Cardiometabolic Risk Score Research Articles

Cardiorespiratory fitness predicts clustered cardiometabolic risk in 10–11.9-year-olds

The aim of this study was to investigate levels of clustered cardiometabolic risk and the odds of being 'at risk' according to cardiorespiratory fitness status in children. Data from 88 10-11.9-year-old children (mean age 11.05 ± 0.51 years), who participated in either the REACH Year 6 or the Benefits of Fitness Circuits for Primary School Populations studies were combined. Waist circumference, systolic blood pressure, diastolic blood pressure, glucose, triglycerides, high-density lipoprotein cholesterol, adiponectin and C-reactive protein were assessed and used to estimate clustered cardiometabolic risk. Participants were classified as 'fit' or 'unfit' using recently published definitions (46.6 and 41.9 mL/kg/min for boys and girls, respectively), and continuous clustered risk scores between fitness groups were assessed. Participants were subsequently assigned to a 'normal' or 'high' clustered cardiometabolic risk group based on risk scores, and logistic regression analysis assessed the odds of belonging to the increased cardiometabolic risk group according to fitness. The unfit group exhibited significantly higher clustered cardiometabolic risk scores (p < 0.001) than the fit group. A clear association between fitness group and being at increased cardiometabolic risk (B = 2.509, p = 0.001) was also identified, and participants classed as being unfit were found to have odds of being classified as 'at risk' of 12.30 (95 % CI = 2.64-57.33). Conclusion Assessing cardiorespiratory fitness is a valid method of identifying children most at risk of cardiometabolic pathologies. The ROC thresholds could be used to identify populations of children most at risk and may therefore be used to effectively target a cardiometabolic risk-reducing public health intervention.

Relative residential property value as a socio-economic status indicator for health research

BackgroundResidential property is reported as the most valuable asset people will own and therefore provides the potential to be used as a socio-economic status (SES) measure. Location is generally recognised as the most important determinant of residential property value.Extending the well-established relationship between poor health and socio-economic disadvantage and the role of residential property in the overall wealth of individuals, this study tested the predictive value of the Relative Location Factor (RLF), a SES measure designed to reflect the relationship between location and residential property value, and six cardiometabolic disease risk factors, central obesity, hypertriglyceridemia, reduced high density lipoprotein (HDL), hypertension, impaired fasting glucose, and high low density lipoprotein (LDL). These risk factors were also summed and expressed as a cumulative cardiometabolic risk (CMR) score.MethodsRLF was calculated using a global hedonic regression model from residential property sales transaction data based upon several residential property characteristics, but deliberately blind to location, to predict the selling price of the property. The predicted selling price was divided by the actual selling price and the results interpolated across the study area and classified as tertiles. The measures used to calculate CMR were collected via clinic visits from a population-based cohort study. Models with individual risk factors and the cumulative cardiometabolic risk (CMR) score as dependent variables were respectively tested using log binomial and Poisson generalised linear models.ResultsA statistically significant relationship was found between RLF, the cumulative CMR score and all but one of the risk factors. In all cases, participants in the most advantaged and intermediate group had a lower risk for cardio-metabolic diseases. For the CMR score the RR for the most advantaged was 19% lower (RR = 0.81; CI 0.76-0.86; p <0.0001) and the middle group was 9% lower (RR = 0.91; CI 0.86-0.95; p <0.0001) than the least advantaged group.ConclusionsThis paper advances the understanding of the nexus between place, health and SES by providing an objective spatially informed SES measure for testing health outcomes and reported a robust association between RLF and several health measures.

Fitness and Adiposity Are Independently Associated with Cardiometabolic Risk in Youth

Purpose. The purpose of the study was to examine the independent associations of adiposity and cardiorespiratory fitness with clustered cardiometabolic risk. Methods. A cross-sectional sample of 192 adolescents (118 boys), aged 14–16 years, was recruited from a South Lanarkshire school in the West of Scotland. Anthropometry and blood pressure were measured, and blood samples were taken. The 20 m multistage fitness test was the indicator of cardiorespiratory fitness (CRF). A clustered cardiometabolic risk score was constructed from HDL-C (inverted), LDL-C, HOMA, systolic blood pressure, and triglycerides. Interleukin-6, C-reactive protein, and adiponectin were also measured and examined relative to the clustered cardiometabolic risk score, CRF, and adiposity. Results. Although significant, partial correlations between BMI and waist circumference (WC) and both CRF and adiponectin were negative and weak to moderate, while correlations between the BMI and WC and CRP were positive but weak to moderate. Weak to moderate negative associations were also evident for adiponectin with CRP, IL-6, and clustered cardiometabolic risk. WC was positively associated while CRF was negatively associated with clustered cardiometabolic risk. With the additional adjustment for either WC or CRF, the independent associations with cardiometabolic risk persisted. Conclusion. WC and CRF are independently associated with clustered cardiometabolic risk in Scottish adolescents.

