Clustered Cardiometabolic Risk Research Articles

Severity of obesity and cardiometabolic risk factors in adults: Sex differences and role of physical activity. The HERMEX study

BackgroundThe aims of this study were 1) to examine potential sex-related differences in major cardiometabolic risk factors among severe/morbid obese (body mass index [BMI]≥35) individuals; 2) to assess whether severity of obesity is associated with more adverse cardiometabolic risk factors in women and men, and 3) to assess whether being physically active (≥500 metabolic equivalents [MET-minutes per week]) may play a role in the association between severity of obesity and the cardiometabolic risk profile. MethodsA total of 886 (438 men) obese individuals participated in a population-based cross-sectional study. We categorized participants as grade I (BMI 30–34.99) and grade II/III (BMI≥35) obese. We measured markers of lipid and glucose metabolism, inflammation (high sensitivity C-reactive protein [hs-CRP]) blood pressure and renal function, as well as self-reported physical activity. ResultsTriglycerides, insulin, HOMA-IR, systolic blood pressure and creatinine levels were higher in severe/morbid obese men than women (all, P<0.05), while women presented higher HDL cholesterol and hs-CRP (P<0.05) than men. Severe/morbid obesity was associated with higher triglycerides, hs-CRP, insulin and insulin resistance, diastolic blood pressure and higher odds of hypertension than grade I obesity both in women and men (all, P<0.05). Severe/morbid obese individuals who were physically inactive presented the least favorable cardiometabolic profile (P<0.05). ConclusionsSevere/morbid obesity is associated with more adverse cardiometabolic risk factors both in women and men. Severe/morbid obese men are more affected than women regarding their cardiometabolic profile, although women presented higher inflammation. Physically inactive individuals with severe/morbid obesity had the most adverse clustered cardiometabolic risk profile.

Independent Associations between Sedentary Time, Moderate-To-Vigorous Physical Activity, Cardiorespiratory Fitness and Cardio-Metabolic Health: A Cross-Sectional Study.

We aimed to study the independent associations of sedentary time (ST), moderate-to-vigorous physical activity (MVPA), and objectively measured cardiorespiratory fitness (CRF) with clustered cardio-metabolic risk and its individual components (waist circumference, fasting glucose, HDL-cholesterol, triglycerides and blood pressure). We also investigated whether any associations between MVPA or ST and clustered cardio-metabolic risk were mediated by CRF. MVPA, ST, CRF and individual cardio-metabolic components were measured in a population-based sample of 341 adults (age 53.8 ± 8.9 years; 61% men) between 2012 and 2014. MVPA and ST were measured with the SenseWear pro 3 Armband and CRF was measured with a maximal exercise test. Multiple linear regression models and the product of coefficients method were used to examine independent associations and mediation effects, respectively. Results showed that low MVPA and low CRF were associated with a higher clustered cardio-metabolic risk (β = -0.26 and β = -0.43, both p<0.001, respectively). CRF explained 73% of the variance in the association between MVPA and clustered cardio-metabolic risk and attenuated this association to non-significance. After mutual adjustment for MVPA and ST, CRF was the most important risk factor for a higher clustered cardio-metabolic risk (β = -0.39, p<0.001). In conclusion, because of the mediating role of CRF, lifestyle-interventions need to be feasible yet challenging enough to lead to increases in CRF to improve someone’s cardio-metabolic health.

Ten-year Change In Sedentary Behavior And Cardiorespiratory Fitness Are Independently Associated With Clustered Cardio-metabolic Risk

