Cardiometabolic Risk In Adolescents Research Articles

Relationship of the Degree of Sarcopenia with the Severity of Nonalcoholic Fatty Liver Disease and Cardiometabolic Risk in Adolescents

The association between nonalcoholic fatty liver disease (NAFLD) and sarcopenia has been suggested. We investigated sarcopenia’s impact on NAFLD severity and its relationship with cardiometabolic risk in adolescents. We conducted a retrospective study on 122 patients aged 13–18 years and diagnosed with both NAFLD and sarcopenia by laboratory tests, abdominal ultrasound (US), and multifrequency bioelectrical impedance analysis. Sarcopenia was stratified into tertiles based on the skeletal muscle-to-fat ratio (MFR), NAFLD severity was established by the US, and cardiometabolic risk was assessed by the triglyceride–glucose (TyG) index and the atherogenic index of plasma (AIP). Compared with the other patients, those in the lower MFR tertiles exhibited a greater severity of NAFLD (p < 0.001) and significantly higher TyG index and AIP. The independent effect of MFR was observed to have a negative correlation with the severity of NAFLD (p < 0.001). Based on the aforementioned results, the degree of sarcopenia can be considered as one of the risk factors of severe NAFLD and might be an indicator of cardiometabolic risk in adolescents. Weight training to reach the amount of muscle mass could be included in the treatment strategies to improve or prevent NAFLD in adolescents with sarcopenia.

Dental caries and adolescent cardiometabolic health from the National Health and Nutrition Examination Survey (NHANES)

Background and aimsTo assess the association between dental caries and cardiometabolic risk in adolescents. Methods and resultsThe analysis included adolescents aged 13–17 years enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018 who completed an Oral Health Examination. Untreated caries was defined as having one or more decayed teeth. Caries experience was assessed by Decayed, Missing, Filled Teeth (DMFT) score. Primary cardiometabolic outcomes included elevated BP (defined as BP 120–129/<80 mmHg) and hypertensive BP (defined as BP ≥ 130/80 mmHg). Secondary cardiometabolic outcomes included obesity, dyslipidemia (defined as any abnormal lipid level), glucose intolerance (measured by HOMA-IR), and microalbuminuria (defined as urine albumin: creatinine ≥30 mg/mg). Adjusted linear and logistic models examined associations using complex survey design procedures.In the sample of 2861 adolescents, 25.6 % (1.3 %) had untreated caries. 55.4 % (1.3 %) had DMFT ≥1. In adjusted regression analyses, untreated caries status was not significantly associated with primary outcomes of elevated BP (OR = 1.04, 95 % CI 0.71, 1.52 p > 0.05), hypertensive BP (OR = 1.72, 95 % CI 0.71, 3.89 p > 0.05), nor secondary cardiometabolic outcomes. No statistically significant associations were found between DMFT score and primary outcomes of elevated BP (OR = 0.01, 95 % CI 0.34, 1.07 p > 0.05), hypertensive BP (OR = 0.91, 95 % CI 0.81, 1.08 p > 0.05), or secondary cardiometabolic outcomes. ConclusionAlthough studies in other countries and in adults show associations between caries and cardiometabolic outcomes, this study did not find an association between caries and cardiometabolic markers.

Poor Eating Habits and Low Physical Activity Contribute to Weight Excess and Increase Cardiometabolic Risk in Adolescents Practicing Soccer as a Recreational Sport.

