Cardiometabolic risk in adolescents: prevalence and associated factors from a population-based survey (2008-2015).

BACKGROUND: The prevalence of the cardio-metabolic risk factors is rapidly increasing amongst the children and adolescents and is a topic of concern due to their induced risk of development of cardiovascular diseases (CVDs) and diabetes mellitus (DM) in adulthood. The aim of this study is to determine the prevalence of the cardio-metabolic risk factors associated with sociodemographic variables amongst the teenagers of rural population in India. METHODS: This cross-sectional study was carried out on 405 teenagers (13-19 years old) in a rural population of central India. The data on the socio-demographic variables and cardio metabolic risk factors were collected using a predesigned proforma. The blood pressure and body mass index (BMI) of the subjects were also recorded. Blood samples were collected for lipid profile and blood sugar. Data was analyzed with the Epi Info software version 6.04. RESULTS: A total of 405 subjects were studied, of whom 182 were male and 223 were female. The prevalence of metabolic syndrome was found to be 9.9% [95% confidence interval (CI): 7.3-13.1]. The prevalence of cardiometabolic risk factors, including low level of high-density lipoprotein cholesterol (HDLC) and impaired fasting glucose (IFG), were found to be 58.3% (95% CI: 53.4-63.0) and 13.8% (95% CI: 10.7-17.5), respectively. 2.2% of the teenagers had a waist circumference (WC) more than the cut off (> 90 th percentile), while high blood pressure was found in 24.40% (95% CI: 18.6-26.7), i.e. > 90 th percentile for age, sex, and height. Similarly, risk factors such as obesity and overweight were found significant (P < 0. 05) in teenagers with family history of obesity. CONCLUSION: Cardiometabolic risk factors is slowly extending to rural areas. Therefore, early detection of these risk factors can be an attempt to prevent or delay the metabolic syndromes, DM, and CVDs.

Prevalence of cardiometabolic risk factors by weight status in a population-based sample of Quebec children and adolescents

It has been hypothesised that rural sub-Saharan Africa is at an early stage of epidemiological transition from communicable to non-communicable diseases (NCD). Limited information exists about the prevalence of cardiometabolic risk factors and the burden of cardiovascular disease (CVD) in the adult Nigerian population, especially in the rural setting. The aim of this study was to assess and describe the prevalence of several cardiometabolic risk factors in the sub-Saharan adult population of a rural Yoruba community, living in south-western Nigeria. The study was a descriptive, cross-sectional, random-sample survey. Participants were visited at home by trained nurses and community health extension workers (CHEW) who administered a questionnaire, took the relevant history, carried out clinical examinations and measurements and took samples for laboratory tests. They were supervised by primary healthcare physicians serving the community. The variables recorded comprised clinical history, CVD risk factors including blood pressure (BP), body mass index (BMI), waist circumference, blood sugar and serum lipid levels, cigarette use, and dietary habits. The participants included 2 000 healthy adults aged 18 to 64 years who had been living in the area for more than three years. The average age was 42.1 +/- 21.6, with 43.7% (873) being males and 56.3% (1127) females; 20.8% were hypertensive with BP > or = 140/90 mmHg, 42.3% of the men and 36.8% of the women had BP > or = 130/85 mmHg; 2.5% had diabetes, 1.9% had hypertriglycerideaemia, 43.1% had low HDL-C, 3.9% had general obesity, 14.7% had abdominal obesity, 3.2% were physically inactive, and 1.7% smoked cigarettes. Overall, 12.9% of the subjects were found to have at least one CVD risk factor. Using the Adult Treatment Panel (ATP) III criteria, 2.1% of men and 2.7% of women in the study population had at least three of the criteria, the commonest being HDL-C < 40 mg/dl in men or < 50 mg/dl in women, followed by BP >or = 130/85 mmHg, then waist circumference > 88 cm in women or > 102 cm in men, followed by blood glucose > or = 110 mg/dl. The results obtained from this study strongly suggest a high prevalence of cardiometabolic risk factors in this rural population and that the epidemiological transition is not restricted to the urban population. This serves as a wake-up call for action in the planning of health services for the management of CVD and other chronic NCDs.