PURPOSE: We aimed to study the independent associations between change in sedentary behavior (SB), moderate-to-vigorous physical activity (MVPA) and objectively measured cardiorespiratory fitness (CRF) over 10 years, and concurrent change in clustered cardio-metabolic risk and its individual components (waist circumference, fasting glucose, HDL-cholesterol, triglycerides and blood pressure). We also determined whether any associations were mediated by change in waist circumference or dietary intake. METHODS: A population-based sample of 425 adults (age (mean±SD) 55.83±9.40; 65%men) were followed prospectively for 9.6±0.52 years. Participants self-reported SB and MVPA and performed a maximal cycle ergometer test to estimate peak oxygen uptake at baseline (2002–2004) and follow up (2012–2014). Multiple linear regression and the product of coefficients method were used to examine independent associations and mediation effects, respectively. RESULTS: Greater increase in SB was associated with more detrimental change in clustered cardio-metabolic risk (standardized β = 0.12, p<0.01) and triglycerides (standardized β = 0.12, p<0.05), independently of baseline and change in MVPA and CRF. Greater increase in MVPA was associated with greater increase in HDL-cholesterol, independent of baseline and change in SB and CRF (standardized β = 0.15, p<0.01). Greater decrease in CRF was associated with more detrimental change in clustered cardio-metabolic risk and all other individual components, independently of baseline and change in SB (absolute standardized β ranging from 0.12 to 0.38, p<0.05). Change in waist circumference mediated the relationship between change in CRF and change in fasting glucose, HDL-cholesterol and triglycerides (a*b [95% CI]: fasting glucose: −0.11 [−0.18, −0.04]; HDL-cholesterol: 0.15 [0.08, 0.22]; triglycerides: −0.40 [−0.81, −0.01]). CONCLUSIONS: A combination of decreasing SB and increasing MVPA and CRF is most beneficial towards cardio-metabolic health. However, some associations between changes in CRF and changes in cardio-metabolic risk were mediated through changes in waist circumference. Therefore, from a public health perspective, lifestyle intervention programs need to focus on all three components, which is decreasing SB, increasing MVPA and CRF.

A Comparison between BMI, Waist Circumference, and Waist-To-Height Ratio for Identifying Cardio-Metabolic Risk in Children and Adolescents.

BackgroundThere is controversial evidence on the associations between anthropometric measures with clustering of cardiovascular disease risk factors in pediatric ages. We aimed to examine the associations between body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) with clustered cardiometabolic risk factors and to determine whether these anthropometric variables can be used to discriminate individuals with increased cardiometabolic risk (increased clustered triglycerides, HDL-cholesterol, systolic and diastolic blood pressure, and HOMA-IR).MethodsThe study sample of 4255 (2191 girls and 2064 boys) participants (8–17 years) was derived from pooled cross-sectional data comprising five studies. Outcomes included a continuous cardiometabolic risk factor z-score [corresponding to the sum of z-scores for triglycerides, HDL-cholesterol, systolic and diastolic blood pressure (mean arterial pressure), and HOMA-IR] and children with ≥1.0 SD in this score were defined as being at risk for clustering cardiometabolic risk factors.. Exposure variables were BMI, WC, WHtR. Statistics included mixed-effect regression and ROC analysis.ResultsAll anthropometric variables were associated with clustered risk and the magnitudes of associations were similar for BMI, WC, and WHtR. Models including anthropometric variables were similar in discriminating children and adolescents at increased risk with areas under the ROC curve between 0.70 and 0.74. The sensitivity (boys: 80.5–86.4%; girls: 76.6–82.3%) was markedly higher than specificity (boys: 51.85–59.4%; girls: 60.8%).ConclusionsThe magnitude of associations for BMI, WC, and WHtR are similar in relation to clustered cardiometabolic risk factors, and perform better at higher levels of BMI. However, the precision of these anthropometric variables to classify increased risk is low.

Adverse associations of car time with markers of cardio-metabolic risk

ObjectiveTo examine associations of time spent sitting in cars with markers of cardio-metabolic risk in Australian adults. MethodData were from 2800 participants (age range: 34–65) in the 2011–12 Australian Diabetes, Obesity and Lifestyle Study. Self-reported time spent in cars was categorized into four groups: ≤15min/day; >15 to ≤30min/day; >30 to ≤60min/day; and >60min/day. Markers of cardio-metabolic risk were body mass index (BMI), waist circumference, systolic and diastolic blood pressure, triglycerides, HDL (high-density lipoprotein)-cholesterol, fasting plasma glucose, 2-h plasma glucose, a clustered cardio-metabolic risk score, and having the metabolic syndrome or not. Multilevel linear and logistic regression analyses examined associations of car time with each cardio-metabolic risk outcome, adjusting for socio-demographic and behavioral variables and medication use for blood pressure and cholesterol/triglycerides. ResultsCompared to spending 15min/day or less in cars, spending more than 1h/day in cars was significantly associated with higher BMI, waist circumference, fasting plasma glucose, and clustered cardio-metabolic risk, after adjusting for socio-demographic attributes and potentially relevant behaviors including leisure-time physical activity and dietary intake. Gender interactions showed car time to be associated with higher BMI in men only. ConclusionsProlonged time spent sitting in cars, in particular over 1h/day, was associated with higher total and central adiposity and a more-adverse cardio-metabolic risk profile. Further studies, ideally using objective measures of sitting time in cars and prospective designs, are needed to confirm the impact of car use on cardio-metabolic disease risk.