Monitoring anthropometry, dietary intake, and physical activity (PA) is essential to prevent/counteract childhood obesity. This study examined dietary intake, PA, and anthropometric characteristics in young boys practicing soccer as a recreational sport. A cross-sectional study included 226 boys aged 8 to 13 years participating in soccer as a recreational activity in football academies located in Tunis, Tunisia. Anthropometric measures allowed the calculation of body mass index, fat mass, and peak height velocity as markers of biological maturity. A three-day food record and a food frequency questionnaire estimated nutrient intake and eating habits. The International Physical Activity Questionnaire (IPAQ) was used to estimate the PA level of the participants. It was found that a high percentage of the children had excess weight (54%) and excess fat mass (47%). The total energy, carbohydrate, and saturated fat intake of the children exceeded the recommended levels by approximately 10%, 15%, and 30%, respectively. However, the intake of unsaturated fat was below the estimated requirements, particularly in obese children. In addition to the unbalanced macronutrient intake, the children also showed an insufficient intake of many essential micronutrients. Around 60% to 70% of the children in all three groups had a low intake of magnesium, n-3 polyunsaturated fatty acids (PUFA), and vitamins B9, B12, and D. Moreover, 20% to 35% of the children in the three groups had an insufficient intake of vitamins A and C. Insufficient vitamin E intake was found in 63% of obese children and 35% of non-obese children. It was observed that the PA level was lower in the overweight/obese group compared to the normal-weight group (p < 0.005). More than three-quarters of overweight/obese children had low PA levels, about 20% were moderately active, and only 1 to 2% were highly active. Conversely, normal-weight children showed moderate to high PA levels. Poor eating behavior, an unbalanced diet, and a low PA level are prevalent in Tunisian boys practicing recreational sports. Such a combination is responsible for a disparity between energy intake and expenditure, contributing to weight excess and increased cardiometabolic risk. The study findings provide meaningful information for practitioners and authorities on applying a balanced diet and adequate PA to prevent and fight against obesity and improve cardiometabolic health in youth.

The interplay between birth weight and obesity in determining childhood and adolescent cardiometabolic risk

Birth weight (BW) is associated with risk of cardiometabolic disease (CMD) in adulthood, which may depend on the state of obesity, in particular if developed at a young age. We hypothesised that BW and a polygenic score (PGS) for BW were associated with cardiometabolic risk and related plasma protein levels in children and adolescents. We aimed to determine the modifying effect of childhood obesity on these associations. We used data from The cross-sectional HOLBAEK Study with 4263 participants (median [IQR] age, 11.7 [9.2, 14.3] years; 57.1% girls and 42.9% boys; 48.6% from an obesity clinic and 51.4% from a population-based group). We gathered information on BW and gestational age, anthropometrics, cardiometabolic risk factors, calculated a PGS for BW, and measured plasma proteins using Olink Inflammation and Cardiovascular II panels. We employed multiple linear regression to examine the associations with BW as a continuous variable and performed interaction analyses to assess the effect of childhood obesity on cardiometabolic risk and plasma protein levels. BW and a PGS for BW associated with cardiometabolic risk and plasma protein levels in childhood and adolescence. Childhood obesity modified the associations between BW and measures of insulin resistance, including HOMA-IR (βadj [95% CI per SD] for obesity:-0.12 [-0.15,-0.08]; normal weight:-0.04 [-0.08, 0.00]; Pinteraction=0.004), c-peptide (obesity:-0.11 [-0.14,-0.08]; normal weight:-0.02 [-0.06, 0.02]; Pinteraction=5.05E-04), and SBP SDS (obesity:-0.12 [-0.16,-0.08]; normal weight:-0.06 [-0.11,-0.01]; Pinteraction=0.0479). Childhood obesity also modified the associations between BW and plasma levels of 14 proteins (e.g., IL15RA, MCP1, and XCL1; Pinteraction < 0.05). We identified associations between lower BW and adverse metabolic phenotypes, particularly insulin resistance, blood pressure, and altered plasma protein levels, which were more pronounced in children with obesity. Developing effective prevention and treatment strategies for this group is needed to reduce the risk of future CMD. Novo Nordisk Foundation (NNF15OC0016544, NNF0064142 to T.H., NNF15OC0016692 to T.H. and A.K., NNF18CC0033668 to S.E.S, NNF18SA0034956 to C.E.F., NNF20SA0067242 to DCA, NNF18CC0034900 to NNF CBMR), The Innovation Fund Denmark (0603-00484B to T.H.), The Danish Cardiovascular Academy (DCA) and the Danish Heart Foundation (HF) (PhD2021007-DCA to P.K.R, 18-R125-A8447-22088 (HF) and 21-R149-A10071-22193 (HF) to M.A.V.L., PhD2023009-HF to L.A.H), EU Horizon (668031, 847989, 825694, 964590 to A.K.), Innovative Health Initiative (101132901 for A.K.), A.P. Møller Foundation (19-L-0366 to T.H.), The Danish National Research Foundation, Steno Diabetes Center Sjælland, and The Region Zealand and Southern Denmark Health Scientific Research Foundation.