Metabolic Syndrome in Youth: Chimera or Useful Concept?

Metabolic syndrome (MetS) is a cluster of cardiometabolic risk factors associated with an increased risk for the development of cardiovascular diseases and type 2 diabetes. The prevalence of the MetS is not particularly high in the overall pediatric population (3 %-4 %) but it is as high as 30 %-50 % among overweight youth. Several definitions of the MetS have been used, thus, generating confusion and difficulties in defining the true prevalence of this syndrome. The recent definition of the International Diabetes Federation has tried to standardize the diagnostic criteria. However, there are still some concerns about use of cut-offs values and dichotomous variables, and some debate as to whether a continuous cardiometabolic risk score could be more appropriate for the pediatric population. Although there are some studies that have shown the association between childhood and adolescent MetS with long-term outcomes, further prospective studies are needed to clarify the true value of diagnosing MetS in youth.

ROC Generated Thresholds for Field-Assessed Aerobic Fitness Related to Body Size and Cardiometabolic Risk in Schoolchildren

Objectives1. to investigate whether 20 m multi-stage shuttle run performance (20mSRT), an indirect measure of aerobic fitness, could discriminate between healthy and overweight status in 9–10.9 yr old schoolchildren using Receiver Operating Characteristic (ROC) analysis; 2. Investigate if cardiometabolic risk differed by aerobic fitness group by applying the ROC cut point to a second, cross-sectional cohort.DesignAnalysis of cross-sectional data.Participants16,619 9–10.9 year old participants from SportsLinx project and 300 11–13.9 year old participants from the Welsh Schools Health and Fitness Study.Outcome MeasuresSportsLinx; 20mSRT, body mass index (BMI), waist circumference, subscapular and superilliac skinfold thicknesses. Welsh Schools Health and Fitness Study; 20mSRT performance, waist circumference, and clustered cardiometabolic risk.AnalysesThree ROC curve analyses were completed, each using 20mSRT performance with ROC curve 1 related to BMI, curve 2 was related to waist circumference and 3 was related to skinfolds (estimated % body fat). These were repeated for both girls and boys. The mean of the three aerobic fitness thresholds was retained for analysis. The thresholds were subsequently applied to clustered cardiometabolic risk data from the Welsh Schools study to assess whether risk differed by aerobic fitness group.ResultsThe diagnostic accuracy of the ROC generated thresholds was higher than would be expected by chance (all models AUC >0.7). The mean thresholds were 33 and 25 shuttles for boys and girls respectively. Participants classified as ‘fit’ had significantly lower cardiometabolic risk scores in comparison to those classed as unfit (p<0.001).ConclusionThe use of the ROC generated cut points by health professionals, teachers and coaches may provide the opportunity to apply population level ‘risk identification and stratification’ processes and plan for “at-risk” children to be referred onto intervention services.

Video game playing time and cardiometabolic risk in adolescents: The AFINOS study

Background and objectiveWe aimed to examine the association of video games playing time with cardiometabolic risk biomarkers in adolescents. Subjects and methodsThis study comprised 181 adolescents (88 girls), aged 13- to 17 years old. Moderate-to-vigorous physical activity (MVPA) was measured by accelerometry, and video game playing time in computer and console was self-reported. Waist circumference, systolic blood pressure (BP) and diastolic BP, mean arterial pressure, HDL-cholesterol, LDL-cholesterol, total cholesterol, triglycerides, glucose, insulin, and apolipoproteins A-1 and B-100 were measured. ResultsComputer games use was not significantly associated with any biomarker (P>0.1) but the time spent using console games was positively associated with diastolic BP, mean arterial pressure, triglycerides, and a clustered cardiometabolic risk score. These results were independent of age, sex, pubertal stage, MVPA, and WC. ConclusionThese results support some evidence regarding a plausible unfavorable role of playing (console) video games on cardiometabolic health in adolescence.

Associations between cardiorespiratory fitness, physical activity and clustered cardiometabolic risk in children and adolescents: the HAPPY study

Clustering of cardiometabolic risk factors can occur during childhood and predisposes individuals to cardiometabolic disease. This study calculated clustered cardiometabolic risk in 100 children and adolescents aged 10-14 years (59 girls) and explored differences according to cardiorespiratory fitness (CRF) levels and time spent at different physical activity (PA) intensities. CRF was determined using a maximal cycle ergometer test, and PA was assessed using accelerometry. A cardiometabolic risk score was computed as the sum of the standardised scores for waist circumference, blood pressure, total cholesterol/high-density lipoprotein ratio, triglycerides and glucose. Differences in clustered cardiometabolic risk between fit and unfit participants, according to previously proposed health-related threshold values, and between tertiles for PA subcomponents were assessed using ANCOVA. Clustered risk was significantly lower (p < 0.001) in the fit group (mean 1.21 ± 3.42) compared to the unfit group (mean -0.74 ± 2.22), while no differences existed between tertiles for any subcomponent of PA. Conclusion These findings suggest that CRF may have an important cardioprotective role in children and adolescents and highlights the importance of promoting CRF in youth.