Prospective associations between sedentary time, physical activity, fitness and cardiometabolic risk factors in people with type 2 diabetes

Aims/hypothesisThe aim of this study was to examine the prospective associations between objectively measured physical activity energy expenditure (PAEE), sedentary time, moderate-to-vigorous-intensity physical activity (MVPA), cardiorespiratory fitness (CRF) and cardiometabolic risk factors over 4 years in individuals with recently diagnosed diabetes.MethodsAmong 308 adults (mean age 61.0 [SD 7.2] years; 34% female) with type 2 diabetes from the Anglo–Danish–Dutch Study of Intensive Treatment in People with Screen Detected Diabetes in Primary Care (ADDITION)-Plus study, we measured physical activity using individually calibrated combined heart rate and movement sensing. Multivariable linear regression models were constructed to examine the associations between baseline PAEE, sedentary time, MVPA, CRF and cardiometabolic risk factors and clustered cardiometabolic risk (CCMR) at follow-up, and change in these exposures and change in CCMR and its components over 4 years of follow-up.ResultsIndividuals who increased their PAEE between baseline and follow-up had a greater reduction in waist circumference (−2.84 cm, 95% CI −4.84, −0.85) and CCMR (−0.17, 95% CI −0.29, −0.04) compared with those who decreased their PAEE. Compared with individuals who decreased their sedentary time, those who increased their sedentary time had a greater increase in waist circumference (3.20 cm, 95% CI 0.84, 5.56). Increases in MVPA were associated with reductions in systolic blood pressure (−6.30 mmHg, 95% CI −11.58, −1.03), while increases in CRF were associated with reductions in CCMR (−0.23, 95% CI −0.40,−0.05) and waist circumference (−3.79 cm, 95% CI −6.62, −0.96). Baseline measures were generally not predictive of cardiometabolic risk at follow-up.Conclusions/interpretationEncouraging people with recently diagnosed diabetes to increase their physical activity and decrease their sedentary time may have beneficial effects on their waist circumference, blood pressure and CCMR.

Strength Capacity and Cardiometabolic Risk Clustering in Colombian young adult.

Strength Capacity and Cardiometabolic Risk Clustering in Colombian young adult.

The combined effect of physical activity and sedentary behaviors on a clustered cardio-metabolic risk score: The Helena study

Background/objectiveIncreased physical activity (PA) and decreased sedentary behaviors (SBs) may have beneficial effects on cardio-metabolic risk in adolescents. The aim of this study was to examine the associations between independent/combined effects of PA and SB with individual/clustered cardio-metabolic risk factors. MethodsA sample of 769 adolescents (12.5–17.5years) from the HELENA cross-sectional study (Healthy Lifestyle in Europe by Nutrition in Adolescence) and with valid data on metabolic risk factors were included. ResultsConcerning moderate-to-vigorous-PA (MVPA) and vigorous-PA (VPA), measured with accelerometers, girls tended to do more MVPA (36%) and VPA (114%) than boys. Unadjusted analyses show a positive association between “PA≥60min/d; SB≥2h” and the ratio TC/HDL-c (β=0.27; 95%CI 0.01 to 0.52; p<0.05), and a negative association between “MVPA≥60min/d; SB<2h” with the ∑4Skinfolds (β=−0.32; 95%CI −0.61 to −0.02; p<0.05). Moreover, “SB≥2h/d” was associated with increased cardio-metabolic risk (PR 1.59; 95%CI 1.05 to 2.39; p<0.05), while “PA≥60min/d; SB<2h” had a protective effect against cardio-metabolic risk (PR 0.48; 95%CI 0.25 to 0.91; p<0.05). After adjustment for potential confounders, a positive association between SB and ∑4Skinfolds was shown (β=0.28; 95%CI 0.04 to 0.53; p<0.05). Furthermore, VO2max (mL/kg/min) tends to increase in those participants who do higher VPA and less SB (p=0.042), and there was a protective effect of “VPA≥30min/d; SB<2h” against cardio-metabolic risk (PR 0.24; 95%CI 0.07 to 0.85; p<0.05). ConclusionThe current study suggests that adolescents should be encouraged to decrease sedentary lifestyle and increase physical activity, especially vigorous physical activity, in order to reduce cardio-metabolic risk.