Association of childhood food consumption and dietary pattern with cardiometabolic risk factors and metabolomics in late adolescence: prospective evidence from ‘Children of 1997’ birth cohort

BackgroundHealthy diet might protect against cardiometabolic diseases, but uncertainty exists about its definition and role in adolescence.MethodIn a subset of Hong Kong’s ‘Children of 1997’ birth cohort (n=2844 out of...

Eating behaviors as pathways from early childhood adversity to adolescent cardiometabolic risk.

To identify specific eating behavior pathways that mediate associations between financial difficulties, negative life events, and maternal depressive symptoms from 0 to 5 years and cardiometabolic risk in adolescence. Hypotheses were tested with data from birth to age 15 years using the Avon Longitudinal Study of Parents and Children, a birth cohort in the United Kingdom (n = 3,887 for current analyses). Mothers reported on financial difficulties, negative life events, and maternal depressive symptoms at multiple points from 0 to 5 years and reported on worry about child overeating at 8 years. Youth self-reported restrained, emotional, and external eating at age 14. Youth completed a cardiometabolic health assessment at age 15 where waist circumference, triglycerides, high-density lipoprotein, and insulin resistance were measured. Longitudinal structural equation modeling with bootstrapping was used to test mediation models. Greater negative life events and maternal depressive symptoms predicted greater parental worry about child overeating at age 8, which directly predicted greater restrained and emotional eating at 14 and cardiometabolic risk at 15. Restrained and emotional eating at 14 directly predicted greater cardiometabolic risk at age 15. Negative life events and maternal depressive symptoms in infancy/early childhood are associated with cardiometabolic risk in adolescence through pathways of parental worry about child overeating in middle childhood and youth-reported restrained and emotional eating in adolescence. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Investigation of Underlying Association between Anthropometric and Cardiorespiratory Fitness Markers among Overweight and Obese Adolescents in Canada.

Adolescents who experience overweight or obesity commonly persist in these conditions into adulthood, thereby elevating their vulnerability to health issues. The focus of this study is on health risk markers such as body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), body surface area (BSA), and cardiorespiratory fitness (CRF). The objectives include updating normative values for BMI, WC, WHtR, and BSA in Canadian adolescents, establishing cardiometabolic risk zones, and developing a composite score considering both anthropometric and CRF markers. Involving 1864 adolescents, the study used the LMS method to generate percentile norms, stratified by age and sex. Cardiometabolic risk zones were established for each marker based on Z-scores, and a composite score was created. An increase in WC of 5.8 and 7.4 cm for boys and girls, respectively, was observed since 1981. Forward multiple regression analyses were conducted to assess the robustness and validity of the proposed model. The results indicated that the model explained nearly 90% (R2 = 0.890) of the common variance between the composite score and the retained independent variables. Moreover, the model demonstrated a mean absolute error (MAE) of approximately 6 percentiles, confirming its high precision. Furthermore, these analyses yielded key thresholds for identifying adolescents at risk: the 70th percentile for high cardiometabolic risk and the 85th percentile for very-high risk. Individually, WC or WHtR seem to be better markers for evaluating cardiometabolic risk than BMI during adolescence. However, CRF showed comparable importance to anthropometric markers in determining cardiometabolic risk. The simultaneous inclusion of anthropometric and CRF markers provides a better picture of the global cardiometabolic risk in adolescents.

Abstract 23: Multidimensional Association of Sleep With Health Behaviors and Cardiometabolic Risk in Adolescents