ContextAdolescents with polycystic ovary syndrome (PCOS) have increased incidence of cardiometabolic risk factors including dyslipidemia. Atherogenic apolipoprotein (apo) B-lipoprotein remnants are associated with increased cardiovascular disease (CVD) risk.ObjectiveThe aim of this study was to determine the concentrations of fasting plasma apoB-lipoprotein remnants, apoB48 and apoB100, and their association with cardiometabolic risk factors and androgen indices in adolescent girls with and without PCOS.Design, setting and participantsParticipants (n = 184) aged 17 years were recruited in the Menstruation in Teenagers Study from the Western Australian Pregnancy Cohort (Raine) Study.The main outcome measuresFasting plasma apo-B48 and -B100 lipoprotein remnant concentrations in adolescent girls with and without PCOS.ResultsFasting plasma apoB48-lipoprotein remnants but not apoB100-lipoprotein remnants were elevated in adolescent girls with increased cardiometabolic risk compared with those with lower cardiometabolic risk (13.91 ± 5.06 vs 12.09 ± 4.47 µg/mL, P < .01). ApoB48-lipoprotein remnants were positively correlated with fasting plasma triglycerides (b = .43, P < .0001). The prevalence of increased cardiometabolic risk factors was 2-fold higher in those diagnosed with PCOS (35.3%) than in those without PCOS (16.3%).Conclusion: Adolescents with PCOS have a 2-fold higher incidence of cardiometabolic risk factors than those without PCOS. Fasting apoB48-lipoprotein remnants are elevated in adolescent girls with a high prevalence of cardiometabolic risk factors.

Background: Although cardiometabolic dysfunction is associated with an increased risk of cancer, the prevalence of cardiometabolic risk factors in patients with and without cancer remains less well-established. Therefore, we aimed to examine the prevalence and association of cardiometabolic risk factors in patients with versus without cancer who do not have established atherosclerotic cardiovascular disease (ASCVD). Methods: Data of ∼1.1 million patients aged 18+ years in the Houston Methodist Learning Health System Outpatient Registry was utilized to identify patients with and without cancer with cardiometabolic risk factors including hyperlipidemia, diabetes mellitus (DM), obesity and hypertension using the ICD-10 codes. Patients with prevalent ASCVD were excluded. Age-adjusted prevalence of cardiometabolic risk factors was calculated and multivariate logistic regression models were utilized to determine the association between cardiometabolic factors and risk of cancer. Results: A total of 76,312 (7.8%) patients with cancer and 897,408 (92.2%) patients without cancer were included. Compared with patients without cancer, patients with cancer had increased age-adjusted prevalence of hypertension (38.4% vs 33.4%), obesity (30.7% vs 29.6%), hyperlipidemia (26.0% vs 22.0%) and DM (13.9% vs 11.0%). Compared with patients without cancer, patients with cancer had significantly increased odds of hyperlipidemia (OR 1.32 [1.30, 1.34]), hypertension (OR 1.82 [1.79, 1.85]) and DM (OR 1.42 [1.39, 1.45]). Conversely, obese patients were less likely to have cancer (OR 0.96 [0.95, 0.98]) compared with patients without cancer. Conclusion: Amongst patients without established ASCVD, increased prevalence of cardiometabolic risk factors is observed in patients with cancer versus without cancer. Strategies optimizing cardiometabolic health such as routine screening, monitoring, evaluation, and management of these factors should be prioritized to curtail adverse cardiovascular and cancer outcomes.