Abstract 26: DASH-Style Eating Pattern in Early Adolescence Reduces Cardiometabolic Risk Clustering

Cardiometabolic risk (CMR) factor clustering has its roots in childhood and the presence of multiple cardiovascular risk factors in younger populations has been linked with early vascular dysfunction. A DASH-style eating pattern has been shown to reduce blood pressure and other selected cardiometabolic outcomes, primarily in adults, but its role in the development of CMR clustering during adolescence has not been studied. Data from the National Heart, Lung, and Blood Institute’s Growth and Health Study (NGHS) will be used to evaluate the relation between early-to-mid adolescent dietary intake and CMR clustering at the end of adolescence. The NGHS began in 1987-1988 with the enrollment of 2,379 adolescent girls (with approximately equal numbers of blacks and whites), ages 9-10 years. Diet was assessed using 3-day diet records during eight of 10 years of follow up. A total of 1,369 girls had complete data on diet, all potential confounding variables, and follow-up over 10 years for all CMR factors of interest. Risk factor clustering scores were created by summing individual CMR outcomes defined as follows: waist circumference ≥88 cm, systolic and/or diastolic blood pressure ≥90th percentile for age, sex and height, LDL ≥110 mg/dL, HDL &lt;50 mg/dL, serum TG ≥110mg/dl, and HOMA-IR ≥4. Multiple logistic regression analyses were used to estimate the impact of a DASH-style pattern on the relative risk (odds ratio) of CMR clustering at the end of adolescence, defined as having ≥ 2 or ≥ 3 of the above risk factors at 18-20 years of age. The proportion of white and black girls with CMR clustering was very similar. However, the types of risk factors differed by race with blacks being nearly twice as likely to have an increased waist size, elevated BP, or insulin resistance and white girls being much more likely to have abnormal lipid levels, particularly elevated triglyceride levels. By the end of adolescence, only 30.1% of girls had no abnormal CMR factors and 34.9% had a single risk factor; 16.6% of girls had two risk factors and 18.4% had between 3-6 prevalent risk factors. Higher intakes of fruit and non-starchy vegetables, dairy, and grains were independently associated with less CMR clustering. After adjusting for age, race, socio-economic status, height, physical activity, and television watching, girls with a DASH-style eating pattern during early-to-mid adolescence were nearly 50% less likely to have three or more CMR factors (O.R.=0.52; 95% CI: 0.30, 0.89) by late adolescence (at 18-20 years of age). These results suggest a DASH-style eating pattern during adolescence, characterized by higher intakes of fruit, non-starchy vegetables, and dairy, may lower risk for the development of subsequent cardiometabolic disorders.

Adolescent dietary intakes predict cardiometabolic risk clustering.

To prospectively examine the relation between adolescent dietary intake and cardiometabolic risk (CMR) clustering at the end of adolescence. Data from the NHLBI Growth and Health Study on 1369 girls enrolled at ages 9-10 in 1987-1988 and followed for 10 years were used to estimate the relative risk of having multiple (≥2 or ≥3) risk factors in late adolescence associated with usual food intake patterns from 9 to 17 years of age. Mean food intakes were derived from multiple 3-day diet records and CMR factors included larger waist circumference, insulin resistance, low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol, high triglycerides, and elevated systolic or diastolic blood pressures. Of 1369 subjects, 18.4 % girls had 3-6 prevalent risk factors by the end of adolescence and 35.0 % had at least two. Higher intakes of fruit and non-starchy vegetables, dairy, and grains were independently associated with having fewer risk factors as were eating patterns characterized by higher combined intakes of these food groups. After adjusting for age, race, socio-economic status, height, physical activity, and television watching, girls with high intakes of dairy and fruits and non-starchy vegetables (vs. those with lower intakes of both) were nearly 50 % less likely to have three or more CMR factors in late adolescence; girls with higher intakes of grains plus fruits and non-starchy vegetables were nearly 60 % less likely. These results suggest that healthy food consumption patterns during adolescence may prevent accumulation of cardiometabolic risk.