Introduction: Insufficient sleep has been recognized by AHA as part of Life’s Essential 8 in the prevention of cardiovascular disease (CVD). While sleep is a multidimensional phenomenon comprised of duration, efficiency, quality, timing, and regularity, prior epidemiological research in youth has predominantly focused on sleep duration. It is important to disentangle which sleep dimensions most associate with other health behaviors and biomarkers for CVD risk in adolescents. Hypothesis: We hypothesize that specific dimensions of insufficient, disturbed, and misaligned sleep will be differentially associated with nutrition, physical activity, and inflammation. Methods: We analyzed data from 421 population-based randomly-selected adolescents from the Penn State Child Cohort (median 16 years; 47% female; 21% racial/ethnic minority) who had at least 5-night at-home actigraphy (ACT), 1-night in-lab 9-h polysomnography (PSG), self-reported insomnia symptoms, daytimes sleepiness, sleep schedule, circadian preference, and dietary assessment, as well as fasting blood draw assayed for C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNFα). Linear regression models tested the independent association of each sleep dimension with caloric intake, ACT-derived sedentary behavior, and blood-based inflammatory biomarkers, while accounting for sex, age, race/ethnicity, and body mass index. Results: Higher ACT-measured night-to-night variability in sleep duration was most strongly associated with increased caloric intake, particularly carbohydrates (B=0.203, p&lt;0.001), while shorter PSG-measured sleep duration was also associated with carbohydrates but to a lesser extent (B=-0.150, p=0.002). Later bedtime on weekdays was most strongly associated with higher bouts of sedentary behavior (B=0.216, p&lt;0.001), while shorter ACT-measured sleep duration was most strongly associated with time spent sedentary (B=-0.226, p&lt;0.001). PSG-measured sleep apnea was most strongly associated with higher CRP (B=0.287, p&lt;0.001) and IL-6 levels (B=0.260, p&lt;0.001), while later bedtime on weekdays (B=0.136, p=0.025) and evening circadian preference (B=-0.124, p=0.017) were also associated with inflammation but to a lesser extent. Conclusions: The association of inadequate sleep with health behaviors and cardiometabolic risk in adolescents is in itself multidimensional. These data support that AHA guidelines should be updated to include insufficient, disturbed, and misaligned sleep as contributors to CVD risk.

Evaluating the association between longitudinal exposure to a PFAS mixture and adolescent cardiometabolic risk in the HOME Study.

Exposure to per- and polyfluoroalkyl substances (PFAS) throughout gestation and childhood may impact cardiometabolic risk. In 179 HOME Study participants (Cincinnati, OH; recruited 2003-2006), we used latent profile analysis to identify two distinct patterns of PFAS exposure from serum concentrations of four PFAS measured at birth and ages 3, 8, and 12 years. We assessed the homeostatic model of insulin resistance, triglycerides-to-high-density lipoprotein cholesterol ratio, leptin-to-adiponectin ratio, systolic blood pressure, visceral fat, and hemoglobin A1c levels at age 12 years. We used multivariable linear regression to assess the association of membership in the longitudinal PFAS mixture exposure group with a summary measure of overall cardiometabolic risk and individual components. One PFAS exposure profile (n = 66, 39%) had higher geometric means of all PFAS across all visits than the other. Although adjusted associations were null in the full sample, child sex modified the association of longitudinal PFAS mixture exposure group with overall cardiometabolic risk, leptin-to-adiponectin ratio, systolic blood pressure, and visceral fat (interaction term P values: 0.02-0.08). Females in the higher exposure group had higher cardiometabolic risk scores (ß = 0.43; 95% CI = -0.08, 0.94), systolic blood pressures (ß = 0.6; 95% CI = 0.1, 1.1), and visceral fat (ß = 0.44; 95% CI = -0.13, 1.01); males had lower cardiometabolic risk scores (ß = -0.52; 95% CI = -1.06, -0.06), leptin-to-adiponectin ratios (ß = -0.7; 95% CI = -1.29, -0.1), systolic blood pressures (ß = -0.14; 95% CI = -0.7, 0.41), and visceral fat (ß = -0.52; 95% CI = -0.84, -0.19). Exposure to this PFAS mixture throughout childhood may have sex-specific effects on adolescent cardiometabolic risk.

