Cardiometabolic risk factor levels in Norwegian children compared to international reference values: The ASK study.

Mette Stavnsbo,Lars B Andersen,Katrine N Aadland,Mai Chinapaw,Eivind Aadland,Turid Skrede,Geir K Resaland,Sigmund A Anderssen,Louise H Naylor

doi:10.1371/journal.pone.0220239

Abstract

ObjectiveTo investigate cardiometabolic risk factor levels in a group of Norwegian 10-year-old children compared to international values and examine the association between cardiorespiratory fitness (CRF) and the reference-standardized clustered risk score.Methods913 children (49% girls) were included from the Active Smarter Kids (ASK) study. Body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC) to HDL-C ratio, triglyceride (TG), glucose, insulin, homeostatic model assessment (HOMA) score and CRF, were standardized according to international age-and sex-specific reference values.ResultsThe Norwegian children had significantly more favorable WC, DBP, glucose, HDL-C and CRF levels compared to the international reference values, but similar or less favorable levels of other cardiometabolic risk factors. CRF was the variable that differed the most from the international values (mean (95% CI) 1.20 (1.16 to 1.24) SD). The clustered risk score (excluding CRF) was higher in the Norwegian children, but decreased to below international levels when including CRF (mean (95% CI) - 0.08 (- 0.12 to –0.05) SD). CRF had a significant inverse association with the clustered risk score (excluding CRF) (β - 0.37 SD, 95% CI –0.43 to –0.31).ConclusionsNorwegian children have substantially higher CRF levels than international standards, and including CRF in clustered risk scores reduces overall risk in Norwegian children below that of international levels. CRF is associated with improved cardiometabolic health in children.

Highlights

The clustering of cardiometabolic risk factors has its origin in childhood [1] and can track into adulthood [2].These risk factors constitute the metabolic syndrome (MetS), but the use of different measures and ensembles of risk factors and thresholds [3,4,5] hampers comparison between studies
The Norwegian children had significantly more favorable waist circumference (WC), diastolic blood pressure (DBP), glucose, high-density lipoprotein cholesterol (HDL-C) and cardiorespiratory fitness (CRF) levels compared to the international reference values, but similar or less favorable levels of other cardiometabolic risk factors
CRF is associated with improved cardiometabolic health in children

Summary

Introduction

The clustering of cardiometabolic risk factors (hypertension, dyslipidemia, adiposity, and glucose intolerance) has its origin in childhood [1] and can track into adulthood [2]. These risk factors constitute the metabolic syndrome (MetS), but the use of different measures and ensembles of risk factors and thresholds [3,4,5] hampers comparison between studies. The reference values can be used to standardize single cardiometabolic risk factors, allowing to compare otherwise population specific continuous clustered risk scores directly to the reference material itself and to other studies adapting the same approach. The study by Stavnsbo et al [10] facilitate international comparisons of prevalence and trends in pediatric cardiometabolic risk

Methods

Results

Conclusion