 to 26.9, p <0.001); we also found a significant reduction in arterial hypertension (difference in proportions: 3.1%, 95% CI: 0.6 to 5.6, p=0.025). In the other components, there were no significant differences.

CONCLUSIONS.

The school-based intervention increased in 59.3% the proportion of students free of any component of the metabolic syndrome.

Metabolic syndrome in Thai adolescents and associated factors: the Thai National Health Examination Survey V (NHES V)

Background

Presence of metabolic syndrome (MetS) in early life may influence cardiovascular outcome later in adulthood. There is limited data regarding MetS among Thai adolescents. This study aimed to estimate the prevalence of MetS and related factors in Thai adolescents.

Methods

Data on MetS components of 1934 Thai adolescents aged 10–16 years were obtained from the 5th National Health Examination Survey. Age at first screen time exposure, duration of screen time, frequency of food intake and physical activities were collected from interviews. MetS was defined according to 3 definitions: International Diabetes Federation (IDF), Cook’s, and de Ferranti’s.

Results

The prevalence of MetS was 4.1% by IDF, 8.0% by Cook’s, and 16.8% by de Ferranti’s definition. The overall prevalence was higher in male (19.0%) than female adolescents (15.3%). The most common MetS components composition among Thai adolescents was high waist circumference with high serum triglyceride and low HDL-cholesterol (40.0% for IDF, 22.6% for Cook’s and 43.5% for de Ferranti’s definition). Exposure to screen media during the first 2 years of life had a 1.3- fold increased odds of MetS by 1 out of 3 definitions (OR 1.30, 95% CI. 1.01–1.68). Duration of physical activity associated with decreased odds of MetS by Cook’s definition (OR 0.96, 95% CI. 0.92–0.99).

Conclusions

The prevalence of MetS among Thai adolescents was higher than previously reported by other studies. Screen media exposure during the first 2 years of life should be discouraged and measures to promote physical activity among children and adolescents should be strengthen.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10728-6.

Contribution of insulin resistance to the relationship between sugar-sweetened beverage intake and a constellation of cardiometabolic abnormalities in adolescents

BACKGROUND

Insulin resistance (IR) is a pathophysiological construct that derives a series of metabolic disturbances that promote cardiometabolic dysfunction. This study evaluated mediating and modifying effects of homeostatic model assessment-based IR (HOMA-IR) on the association between sugar-sweetened beverage (SSB) consumption and a constellation of adolescent cardiometabolic abnormalities.

METHODS

Comprehensive data on sociodemographics, diet, physical activity, and anthropometric and biochemical parameters for 1454 adolescents were obtained from a large-scale representative study for adolescent metabolic syndrome (MetS) conducted in Taiwan. The original (HOMA1-IR) and updated nonlinear (HOMA2-IR) HOMA-IR indicators were used as IR biomarkers. Principal component (PC) analysis was employed to create reduced groups of variables and risk scores for retained PCs.

RESULTS

Higher SSB intake was associated with higher levels of HOMA1-IR and HOMA2-IR, and the two IR biomarkers were positively correlated with metabolic dysfunction clustering. Compared with SSB nondrinkers, adolescents who consumed >500 mL/day of hand-shaken high-fructose corn syrup beverages (HHB) had a 0.22 increase in the number of abnormal MetS components, and HOMA-IR mediation explained 33.9-37.9% of the effect. IR biomarkers accounted for 26.5-31.0% of the relationship between >500 mL/day of SSB consumption and bodyweight-enhanced PC scores. The effects of HOMA-IR indicators on all bodyweight-related factors were consistently intensified among >350 mL/day HHB drinkers (all P_interaction < 0.05).

CONCLUSIONS

Fructose-rich SSB intake correlates with a constellation of cardiometabolic abnormalities in adolescents, and this association may be partly mediated by HOMA-IR levels. The adverse effects of HOMA-IR on bodyweight-associated cardiometabolic risk factors depend on the type of SSB consumption, with enhanced risks observed in the intake of high amounts of HFCS-containing SSBs.

Dose-response association between sugar- and artificially sweetened beverage consumption and the risk of metabolic syndrome: a meta-analysis of population-based epidemiological studies

OBJECTIVE

The associations between sugar-sweetened beverage (SSB) and artificially sweetened beverage (ASB) consumption and the risk of metabolic syndrome (MetS) remain controversial. A quantitative assessment of dose-response associations has not been reported. This study aims to assess the associations between the risk of MetS and SSB, ASB, and total sweetened beverage (TSB, the combination of SSB and ASB) consumption by reviewing population-based epidemiological studies.