Bisphenol A and cardiometabolic risk in adolescents: Data from the Generation XXI cohort

Background and aimsBisphenol A (BPA), an endocrine disruptor widely used in food contact materials, has been linked to a worse health profile. This study intends to estimate the association between BPA exposure and cardiometabolic patterns at adolescence. Methods and resultsData from the Portuguese population-based birth cohort Generation XXI at the age of 13 were used (n = 2386 providing 3-day food diaries and fasting blood samples). BPA exposure was measured in 24-h urine from a subsample (n = 206) and then predicted in all participants using a random forest method and considering dietary intake from diaries. Three cardiometabolic patterns were identified (normal, modified lipid profile and higher cardiometabolic risk) using a probabilistic Gaussian mixture model. Multinomial regression models were applied to associate BPA exposure (lower, medium, higher) and cardiometabolic patterns, adjusting for confounders. The median BPA exposure was 1532 ng/d, corresponding to 29.4 ng/kg/d. Adolescents higher exposed to BPA (compared to medium and lower levels) had higher BMI z-score (kg/m2) (0.68 vs. 0.39 and 0.52, respectively; p = 0.008), higher levels of body fat (kg) (16.3 vs. 13.8 and 14.6, respectively; p = 0.002), waist circumference (76.2 vs. 73.7 and 74.9, respectively; p = 0.026), insulinemia (ug/mL) (14.1 vs. 12.7 and 13.1, respectively; p = 0.039) and triglyceridemia (mg/dL) (72.7 vs. 66.1 and 66.5, respectively; p = 0.030). After adjustment, a significant association between higher BPA and a higher cardiometabolic risk pattern was observed (OR: 2.55; 95%CI: 1.41, 4.63). ConclusionHigher BPA exposure was associated with a higher cardiometabolic risk pattern in adolescents, evidencing the role of food contaminants in health.

Ferritin is a potential marker of cardiometabolic risk in adolescents and young adults with sleep-disordered breathing.

To explore markers that reflect sleep-disordered breathing (SDB) severity and investigate their associations with cardiometabolic risk factors in adolescents and young adults. Participants were recruited from our SDB epidemiological cohort. They underwent overnight polysomnography and ambulatory blood pressure (BP) monitoring. Complete blood count, ferritin, high-sensitivity C-reactive protein (hs-CRP), fasting blood glucose, and lipid profile were measured. Multiple linear regression was used to examine the association between red cell indices (RCIs), ferritin, and obstructive apnea-hypopnea index (OAHI). Subgroup analyses on participants with SDB were performed for the association of RCIs and ferritin with lipid profile, hs-CRP, and BP. There were 88 participants with SDB and 155 healthy controls aged 16-25 years. Hemoglobin (Hb; p<.001), hematocrit (HCT; p<.001), and ferritin (p<.001) were elevated with increasing SDB severity and were independently associated with OAHI (β=1.06, p<.001; β=40.2, p<.001; β=4.89×10-3, p=.024, respectively). In participants with SDB, after adjusting for age, sex, and BMI, significant associations were found between ferritin with low-density lipoprotein (LDL; β=0.936×10-3, p=.008) and triglyceride (TG; β =1.08×10-3, p<.001), as well as between Hb (β=1.40, p=.007), HCT (β=51.5, p=.010) and mean arterial pressure (MAP). Ferritin (β=0.091, p=.002), Hb (β=0.975, p=.005), and HCT (β=38.8, p=.004) were associated with hs-CRP independent of age, sex, BMI, plasma LDL, and MAP. OAHI was not associated with LDL and TG in the multivariable models. Serum ferritin, but not OAHI, was associated with LDL and TG in participants with SDB, suggesting it is a potential marker of cardiometabolic risk in patients with SDB.

The dietary approaches to stop hypertension (DASH) dietary pattern in childhood in relation to cardiometabolic risk in adolescence and early adulthood in the ALSPAC birth cohort.

To investigate the relationship between the dietary approaches to stop hypertension (DASH)-style dietary patterns in childhood and cardiometabolic risk (CMR) in adolescence/early adulthood. Data were obtained from the Avon Longitudinal Study of Parents and Children (ALSPAC) prospective cohort. Diet diary data collected at 7, 10 and 13 years were used to calculate DASH-style diet scores (DDS). Multivariable linear regression models were used to investigate the associations between the DDS at 7, 10 and 13 years and CMR scores, calculated at 17 and 24 years. The ALSPAC cohort included children born in south-west England in 1991-1992. Children with complete dietary, covariate and cardiometabolic data at 17 (n 1,526) and 24 years (n 1,524). A higher DDS at 7 and 10 years was negatively associated with CMR scores at 17 years (β = -0·64 (95 % CI -1·27, -0·006), Ptrend=0·027 for fifth v. first DDS quintile at 7 years; β = -0·73 (95 % CI -1·35, -0·12) and Ptrend=0·037 for fifth v. first DDS quintile at 10 years) and at 24 years (β = -0·92 (95 % CI -1·49, -0·34) Ptrend = 0·001 for fifth v. first DDS quintile at 7 years; β = -0·60 (95 % CI -1·20, -0·05) Ptrend = 0·092 for fifth v. first DDS quintile at 10 years). No associations were found between the DDS at 13 years and CMR score at 17 and 24 years. Greater adherence with a DASH-style diet during childhood was associated with better cardiometabolic health in adolescence/adulthood in the ALSPAC cohort. The components of the DASH diet could be recommended to improve children's cardiometabolic health.