Sleep duration and cardiometabolic risk factors among individuals with type 2 diabetes

ObjectiveTo examine the association between sleep duration and cardiometabolic risk factors among individuals with recently diagnosed type 2 diabetes (n = 391). MethodsSleep duration was derived using a combination of questionnaire and objective heart rate and movement sensing in the UK ADDITION-Plus study (2002–2007). Adjusted means were estimated for individual cardiometabolic risk factors and clustered cardiometabolic risk (CCMR) by five categories of sleep duration. ResultsWe observed a J-shaped association between sleep duration and CCMR – individuals sleeping 7 to <8 h had a significantly better CCMR profile than those sleeping ≥9 h. Independent of physical activity and sedentary time, individuals sleeping 7 to <8 h had lower triacylglycerol (0.62 mmol/l (0.29, 1.06)) and higher high-density lipoprotein (HDL)-cholesterol levels (0.23 mmol/l (0.16, 0.30)) compared with those sleeping ≥9 h, and a lower waist circumference (7.87 cm (6.06, 9.68)) and body mass index (BMI) (3.47 kg/m2 (2.69, 4.25)) than those sleeping <6 h. Although sleeping 7 to <8 h was associated with lower levels of systolic and diastolic blood pressure, HbA1c, total cholesterol, and low-density lipoprotein (LDL)-cholesterol, these associations were not statistically significant. ConclusionsSleep duration has a J-shaped association with CCMR in individuals with diabetes, independent of potential confounding. Health promotion interventions might highlight the importance of adequate sleep in this high-risk population.

The Association Between Cardiorespiratory Fitness and Cardiometabolic Risk in Children is Mediated by Abdominal Adiposity: The HAPPY Study.

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.

Progression of cardio-metabolic risk factors in subjects born small and large for gestational age.

BackgroundSubjects born small (SGA) and large (LGA) for gestational age have an increased risk of cardio-metabolic alterations already during prepuberty. Nevertheless, the progression of their cardio-metabolic profile from childhood to adolescence has not been fully explored. Our aim was to assess potential changes in the cardio-metabolic profile from childhood to adolescence in subjects born SGA and LGA compared to those born appropriate (AGA) for gestational age.MethodsThis longitudinal study included 35 AGA, 24 SGA and 31 LGA subjects evaluated during childhood (mean age (±SD) 8.4±1.4 yr) and then re-assessed during adolescence (mean age 13.3±1.8 yr). BMI, blood pressure, insulin resistance (fasting insulin, HOMA-IR) and lipids were assessed. A cardio-metabolic risk z-score was applied and this consisted in calculating the sum of sex-specific z-scores for BMI, blood pressure, HOMA-IR, triglycerides and triglycerides:high-density lipoprotein cholesterol ratio.ResultsFasting insulin and HOMA-IR were higher in SGA and LGA than AGA subjects both during childhood (all P<0.01) and adolescence (all P<0.01). Similarly, the clustered cardio-metabolic risk score was higher in SGA and LGA than AGA children (both P<0.05), and these differences among groups increased during adolescence (both P<0.05). Of note, a progression of the clustered cardio-metabolic risk score was observed from childhood to adolescence within SGA and within LGA subjects (both P<0.05).ConclusionsSGA and LGA subjects showed an adverse cardio-metabolic profile during childhood when compared to AGA peers, with a worsening of this profile during adolescence. These findings indicate an overtime progression of insulin resistance and overall estimated cardiovascular risk from childhood to adolescence in SGA and LGA populations.

The prospective relationship between sedentary time and cardiometabolic health in adults at increased cardiometabolic risk - the Hoorn Prevention Study.