It is known that the presence of overt hypothyroidism carries additional risks of developing cardiovascular diseases due to impaired lipid and carbohydrate metabolism. But whether subclinical hypothyroidism (SH) has the same negative impact is still controversial. The assessment of its role is especially important in patients with existing arterial hypertension (AH) in the early stages of the disease in order to prevent future complications. The aim of this work is to identify and assess the prevalence of early cardiometabolic risk factors in patients with AH combined with SH. Materials and methods. 66 patients (55.4 % women) aged from 25 to 59 years with a median age of 51.1 years were included in the study during 2019–2020 years. All the patients were divided into 3 groups, randomized by age and sex: group 1 (n = 21) – vo­lunteers without AH and SH; group 2 (n = 25) – euthyroid patients with stage 1–2 grade 1–2 AH and low-to-moderate cardiovascular risk (CVR); group 3 (n = 20) – patients with stage 1–2 grade 1–2 AH and low-to-moderate CVR in combination with SH. Blood pressure was measured, anthropometric data were assessed, glucose levels and lipid profile indicators were determined in all patients. Results. Comparative characteristics of the groups showed a rise in the frequency of detecting increased waist circumference and the waist-to-hip ratio, obesity, metabolic syndrome, its individual components and lipid profile disorders, especially the levels of total cholesterol and high-density lipoprotein cholesterol in patients with SH even in the early stages of AH and CVR of low gradations. However, dyslipidemias in general and hypertriglyceridemia in particular were more common in euthyroid hypertensive patients compared to patients with AH and concomitant SH. There was also a tendency towards an increase in gynoid obesity and a worsening of the lipid and carbohydrate profile disorders in SH patients in comparison to euthyroid patients with AH, although the differences were not statistically significant. Conclusions. Evaluation of cardiometabolic risk factors revealed the increase in severity of female obesity and worsening of abnormalities in lipid and carbohydrate profiles with the SH development in patients even in the early stages of AH and low-CVR, that additionally increases the risk of cardiovascular complications.

To describe the prevalence of cardiometabolic risk factor clustering in Samoan adolescents and to relate risk factor clustering to weight status and general modernization. Anthropometric and biochemical data collected from adolescents aged 12-17.9 years who participated in the Samoan Family Study of Overweight and Diabetes were used to describe the prevalence of cardiometabolic risk factors (high waist circumference, high blood pressure, high triglyceride level, low-high-density lipoprotein cholesterol, and high fasting serum glucose). A total of 436 adolescents were included in this analysis; 237 (54.4%) from American Samoa (n = 123 males) and 199 (45.6%) from Samoa (n = 90 males). Risk factor clustering was indicated by the presence of ≥ 3 risk factors. Cardiometabolic risk factor clustering was greater in American Samoan adolescents (17.9% males, 21.9% females) than Samoan adolescents (1.1% males, 2.8% females). The frequency of risk factor clustering varied according to body mass index status. In males, risk factor clustering was entirely confined to obese adolescents, whereas female adolescents who were overweight or obese were at risk. Cardiometabolic risk factor clustering is prevalent in the young American Samoan population and is likely to become more prevalent with increasing modernization in Samoan youth. Screening and intervention should be targeted at this age group to reduce the non-communicable disease burden faced by these populations.

Increased visceral adipose tissue (VAT) precedes development of insulin resistance and dyslipidemia in adults. The associations of abdominal adiposity derived from dual-energy X-ray absorptiometry (DXA), including VAT, subcutaneous abdominal adipose tissue (SAAT) and total abdominal adipose tissue (TAAT) with cardio-metabolic risk in adolescents are understudied. We examined the cross-sectional associations of DXA-measured abdominal adiposity with cardio-metabolic risk and related markers in early adolescence (mean [SD] age 13.0 [0.7] years). We collected data from 740 adolescents (374 girls and 366 boys) in Project Viva, a U.S. pre-birth cohort. We used DXA estimates of VAT, SAAT and TAAT area. We conducted overall and sex-stratified linear regression models, adjusting for age, sex (in overall models), race/ethnicity, puberty score and body mass index (BMI) z-score. Mean BMI z-score was 0.59 (1.28). After adjustment, greater VAT (per 1 SD score) was associated with higher metabolic risk z-score (β 0.14 units; 95% CI 0.08, 0.20), higher log high-sensitivity C-reactive protein (β 0.51 mg/L; 0.36, 0.66) and log leptin (β 0.36 ng/mL; 0.27, 0.44), and lower log adiponectin (β -0.08 ug/mL; -0.13, -0.02). SAAT and TAAT showed similar associations as VAT with comparable or greater effect sizes. In early adolescence, DXA-measured VAT, SAAT and TAAT are associated with cardio-metabolic risk and related markers, independent of current BMI. Among two adolescents with the same BMI, there is an associated higher cardio-metabolic risk in the adolescent with greater DXA-measured abdominal adiposity.