Abnormal Body Composition Increases the Cardiometabolic Risk in Adolescents and Young Adults With Turner Syndrome

ObjectiveTo determine the cardiometabolic risk of adolescents and adults with Turner syndrome (TS) and whether and how anthropometry and body composition predict this risk. MethodsWe compared the anthropometric, biochemical, and dual-energy x-ray absorptiometry–derived body composition parameters of 103 girls and women with TS aged 12 to 30 years and 103 controls of the same age and body mass index: (1) between TS with and without metabolic syndrome (MetS), (2) between the different karyotypes of TS, and (3) between growth hormone recipients and nonrecipients. ResultsIndividuals with TS had higher prevalence rates of truncal obesity (57.2%), MetS (37.9%), prediabetes (20.4%), dyslipidemia (73.8%), hypertension (9.7%), and hepatic steatosis (15.5%) and a greater total body fat percentage (38.43% vs 34.26%) and fat mass index (9.15 vs 6.71 kg/m2) but a lower lean mass index (11.05 vs 12.49 kg/m2) than controls (P <.001). Individuals with TS and MetS (n = 39) had a higher total body fat percentage (41.74% vs 36.42%, P <.0001), truncal fat percentage (44.66% vs 36.09%, P <.0001), and visceral adipose tissue mass (495.57 vs 276 g, P <.0001) than those with TS but without MetS. Those with classic TS (45,X) had a higher prevalence of prediabetes (32.6% vs 10.5%, P =.01). Growth hormone recipients had a lower prevalence of MetS and lesser truncal obesity. Altered body composition was significantly correlated with metabolic risk. The truncal fat percentage independently predicted MetS (odds ratio, 1.12; 95% confidence interval, 1.003-1.24; P =.04). Waist circumference and waist-hip ratio predicted metabolic risk with good sensitivity and specificity. ConclusionAdverse cardiometabolic risk and altered body composition start early in life in TS. Postpubertal women with TS should be routinely assessed for truncal obesity, dysglycemia, dyslipidemia, and liver steatosis, irrespective of body mass index and karyotype.

Adolescent Diet Quality, Cardiometabolic Risk, and Adiposity: A Prospective Cohort

ObjectiveExamine the prospective association among diet with adolescent cardiometabolic risk (CMR) and anthropometrics. MethodsSecondary analysis of an observational study of adolescents aged 10–16 years. Twenty-four-hour food recalls were used to calculate Healthy Eating Index-2015 (HEI-2015) scores. Anthropometrics were assessed using magnetic resonance imaging, dual-energy x-ray absorptiometry, and height/weight measurements. CMR included mean arterial pressure, homeostatic model assessment for insulin resistance, high-density lipoprotein cholesterol, and triglycerides. Associations between HEI-2015 score at baseline with follow-up adiposity and CMR were examined using regression models. ResultsA total of 192 adolescents were included. Baseline HEI-2015 scores were inversely associated with follow-up total CMR z-score (P = 0.01), homeostatic model assessment for insulin resistance (P < 0.01), waist circumference z-score (P = 0.02), body mass index percentile (P = 0.01), fat mass (P = 0.04), lean mass (P = 0.02), and visceral adipose tissue mass (P = 0.01). Conclusions and ImplicationsAdolescents with lower adherence to dietary guidelines and greater CMR and anthropometry measurements at baseline continued this trajectory across the observation.