DESIGN

Meta-analysis.

SETTING

We searched PubMed, Embase and Web of Science databases prior to 4 November 2019, for relevant studies investigating the SSB-MetS and ASB-MetS associations. A random effects model was used to estimate pooled relative risks (RR) and 95 % CI. Dose-response association was assessed using a restricted cubic splines model.

PARTICIPANTS

We identified seventeen articles (twenty-four studies, including 93 095 participants and 20 749 MetS patients).

RESULTS

The pooled RR for the risk of MetS were 1·51 (95 % CI 1·34, 1·69), 1·56 (1·32, 1·83) and 1·44 (1·19, 1·75) in high consumption group of TSB, SSB and ASB, respectively; and 1·20 (1·13, 1·28), 1·19 (1·11, 1·28) and 1·31 (1·05, 1·65) per 250 ml/d increase in TSB, SSB and ASB consumption, respectively. Additionally, we found evidence of non-linear, TSB-MetS and SSB-MetS dose-response associations and a linear ASB-MetS dose-response association.

CONCLUSIONS

TSB, SSB and ASB consumption was associated with the risk of MetS. The present findings provide evidence that supports reducing intake of these beverages to lower the TSB-, SSB- and ASB-related risk of MetS.

Characteristic-Grouped Adiposity Indicators for Identifying Metabolic Syndrome in Adolescents: Develop and Valid Risk Screening Tools Using Dual Population

A simple, robust, and characterized adiposity indicator may be appropriate to be used as a risk screening tool for identifying metabolic syndrome (MetS) in adolescents. This study used dual adolescent populations to develop and validate efficient adiposity indicators from 12 characterized candidates for identifying MetS that may occur during the transition from adolescence to young adulthood. Data from the adolescent Nutrition and Health Survey in Taiwan (n = 1920, 12–18 years) and the multilevel Risk Profiles for adolescent MetS study (n = 2727, 12–16 years) were respectively used as training and validation datasets. The diagnostic criteria defined by the International Diabetes Federation for adolescents (IDF-adoMetS) and the Joint Interim Statement for adults (JIS-AdMetS) were employed to evaluate MetS. In the training dataset, principal component analysis converted 12 interrelated obesity indices into bodyfat-, lipid-, and body-shape-enhanced groups, with the first two characteristic-groups having a higher discriminatory capability in identifying IDF-adoMetS and JIS-AdMetS. In the validation dataset, abdominal volume index (AVI) among girls and waist circumference (WC) among boys were respectively validated to have a higher Youden’s index (0.740–0.816 and 0.798–0.884) in identifying the two MetS. Every 7.4 and 4.3 positive tests of AVI (cutoff = 13.96) had an accurate IDF-adoMetS and JIS-AdMetS, respectively, and every 32.4 total tests of WC (cutoff = 90.5 cm) had a correct identification for the two MetS. This study stresses the discriminatory capability of bodyfat- and lipid-enhanced adiposity indicators for identifying MetS. AVI and WC were, respectively, supported as a risk screening tool for identifying female and male MetS as adolescents transition to adulthood.

Immigrant⁻Native Differences in Sugar-Sweetened Beverage and Snack Consumption and Preventive Behaviors Associated with Severe Early Childhood Caries: A Large-Scale Survey in Taiwan

This study assessed the differences between immigrants and natives in terms of combined effects of sugar-sweetened beverage (SSB) or snack consumption and preventive behaviors for severe early childhood caries (SECC) through a large-scale survey of 31,565 native and 1046 immigrant child–parent pairs in Taiwan. Children aged 3–5 years underwent dental examinations, and parents completed structured questionnaires. Immigrants had a significantly higher SECC prevalence than native children (32.3% vs. 19.4%). A combined effect of SECC was observed in native children who did not receive assistance when brushing teeth at night before sleep and those who consumed SSBs more than four times weekly (adjusted odds ratio (aOR) = 4.8). Moreover, native children who did not use dental floss and who consumed snacks more than four times weekly had an aOR of 4.1 for SECC. The combined effects of children with immigrant parents who did not receive assistance when brushing their teeth at night before sleep and those who consumed snacks more than four times weekly had an aOR of 8.2 for SECC. The results suggest the necessity of cross-cultural caries prevention programs for immigrants. Parents must limit children’s SSB and snack intake, and implement preventive measures to reduce SECC development.