Overweight and obesity in adolescents have exponentially increased in the last decades and are considered a primary driver of other chronic diseases, such as diabetes and hypertension. Cardiometabolic risk factors, if not early managed, tend to persist in adult life, and some studies suggest different prevalences according to obesity category. This association among young people, however, is still unclear. The aim of this study was to evaluate the association of severity of obesity and known cardiometabolic risk factors in a representative sample of Brazilian adolescents from ERICA (Study of Cardiovascular Risk in Adolescents), a multicenter, school-based cross-sectional study composed of 75,000 students. For this analysis, we used data from students with overweight or obesity according to the IOTF reference values for body mass index: overweight ≥ 25kg/m²; class I obesity ≥ 30kg/m²; class II ≥ 35kg/m²; class III ≥ 40kg/m². Prevalences of abnormal cardiometabolic risk factors according to the severity of obesity were calculated for overall sample and stratified by sex and age groups (12-14 or 15-17 years). Adjusted Wald’s test for trends and Poisson regression models were used. From the 8,708 adolescents with excess weight, 71.6% were classified with overweight, 23.2% with class I obesity, 4.1% with class II and 1.2% with class III. As severity of obesity increased, there was an increase in the prevalence of higher levels of blood pressure, total and LDL-cholesterol, triglycerides, glycated hemoglobin, fasting glucose, insulin and metabolic syndrome (p≤0.05). Prevalence of low HDL-cholesterol levels was inversely proportional to increase in severity of obesity (p≤0.01). Increasing severity of obesity was associated with higher prevalence of all cardiometabolic risk factors in both age groups, except for fasting glucose in 15-17 years adolescents. After adjustment for sex, age, skin color and socioeconomic status, individuals with class III obesity had the highest prevalence of all the evaluated cardiometabolic variables, such as high levels of blood pressure [odds ratio (OR) compared to overweight = 2.4; 95%CI 1.5 - 3.8), triglyceride (OR = 2.99; 95%CI 1.8 - 4.9), LDL-cholesterol (OR = 2.5; 95%CI 1.2 – 5.3), glycated hemoglobin (OR = 2.0; 95%CI 1.3 - 3.2) and insulin (OR = 8.3; 95%CI 6.3 – 10.8). Metabolic syndrome in class III obese adolescents, when compared to overweight and class I obese, was 2 and 9 times more frequent, respectively. Our study involving Brazilian youth shows a positive association between severity of obesity and prevalence of cardiometabolic risk factors, indicating the need to further stratify them in this population. Investigating the association between severity of obesity and cardiometabolic risk factors can help us to identify the individuals at higher risk groups and develop public health strategies against obesity related outcomes early in life. Support: CAPES

Objective: Obesity in childhood has been shown to increase the risk of cardiometabolic disease. Identification of obese youth with cardiometabolic components may define a high-risk group within the obese child population. The objective was to assess the prevalence of the cardiometabolic risk factors in obese youth. Design and method: Six hundred and eleven obese Caucasians of both sexes (270 females), of European origin, from 6 to 18 years of age (mean age 11.3 2.4) were included. Obesity was defined as higher than or equal to 95th percentile for age and sex. The subjects were qualified as normotensive or high blood pressure (BP) according to the ESH office BP criteria (Lurbe et al, 2009). Fasting blood was obtained and glucose, insulin, and lipid profile, were assessed. Hyperinsulinism was defined from norms for pubertal stage. Abnormal fasting lipids were defined from normative data (Daniels et al, 2008). Results: Moderate obesity was present in 86% and there were no sex differences in mean BMI z-score. From the total population, 354 (57.8%) had at least one cardiometabolic risk factor in addition to obesity. The prevalence of cardiometabolic risk factors were: 235 subjects (39%) with one risk factor, 101 subjects (16.5%) with two factors, 17 subjects (2.8%) with three, and one subject had four components (0.2%). There were no significant differences in the prevalence between males and females. Among all the risk factors the most prevalent was hyperinsulinism (30.8%), followed by lipid abnormalities (12.9%), and high BP (10.5%). High BP was associated with hyperinsulinism in 10%, with lipid abnormalities in 8%, and with both hyperinsulinism and lipid abnormalities in 0.6%.Conclusions: The presence in more than half of the obese population of at least one cardiometabolic risk factor stresses the importance of adiposity. High BP is frequently associated with one or more cardiometabolic risk factor.