Prospective association between an obesogenic dietary pattern in early adolescence and metabolomics derived and traditional cardiometabolic risk scores in adolescents and young adults from the ALSPAC cohort

BackgroundDietary intake during early life may be a modifying factor for cardiometabolic risk (CMR). Metabolomic profiling may enable more precise identification of CMR in adolescence than traditional CMR scores. We aim to assess and compare the prospective associations between an obesogenic dietary pattern (DP) score at age 13 years with a novel vs. traditional CMR score in adolescence and young adulthood in the Avon Longitudinal Study of Parents and Children (ALSPAC).MethodsStudy participants were ALSPAC children with diet diary data at age 13. The obesogenic DP z-score, characterized by high energy-density, high % of energy from total fat and free sugars, and low fibre density, was previously derived using reduced rank regression. CMR scores were calculated by combining novel metabolites or traditional risk factors (fat mass index, insulin resistance, mean arterial blood pressure, triacylglycerol, HDL and LDL cholesterol) at age 15 (n = 1808), 17 (n = 1629), and 24 years (n = 1760). Multivariable linear regression models estimated associations of DP z-score with log-transformed CMR z-scores.ResultsCompared to the lowest tertile, the highest DP z-score tertile at age 13 was associated with an increase in the metabolomics CMR z-score at age 15 (β = 0.20, 95% CI 0.09, 0.32, p trend < 0.001) and at age 17 (β = 0.22, 95% CI 0.10, 0.34, p trend < 0.001), and with the traditional CMR z-score at age 15 (β = 0.15, 95% CI 0.05, 0.24, p trend 0.020). There was no evidence of an association at age 17 for the traditional CMR z-score (β = 0.07, 95% CI -0.03, 0.16, p trend 0.137) or for both scores at age 24.ConclusionsAn obesogenic DP was associated with greater CMR in adolescents. Stronger associations were observed with a novel metabolite CMR score compared to traditional risk factors. There may be benefits from modifying diet during adolescence for CMR health, which should be prioritized for further research in trials.

Association Between Dietary Fiber Intake and Cardiometabolic Risk Factors in Adolescents in the United States

To determine the association between dietary fiber intake and markers of cardiometabolic risk in adolescents, with blood pressure (BP) as the primary outcome of interest and secondary outcome measures including other established markers of childhood cardiometabolic risk, such as obesity, lipids, albuminuria, estimated glomerular filtration rate (eGFR), and uric acid. Dietary fiber intake was assessed by two 24-hour dietary recall interviews, which were averaged and corrected for body weight. Logistic and linear regression models were used to analyze the cross-sectional association between dietary fiber and cardiometabolic markers. Participants aged 13-17 years in the National Health and Nutritional Examination Survey 2009-2018 who completed a 24-hour dietary recall survey were included. Exclusion criteria included pregnancy, small for gestational age status, and history of major health comorbidities. In fully adjusted regression models, low dietary fiber intake was significantly associated with greater diastolic blood pressure (β=-13.29; 95% CI, -20.66 to -5.93), body mass index z-score (β=-0.91; 95% CI, -1.47 to -0.34), and uric acid (β=-0.80; 95% CI, -1.44 to -0.16). The association found between low dietary fiber intake and poor childhood cardiometabolic risk markers indicate a need for prospective studies using fiber intake as a dietary intervention in childhood and as a tool for prevention of many chronic conditions.

Challenges and Opportunities in Diagnosis and Management of Cardiometabolic Risk in Adolescents.

This review aims to elucidate the limitations of diagnosing metabolic syndrome in adolescents as well as challenges and opportunities in the identification and reduction of cardiometabolic risk in this population. There are multiple criticisms of how we define and approach obesity in clinical practice and scientific research, and weight stigma further complicates the process of making and communicating weight-related diagnoses. While the goal of diagnosing and managing metabolic syndrome in adolescents would be to identify individuals at elevated future cardiometabolic risk and intervene to reduce the modifiable component of this risk, there is evidence that identifying cardiometabolic risk factor clustering may be more useful in adolescents than establishing a cutoff-based diagnosis of metabolic syndrome. It has also become clear that many heritable factors and social and structural determinants of health contribute more to weight and body mass index than do individual behavioral choices about nutrition and physical activity. Promoting cardiometabolic health equity requires that we intervene on the obesogenic environment and mitigate the compounding effects of weight stigma and systemic racism. The existing options to diagnose and manage future cardiometabolic risk in children and adolescents are flawed and limited. While striving to improve population health through policy and societal interventions, there are opportunities to intervene at all levels of the socioecological model in order to decrease future morbidity and mortality from the chronic cardiometabolic diseases associated with central adiposity in both children and adults. More research is needed to identify the most effective interventions.

