Association Between Vitamin D Deficiency and Cardiometabolic Risk Clustering Among Rural Community-Dwelling Older Adults: A Cross-Sectional Study.

This study investigated whether serum 25-hydroxyvitamin D (25(OH)D) modifies the association between meeting WHO aerobic physical activity guidelines and cardiometabolic risk clustering among rural older adults in South Korea. This cross-sectional study analyzed 2023 Korea National Health and Nutrition Examination Survey (KNHANES) data for rural-dwelling adults aged ≥65 years with complete data (n = 441). Cardiometabolic risk clustering (CMRC) was defined as the presence of ≥3 of five risk factors (abdominal obesity, elevated blood pressure, low HDL-cholesterol, elevated triglycerides, and hyperglycemia). Exposures were continuous serum 25-hydroxyvitamin D (25(OH)D) and adherence to the WHO aerobic physical activity guidelines (yes/no). Multivariable logistic regression models tested the 25(OH)D × physical activity interaction, adjusting for sex, age (≥75 vs. <75 years), education, household income, smoking status, alcohol use, and obesity (BMI ≥ 25 kg/m2). Conditional effects of physical activity were estimated at the 16th, 50th, and 84th percentiles of 25(OH)D. A significant interaction between 25(OH)D and physical activity was observed (OR = 0.91, 95% CI: 0.85-0.97; p = 0.005). Physical activity was not associated with CMRC at low 25(OH)D (16th percentile, 17.08 ng/mL; OR = 1.64, 95% CI: 0.78-3.47), but it was associated with lower odds of CMRC at high 25(OH)D (84th percentile, 36.98 ng/mL; OR = 0.25, 95% CI: 0.10-0.62). Vitamin D status modified the association between aerobic physical activity and cardiometabolic risk clustering among rural older adults. Integrated prevention strategies addressing both physical activity and vitamin D insufficiency may be valuable in rural aging populations.

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.

Backround: Hepatic steatosis and hepatic fibrosis are systemic conditions that increase cardiometabolic risk. However, nationally representative data evaluating these associations are limited. Research Question: Among adults in the United States, does the presence of hepatic steatosis, and within steatosis, the presence of hepatic fibrosis, increase the likelihood of having metabolic syndrome and higher levels of insulin resistance? Methods: We analyzed data from 9,086 adults aged ≥20 years from the 2017–2023 National Health and Nutrition Examination Survey. Hepatic steatosis was defined by a controlled attenuation parameter ≥290 dB/m (corresponding to S3 steatosis), and significant hepatic fibrosis by liver stiffness measurement ≥8.0 kPa (corresponding to F2 fibrosis). Modified metabolic syndrome was defined as meeting ≥3 of 5 criteria: central obesity, hypertension, dysglycemia, low high-density lipoprotein cholesterol, and elevated non-high-density lipoprotein cholesterol. Insulin resistance was assessed using the homeostasis model assessment. Analyses applied appropriate complex survey weights. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression. Group differences in insulin resistance were tested with weighted t-tests. Results: After adjusting for age and sex, hepatic steatosis was associated with a fivefold increase in odds of modified metabolic syndrome (OR 4.97; 95% CI, 4.44–5.57). The strongest contributing components were central obesity (OR 10.19; 95% CI, 8.57–12.11) and dysglycemia (OR 2.93; 95% CI, 2.63–3.25). Among individuals with hepatic steatosis, those with hepatic fibrosis had 76% higher odds of metabolic syndrome (OR 1.76; 95% CI, 1.35–2.28). Mean insulin resistance was significantly higher in those with hepatic steatosis compared to those without (6.57 ± 11.57 vs 2.90 ± 6.97; p &lt; 0.001), and was further elevated in those with hepatic fibrosis (10.53 ± 19.30 vs 5.55 ± 8.23; p &lt; 0.001). Conclusion: In a nationally representative sample of U.S. adults, hepatic steatosis was strongly associated with clustering of cardiometabolic risk factors and elevated insulin resistance. Hepatic fibrosis further intensified these associations. These findings support early metabolic screening and intensive risk-factor management in individuals with hepatic steatosis, particularly those with hepatic fibrosis.

Background/Objectives: Cardiometabolic risk clustering (CMRC), the coexistence of multiple risk factors, markedly increases the risk of cardiovascular disease and diabetes. While obesity is central, the independent roles of vitamin D status and systemic inflammation remain unclear. This study examined determinants of CMRC in middle-aged Korean adults, focusing on vitamin D and C-reactive protein (CRP). Methods: Cross-sectional data were analyzed from 2062 adults aged 40–64 years in the 2023 Korea National Health and Nutrition Examination Survey. CMRC was defined as ≥3 of abdominal obesity, hypertension, diabetes, hypertriglyceridemia, and low high-density lipoprotein cholesterol. Serum 25-hydroxyvitamin D [25(OH)D], CRP, lifestyle behaviors, and covariates were assessed. Complex-sample logistic regression identified factors associated with CMRC. Results: CMRC prevalence was 16.5%. Older age (OR = 1.04, 95% CI: 1.02–1.06), current smoking (OR = 1.76, 95% CI: 1.26–2.45), elevated CRP (1–3 mg/L: OR = 1.40, 95% CI: 1.04–1.87; ≥3 mg/L: OR = 1.63, 95% CI: 1.00–2.66), and obesity (OR = 8.29, 95% CI: 6.12–11.21) increased CMRC risk. Protective factors included male sex (OR = 0.60, 95% CI: 0.45–0.81), sufficient vitamin D (≥20 ng/mL: OR = 0.76, 95% CI: 0.58–0.99), and meeting World Health Organization physical activity guidelines (OR = 0.71, 95% CI: 0.55–0.92). Conclusions: These survey-weighted associations may help identify at-risk mid-life adults at the population level and motivate longitudinal evaluation of vitamin D deficiency and inflammation in risk assessment and targeted prevention.