The prevalence of cardiometabolic risk factors (CMRFs) is increasing in sub-Saharan Africa and represents a serious public health issue. Accurate data are required to implement adapted prevention programs and healthcare strategies. Thus, the aim of this study was to estimate the prevalence rates of CMRFs according to the level of urbanization, age and gender in Gabon. A cross-sectional study was conducted in northern (Bitam), western coast (Libreville, Melen) and southeast (Koulamoutou) areas of Gabon using the World Health Organization's (WHO) stepwise approach for the surveillance of chronic disease risk factors. Participants over 18 years of age, without known underlying disease, living in rural and urban areas of Gabon were included. Sociodemographic, biological, and behavioral data were collected. Univariate and multivariate analysis were used to identify the CMRFs. Of the 978 participants, 499 lived in urban and 479 in rural areas. Their median age was 38[28-50] years. Tobacco (26.1% vs 6.2%; p < 0.01) and excessive alcohol consumption (19.4% vs 9.6%; p < 0.01) predominated in rural than in urban areas, respectively. Urban dwellers had more often insufficient physical activity than rural people (29.5% vs 16.3%; p < 0.01). In total, 79.9% of participants aged under 54 years had a high blood pressure;10.6% of the younger participants had pre-hypertension. Metabolic syndrome was more frequent in women (21.7%) than in men (10.0%) (p < 0.01); 6.4% of men and 2.5% of women had a high Framingham score (p = 0.03). Finally, 54.0% of the participants had three or four CMRFs. The multivariate analysis showed that men were more likely to be smokers and to be at risk of pre-hypertension or high blood pressure (p < 0.01). Women were more likely to be obese or to have a metabolic syndrome (p < 0.01). Living in urban areas was also a risk factor for hypertension, diabetes, metabolic syndrome and high LDL cholesterol level. The prevalence of CMRFs was high in the study population. Disparities were observed according to urban and rural areas, gender and age. National prevention and healthcare strategies for cardiometabolic diseases in Gabon should consider these observed differences.

Severe childhood obesity is associated with increased prevalence of cardiometabolic risk factors (CMRFs). Among children with Class 1 obesity, higher BMI may indicate greater cardiometabolic risk. Class 1 obesity reflects a wide spectrum of BMI values. Each 10% increase in BMI above the 95th percentile is equivalent to an average increase of 2.15 kg/m2 and 2.75 kg/m2 in BMI among children and adolescents, respectively. Such increments may be of clinical importance. The study aimed to determine the prevalence and clustering of CMRFs in children and adolescents with BMI 110%-119% of the 95th BMI percentile. A cross-sectional analysis of data, from an Israeli health maintenance organization, of children and adolescents (5-17 years) with overweight or Class 1 obesity, and at least one measurement of lipid profile during Jan/2020-May/2021. CMRFs were defined as abnormal lipid profile, elevated alanine aminotransferase, hypertension, and prediabetes or diabetes. Study groups included overweight and Class 1 Obesity-A (BMI < 110%) and Obesity-B (BMI ≥ 110%) of the 95th BMI percentile. Of 7211 subjects included, 40.2% were overweight, 50.3% obesity-A, and 9.5% obesity-B. Multivariable analyses showed that children and adolescents from the Obesity-B group had increased odds for higher triglycerides, LDL cholesterol, and ALT levels; and lower HDL cholesterol levels, as compared to Obesity-A. The odds of prediabetes (insignificant) tended to be higher in the Obesity-B group, which was associated with increased CMRFs clustering. Among children and adolescents with Class 1 obesity, BMI ≥ 110% of the 95th percentile was associated with higher prevalence and clustering of CMRFs.