Neonatal and adolescent adipocytokines as predictors of adiposity and cardiometabolic risk in adolescence

Neonatal and adolescent adipocytokines as predictors of adiposity and cardiometabolic risk in adolescence

Determinants of Longitudinal Changes in Cardiometabolic Risk in Adolescents with Overweight/Obesity: The EVASYON Study.

We investigated which determinants (socioeconomic, early life factors, body composition changes, fitness changes and/or physical activity changes) best predicted longitudinal outcomes in cardiometabolic risk profile (Z-score change) in adolescents with OW/OB who underwent a 13-month multidisciplinary lifestyle intervention. A total of 165 adolescents (13–16 y; 46% boys) from the EVASYON study were included. Socioeconomic variables and early life factors were obtained from the medical records. Body composition was assessed using anthropometry. Fitness and physical activity were measured with field-based tests and questionnaires. Cardiometabolic risk factors (fasting glucose, HDL cholesterol, triglycerides, blood pressure and waist circumference) were derived from standard methods in the hospital. Body weight changes, sex and mother’s education were selected in the stepwise process as the most important determinants of changes in cardiometabolic risk profile (R2 = 0.26, p = 0.002; R2 = 0.14, p = 0.013; and R2 = 0.14, p = 0.017, respectively). Both boys and girls showed a lower cardiometabolic risk score with the reduction in body weight (r = 0.535, p = 0.009 and r = 0.506, p = 0.005, respectively). There was no interaction between sex and body weight change (p = 0.614). In conclusion, the simple measure of changes in body weight should be considered to track changes in cardiometabolic risk profile in adolescents with OW/OB.

Physical activity modifies the relation between gestational perfluorooctanoic acid exposure and adolescent cardiometabolic risk

ObjectiveExposure to per- and polyfluoroalkyl substances (PFAS) – endocrine disrupting chemicals – may increase cardiometabolic risk. We evaluated whether adolescent lifestyle factors modified associations between gestational PFAS exposure and cardiometabolic risk using a prospective cohort study. MethodsIn 166 mother-child pairs (HOME Study), we measured concentrations of four PFAS in maternal serum collected during pregnancy. When children were age 12 years, we calculated cardiometabolic risk scores from visceral adiposity area, blood pressure, and fasting serum biomarkers. We assessed adolescent physical activity and Healthy Eating Index scores using the Physical Activity Questionnaire for Older Children (PAQ-C), actigraphy, and 24-h diet recalls. Using multivariable linear regression and weighted quantile sum regression, we examined whether physical activity or diet modified covariate-adjusted associations of PFAS and their mixture with cardiometabolic risk scores. ResultsPhysical activity modified associations between perfluorooctanoic acid (PFOA) and cardiometabolic risk scores. Each doubling of PFOA was associated with worse cardiometabolic risk scores among children with PAQ-C scores < median (β:1.4; 95% CI:0.5, 2.2, n = 82), but not among those with PAQ-C scores ≥ median (β: 0.2; 95% CI: 1.2, 0.7, n = 84) (interaction p-value = 0.01). Associations were most prominent for insulin resistance, leptin-adiponectin ratio, and visceral fat area. We observed results suggesting that physical activity modified the association of PFAS mixture with cardiometabolic risk scores, insulin resistance, and visceral fat area (interaction p-values = 0.17, 0.07, and 0.10, respectively); however, the 95% CIs of the interaction terms included the null value. We observed similar, but attenuated patterns for PFOA and actigraphy-based measures of physical activity. Diet did not modify any associations. Physical activity or diet did not modify associations for other PFAS. ConclusionsChildhood physical activity modified associations of prenatal serum PFOA concentrations with children's cardiometabolic risk in this cohort, indicating that lifestyle interventions may ameliorate the adverse effects of PFOA exposure.