The study findings investigated uric acid reference values and their association with a cluster of cardiometabolic risk factors among adolescents using the Korea National Health and Nutrition Examination Survey (KNHANES). A retrospective cross-sectional study was conducted using the KNHANES database from 2016 to 2018, involving a total of 2,462 participants aged between 10 and 18 years. Based on age- and sex-specific percentile curves for serum uric acid (SUA) levels from the KNHANES, we examined the correlation between cardiometabolic risk factors and serum uric acid levels. The percentile values of SUA varied with sex and age. In male subjects, SUA levels tended to increase from 10 to 14 years of age and plateaued after 14 years of age. Moreover, the overall uric acid level in females was found to be lower than that in males; the levels tended to increase at approximately 10 to 12 years old but were relatively consistent according to age. Mean uric acid levels increased according to obesity status in both males and females. However, correlation analysis revealed that SUA levels were associated with several metabolic risks even after adjusting for obesity. The detailed metabolic syndrome (MetS) components that were observed to be associated with an increase in uric acid levels were different between males and females, but overall, high uric acid levels increased MetS risk. Additionally, a significant increase in MetS-related odds ratio (OR) for components, including waist circumference (WC), triglyceride (TG) levels, and low high-density lipoprotein cholesterol (HDL-c), was observed. However, differences between sexes were apparent, with a more pronounced increase in OR based on SUA levels in girls. SUA levels were closely associated with MetS and its components, even in nonobese subjects. Therefore, high SUA levels in children and young adolescents should be closely monitored to prevent MetS.

Background: This retrospective cohort study aimed to examine the interaction effect between puberty stage and weight status on individual and clustering of cardiometabolic risk factors (CMRFs) among Mexican American children and adolescents. A total of 333 children and adolescents (aged 8-18 years) enrolled in the Cameron County Hispanic Cohort (CCHC) from 2014 to 2020 were included in the study. Methods: CCHC is a longitudinal, randomly recruited cohort based on the United States Census tracts/blocks of Mexican Americans living on the Texas-Mexico border. Individual CMRFs, including high blood pressure, central obesity, hypertriglyceridemia, low high-density lipoprotein cholesterol, and insulin resistance (IR) were assessed. Clustering of CMRFs is defined as the presence of three or more individual CMRFs. Puberty stages were assessed using the Tanner criteria. Multivariable logistic regressions were conducted to assess the association of puberty, weight status, and the interaction of the two main exposures with individual and clustering of CMRFs. Results: We observed that weight status had a dominant effect on all CMRF measures. The effect was especially prominent on central obesity and clustering of CMRFs. There were 95.4% of children with central obesity and 98.4% of those with clustering of CMRF were either overweight or obese. Entering puberty was associated with an increased risk of having IR [Tanner stage 2 vs. 1: odds ratio (OR) = 3.25, 95% confidence interval (95% CI) 1.28-8.27; Tanner stage 3 vs. 1: OR = 3.50, 95% CI 1.45-8.46] and hypertriglyceridemia (Tanner stage 2 vs. 1: OR = 2.67, 95% CI 1.11-6.45). However, the effects were not observed among those reaching the end of puberty (Tanner stage 4 and 5). Conclusions: A significant interaction effect between weight status and puberty was not detected on any individual CMRF and in the clustering of CMRFs. Other factors positively associated with individual CMRFs, especially IR, were being female and having a family history of diabetes.

Clustering of cardiometabolic risk factors and risk of elevated HbA1c in non-Hispanic White, non-Hispanic Black and Mexican-American adults with type 2 diabetes

Vitamin D insufficiency is known to be related to cardiometabolic disorders; however, the associations among serum 25-hydroxyvitamin D (25(OH)D) concentration and metabolic syndrome and cardiometabolic risk factors in children and adolescents have not yet been clearly delineated. For this reason, we investigated the relationship among serum 25(OH)D concentration and metabolic syndrome and cardiometabolic risk factors among Korean adolescents. We performed a cross-sectional analysis and used hierarchical multivariate logistic regression analysis models to adjust for confounding variables. We used the data gathered during the 2008-2009 Korea National Health and Nutrition Examination Survey (KNHANES). Our subjects included 1504 Korean adolescents aged 12-18 years who participated in the KNHANES. Vitamin D insufficiency, defined as 25(OH)D concentration <50 nmol/l, was found in 75·3% of Korean adolescents and was associated with an increased risk of the prevalence of metabolic syndrome. Waist circumference and BMI were the most closely correlated cardiometabolic components of metabolic syndrome according to serum 25(OH)D status, but no significant relationship was found between serum 25(OH)D concentration and insulin resistance or for the risks for high blood pressure, hyperglycaemia, reduced HDL-cholesterol or hypertriacylglycerolaemia, with or without adjustment for confounding variables. Low serum 25(OH)D concentration appears to be associated with several cardiometabolic risk factors and an increased risk of the prevalence of metabolic syndrome in Korean adolescents.