BackgroundSedentary time has been identified as an important and independent risk factor for the development of type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD) in adults. However, to date most studies have focused on TV time, few also included other sedentary behaviours such as computer use and reading, and most studies had a cross-sectional design. We aimed to examine the prospective relationship between time spent on sedentary behaviours in different domains with individual and clustered cardiometabolic risk in adults.MethodsLongitudinal data of 622 adults aged 30-50 years (42% males) at increased cardiometabolic risk were used. Leisure time TV viewing, computer use, reading and other sedentary activities (e.g. passive transport) were assessed using a subscale of the Activity Questionnaire for Adolescents and Adults (AQuAA), and summed into overall sedentary behaviour (min/day). Weight and blood pressure were measured, waist-to-hip ratio and BMI calculated, and fasting plasma levels of glucose, HbA1c, total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides determined. T2DM risk score was estimated according to the ARIC formula and CVD mortality risk according to the SCORE formula.ResultsGeneralized Estimating Equation analysis demonstrated that over a two-year period higher levels of overall sedentary time and TV time were weakly but negatively associated with one out of 13 studied cardiometabolic risk factors (i.e. HDL cholesterol).ConclusionOverall sedentary time, as well as sedentary time in different domains, was virtually not related with cardiometabolic risk factors.

Objectively measured sedentary behaviour and cardio-metabolic risk in youth: a review of evidence.

The aim of this paper was to review studies that examine the association between volume and pattern of objectively measured sedentary behaviour and markers of cardio-metabolic risk in youth. A search for relevant articles was conducted in PubMed and SportDiscus, and the following inclusion criteria were applied: (i) youth participants (age range 6-19); (ii) accelerometer-measured volume and/or pattern of sedentary behaviour and its association with ≥1 cardio-metabolic outcome; and (iii) published, in press or accepted in an English language peer-reviewed journal between January 2000 and October 2013. A total of 45 articles met the a priori criteria and, thus, were considered eligible for inclusion. Although youth accumulate approximately 6 to 8 h of daily sedentary behaviour, little evidence supports an association with individual and clustered cardio-metabolic risk when adjusted for moderate-to-vigorous physical activity (MVPA). We suggest that youth should be encouraged to engage in recommended levels of MVPA and reduce excessive time spent in screen-based sedentary behaviour. Future studies should examine the association between volume and pattern of objectively measured sedentary behaviour and cardio-metabolic risk independent of time spent in MVPA.

Diet patterns and clustering of cardiometabolic risk during adolescence (267.5)

Objective: To examine the relation between adolescent dietary patterns and cardiometabolic risk (CMR) clustering at end of adolescence.Methods: Data for 1369 girls enrolled at 9‐10 years of age in the longitudinal NHLBI Growth and Health Study were used. Girls with complete data over 10 years on diet, and six CMR factors, and all confounders of interest were included. Mean dietary data were derived from 3‐day records. CMR factors analyzed included increased waist circumference, elevated blood pressure, insulin resistance, low HDL‐cholesterol and high LDL‐cholesterol and triglyceride levels. Multiple logistic regression analysis was used to estimate the relative risk of having multiple (蠅 2 or 蠅 3) risk factors in late adolescence associated with usual dietary patterns from 9‐17 years of age.Results: Of 1369 subjects included, 252 (18.4%) had 3‐6 risk factors while 479 (35.0%) had two or more. Higher intakes of fruit and non‐starchy vegetables, dairy, and grains were independently associated with having fewer risk factors as were eating patterns characterized by higher combined intakes of these food groups. After adjusting for age, race, socio‐economic status, height, physical activity, and television watching, girls with high intakes of both dairy and fruits and non‐starchy vegetables (vs. lower intakes) were nearly 50% less likely to have 蠅 3 CMR factors while girls with higher intakes of grains and fruits and non‐starchy vegetables (vs. lower intakes) were nearly 60% less likely to have 蠅 3 CMR factors.Conclusion: These data suggest that CMR clustering at the end of adolescence is associated with dietary patterns during adolescence.