Background. Cardiometabolic risk factors significantly accelerate the progression of coronary artery disease (CAD); however, whether CAD patients in South China are aware of the prevalence of these risk factors is not clear yet. Methods. The study consisted of 2312 in-admission CAD patients from 2008 to 2011 in South China. Disease history including hypertension, dyslipidemia, and diabetes was relied on patients' self-reported records. Physical and clinical examinations were tested to assess the real prevalence of the cardiometabolic risk factors. Results. 57.9% of CAD patients had more than 3 cardiometabolic risk factors in terms of the metabolic syndrome. The self-known and real prevalence of hypertension, diabetes, and dyslipidemia were 56.6%, 28.3%, and 25.1% and 91.3%, 40.9%, and 92.0%, respectively. The awareness rates were 64.4%, 66.3%, and 28.5% for hypertension, diabetes, and dyslipidemia. The prevalence of cardiometabolic risk factors was significantly different among gender and among disease status. Conclusions. Most CAD patients in South China had more than three cardiometabolic risk factors. However, the awareness rate of cardiometabolic diseases was low, especially for dyslipidemia. Strategies of routine physical examination programs are needed for the early detection and treatment of cardiometabolic risk factors in order to prevent CAD progression and prognosis.

BackgroundThe prevalence of severe obesity among children and young adults has increased over the past decade. Although the prevalence of cardiometabolic risk factors is relatively low among children and young adults who are overweight or obese, those with more severe forms of obesity may be at greater risk.MethodsWe performed a cross-sectional analysis of data from overweight or obese children and young adults 3 to 19 years of age who were included in the National Health and Nutrition Examination Survey from 1999 through 2012 to assess the prevalence of multiple cardiometabolic risk factors according to the severity of obesity. Weight status was classified on the basis of measured height and weight. We used standard definitions of abnormal values for total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, triglycerides, blood pressure, glycated hemoglobin, and fasting glucose and report the prevalence of abnormal values in children and young adults according to weight status.ResultsAmong 8579 children and young adults with a body-mass index at the 85th percentile or higher (according to the Centers for Disease Control and Prevention growth charts), 46.9% were overweight, 36.4% had class I obesity, 11.9% had class II obesity, and 4.8% had class III obesity. Mean values for some, but not all, cardiometabolic variables were higher with greater severity of obesity in both male and female participants, and the values were higher in male participants than in female participants; for HDL cholesterol, the mean values were lower with greater severity of obesity. Multivariable models that controlled for age, race or ethnic group, and sex showed that the greater the severity of obesity, the higher the risks of a low HDL cholesterol level, high systolic and diastolic blood pressures, and high triglyceride and glycated hemoglobin levels.ConclusionsSevere obesity in children and young adults was associated with an increased prevalence of cardiometabolic risk factors, particularly among boys and young men.

ObjectiveTo examine the associations between body mass index (BMI) and waist-to-height ratio (WHtR) measured in childhood and adolescence and cardiometabolic risk factors in adolescence.MethodsSecondary data analysis of the Avon Longitudinal Study of Parents and Children, a population based cohort. Data from 2858 adolescents aged 15.5 (standard deviation 0.4) years and 2710 of these participants as children aged 7–9 years were used in this analysis. Outcome measures were cardiometabolic risk factors, including triglycerides, low density lipoprotein cholesterol, high density lipoprotein cholesterol, insulin, glucose and blood pressure at 15 years of age.ResultsBoth BMI and WHtR measured at ages 7–9 years and at age 15 years were associated with cardiometabolic risk factors in adolescents. A WHtR ≥0.5 at 7–9 years increased the odds by 4.6 [95% confidence interval 2.6 to 8.1] for males and 1.6 [0.7 to 3.9] for females of having three or more cardiometabolic risk factors in adolescence. Cross-sectional analysis indicated that adolescents who had a WHtR ≥0.5, the odds ratio of having three or more cardiometabolic risk factors was 6.8 [4.4 to 10.6] for males and 3.8 [2.3 to 6.3] for females. The WHtR cut-point was highly specific in identifying cardiometabolic risk co-occurrence in male children and adolescents as well as female children (90 to 95%), but had poor sensitivity (17 to 53%). Similar associations were observed when BMI was used to define excess adiposity.ConclusionsWHtR is a simple alternative to age and sex adjusted BMI for assessing cardiometabolic risk in adolescents.