It is unclear whether cardiorespiratory fitness (CRF) is independently linked to cardiometabolic risk in children. This study investigated a) the association between CRF level and presence of cardiometabolic risk disorders using health-related cut points, and b) whether these associations were mediated by abdominal adiposity in children. This was a cross-sectional design study. Anthropometry, biochemical parameters and CRF were assessed in 147 schoolchildren (75 girls) aged 10 to 14 years. CRF was determined using a maximal cycle ergometer test. Children were classified as 'fit' or 'unfit' according to published thresholds. Logistic regression was used to investigate the odds of having individual and clustered cardiometabolic risk factors according to CRF level and whether abdominal adiposity mediated these associations. Children classified as unfit had increased odds of presenting individual and clustered cardiometabolic risk factors (P < .05), but these associations no longer remained after adjusting for abdominal adiposity (P > .05). This study suggests that the association between CRF and cardiometabolic risk is mediated by abdominal adiposity in 10- to 14-year-old children and that abdominal adiposity may be a more important determinant of adverse cardiometabolic health in this age group.

Correlation Between Serum 25-Hydroxyvitamin D Levels and Allergic Rhinitis in Children and Adolescents in Korea

Trends and Clustering of Cardiometabolic Risk Factors in American Adolescents From 1999 to 2008

Moderate-to-vigorous physical activity, but not sedentary time, predicts changes in cardiometabolic risk factors in 10-y-old children: the Active Smarter Kids Study ,

Background: Cross-sectional data have suggested an inverse relation between physical activity and cardiometabolic risk factors that is independent of sedentary time. However, little is known about which subcomponent of physical activity may predict cardiometabolic risk factors in youths. Objective: We examined the independent prospective associations between objectively measured sedentary time and subcomponents of physical activity with individual and clustered cardiometabolic risk factors in healthy children aged 10 y. Design: We included 700 children (49.1% males; 50.9% females) in which sedentary time and physical activity were measured with the use of accelerometry. Systolic blood pressure, waist circumference (WC), and fasting blood sample (total cholesterol, high-density lipoprotein cholesterol, triglycerides, glucose, fasting insulin) were measured with the use of standard clinical methods and analyzed individually and as a clustered cardiometabolic risk score standardized by age and sex (z score). Exposure and outcome variables were measured at baseline and at follow-up 7 mo later. Results: Sedentary time was not associated with any of the individual cardiometabolic risk factors or clustered cardiometabolic risk in prospective analyses. Moderate physical activity at baseline predicted lower concentrations of triglycerides (P = 0.021) and homeostatic model assessment for insulin resistance (P = 0.027) at follow-up independent of sex, socioeconomic status, Tanner stage, monitor wear time, or WC. Moderate-to-vigorous physical activity (P = 0.043) and vigorous physical activity (P = 0.028) predicted clustered cardiometabolic risk at follow-up, but these associations were attenuated after adjusting for WC. Conclusions: Physical activity, but not sedentary time, is prospectively associated with cardiometabolic risk in healthy children. Public health strategies aimed at improving children’s cardiometabolic profile should strive for increasing physical activity of at least moderate intensity rather than reducing sedentary time. This trial was registered at clinicaltrials.gov as NCT02132494.

Premetabolic syndrome and clustering of cardiometabolic risk factors in White, Black and Mexican American adults

The present study aimed to verify the clustering of cardiometabolic risk factors for cardiovascular diseases (CVD) and its relationship with the continuous cardiometabolic risk score (cMetS). Cross-sectional study with 631 children aged 6 to 9years. Cardiorespiratory fitness, glucose, systolic blood pressure, total cholesterol/high-density lipoprotein cholesterol ratio, triglycerides, and waist circumference were assessed. The number of children in whom the risk factors were not independently distributed was analyzed. Z-scores were computed for each risk factor to calculate the cMetS. There was a high proportion of children with clustering of risk factors for CVD. The clustering of risk factors was apparent in 11.3% of the children for four or more risk factors, and 21.9% had three or more risk factors. The cMetS showed a linear relationship with the increase in the number of risk factors. A cMetS value higher than 0.91 indicated clustering of cardiometabolic risk factors amongst children. The use of clustering of cardiometabolic risk factors identified a high proportion of children with the presence of relevant cardiometabolic alterations. A cMetS value higher than 0.91 (relative to an international standard) indicated higher clustering of cardiometabolic risk factors amongst children. The online version contains supplementary material available at 10.1007/s40200-021-00845-9.