Strength Capacity and Cardiometabolic Risk Clustering in Adolescents

The purpose of this study was to determine the gender-specific independent association between muscular strength and cardiometabolic risk clustering in a large cohort (n = 1421) of children. Principal component analysis was used to determine the pattern of risk clustering and to derive a continuous aggregate score (MetScore) from various cardiometabolic risk components: percent body fat (%BF), fasting glucose, blood pressure, plasma triglycerides levels, and HDL-cholesterol. Gender-stratified risk and MetScore were assessed by using general linear models and logistic regression for differences between strength tertiles, as well as independent associations with age, BMI, estimated cardiorespiratory fitness (CRF), physical activity, and muscular strength (normalized for body mass). In both boys (n = 670) and girls (n = 751), there were significant differences in cardiometabolic profiles across strength tertiles, such that stronger adolescents had lower overall risk. Age, BMI, cardiorespiratory fitness, physical activity participation, and strength were all individually correlated with multiple risk components, as well as the overall MetScore. However, in the adjusted model, only BMI (β = 0.30), physical inactivity (β = 0.30), and normalized strength capacity (β = -1.5) emerged as significant (P < .05) predictors of MetScore. %BF was the strongest loading coefficient within the principal component analysis-derived MetScore outcome. Normalized strength is independently associated with lower cardiometabolic risk in boys and girls. Moreover, %BF was associated with all cardiometabolic risk factors and carried the strongest loading coefficient. These findings bolster the importance of early strength acquisition and healthy body composition in childhood.

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

AimTo determine which cardiometabolic risk factors and clusters of cardiometabolic risk factors that are mostly associated with elevated HbA1c in non-Hispanic White (NHW), non-Hispanic Black (NHB) and Mexican-American (MA) adults who have type 2 diabetes. MethodsData (n=2910) from the United States National Health and Nutritional Examination Surveys were used in this study. Elevated HbA1c was defined as having HbA1c value was 7% or greater. Race/ethnicity-specific associations of individual and clustered (2–5 factors) cardiometabolic risk factors with elevated HbA1c were determined using prevalence odds ratio from multivariate logistic regression analyses. Statistical adjustments were made for sex, age, education, income and marital status. ResultsJoint occurrence of abdominal obesity, high blood pressure, and elevated triglycerides and joint occurrence of high blood pressure, elevated triglycerides and low HDL were more highly associated with elevated odds of HbA1c compared to other cardiometabolic risk factors joint occurrences. Joint occurrences of abdominal obesity, high blood pressure, and elevated triglycerides was associated with 2.3 (95% CI: 1.2–3.3), 9.1 (95% CI: 2.9–28.7) and 4.8 (95% CI: 2.0–11.5) increased odds of elevated HbA1c in NHW, NHB and MA, respectively. The corresponding values for the joint occurrence of high blood pressure, elevated triglycerides and low HDL was associated with 2.4 (95% CI: 1.2–3.7), 3.5 (95% CI: 1.1–5.5) and 2.6 (95% CI: 1.5–4.7) increased odds of elevated HbA1c in NHW, NHB and MA, respectively. ConclusionThis finding calls for consideration of cardiovascular risk factor clustering in deciding medical therapies to optimize glycemic control in individuals with type 2 diabetes. Interventions designed to achieve glycemic control coupled with modification of cardiometabolic risk factors may be crucial in alleviating sequelae resulting from type 2 diabetes.

Strength Capacity and Cardiometabolic Risk Clustering in Adolescents

Strength Capacity and Cardiometabolic Risk Clustering in Adolescents

Assessment of biochemical liver markers, physical activity, fitness and body mass index for a cardiometabolic risk model in childhood

The aim of this study was to investigate clustered cardiometabolic risk scores in healthy 10- to 12-year-olds using anthropometric characteristics, measurements of cardiorespiratory fitness (CRF) and physical activity and blood markers of metabolic disease. We also evaluated how including markers of liver cell injury would affect the clustered cardiometabolic risk assessment model. This cross-sectional study focused on 99 children aged 10-12 years. The main outcome included assessing participants with increased and low cardiometabolic risk factors using a clustered risk score model that incorporated markers implicated in metabolic syndrome pathogenesis. Two clustered risk scores were calculated, one incorporating markers of liver cell injury. Children classified as 'increased risk' exhibited significantly lower CRF and higher body mass index Z-scores than their 'low-risk' peers. No significant differences in physical activity were observed. This trend remained unchanged when markers of liver injury were included in the clustered risk assessment model. The clustered risk score model is a scientifically robust method of cardiometabolic risk assessment, which reiterates the importance of weight reduction and CRF promotion in childhood. Our study did not show a significant contribution of liver injury markers, and further research is needed to evaluate their effect on cardiometabolic risk stratification in childhood.