Early adulthood television viewing and cardiometabolic risk profiles in early middle age: results from a population, prospective cohort study

Little research has been done on the long-term longitudinal associations between markers of sedentary behaviour and health risks. We hypothesised that television (TV) viewing in early to mid-adulthood predicts an adverse cardiometabolic risk factor profile in middle age independently of participation in physical activity. We used prospective data from 5,972 (2,947 men) participants of the 1958 British Birth Cohort study. TV viewing and exercise frequency were obtained at age 23 years. Daily TV viewing and weekly moderate to vigorous physical activity were assessed at age 44 years, as well as HbA(1c), triacylglycerol, total and HDL-cholesterol, systolic and diastolic blood pressure, and waist circumference. We used generalised linear models and multiple linear regression to examine the associations between TV viewing at age 23 years and the cardiometabolic risk markers (including a clustered cardiometabolic risk score) at 44 years, while adjusting for sex, exercise participation and TV viewing at age 44 years, and other potential confounders. In the multivariable models, TV viewing frequency at age 23 years showed positive associations with C-reactive protein (generalised linear model change 12.6%, 95% CI 3.5, 22.8; p = 0.005), fibrinogen (change 1.8%, 95% CI 0.3, 3.3; p = 0.020), waist circumference (coefficient 1.17, 95% CI 0.32, 2.01; p = 0.004), systolic (coefficient 1.44, 95% CI 0.33, 2.54; p = 0.019) and diastolic (coefficient 0.75, 95% CI -0.01, 1.51; p = 0.053) blood pressure, and clustered cardiometabolic risk score (men only, coefficient 0.06, 95% CI 0.01, 0.11; p = 0.038). Adjustments for baseline (age 23 years) BMI attenuated these associations towards null. TV viewing habits in early adulthood are associated with adverse cardiometabolic profiles in early middle adulthood that are independent of TV viewing habits and physical activity in middle age, but not independent of BMI in early adulthood.

DIABRISK - SL Prevention of cardio-metabolic disease with life style modification in young urban Sri Lankan's - study protocol for a randomized controlled trial

BackgroundUrban South-Asian's are predisposed to early onset of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). There is an urgent need for country specific primary prevention strategies to address the growing burden of cardio-metabolic disease in this population. The aim of this clinical trial is to evaluate whether intensive (3-monthly) lifestyle modification advice is superior to a less-intensive (12 monthly; control group) lifestyle modification advice on a primary composite cardio-metabolic end point in 'at risk' urban subjects aged between 5-40 years.Methods/DesignThis is an open randomised controlled parallel group clinical trial performed at a single centre in Colombo, Sri-Lanka. A cluster sampling strategy was used to select a large representative sample of subjects aged between 5-40 years at high risk of T2DM and CVD for the intervention study. We have screened 23,298 (males 47% females 53%) healthy subjects for four risk factors: obesity, elevated waist circumference, family history of diabetes and physical inactivity, using a questionnaire and anthropometry. Those with two or more risk-factors were recruited to the intervention trial. We aim to recruit 4600 subjects for the intervention trial. The primary composite cardio-metabolic end point is; new onset T2DM, impaired glucose tolerance, impaired fasting glycaemia, new onset hypertension and albuminuria, following 5 years of intervention. The effect of the intervention on pre-specified secondary endpoints will also be evaluated. The study will be conducted according to good clinical and ethical practice, data analysis and reporting guidelines.DiscussionDIABRISK-SL is a large population based trial to evaluate the prevalence of diabetes, pre-diabetes and cardio-metabolic risk factors among young urban Sri-Lankans and the effect of a primary prevention strategy on cardio-metabolic disease end points. This work will enable country specific and regional cardio-metabolic risk scores to be derived. Further if the proposed intervention is successful the results of this study can be translated and implemented as a low-cost primary prevention tool in Sri-Lanka and other low/middle income developing countries.Trial registrationThe trial is registered with the World Health Organisation and Sri-Lanka clinical trial registry number SLCTR/2008/003

Volume, patterns, and types of sedentary behavior and cardio-metabolic health in children and adolescents: a cross-sectional study

BackgroundCardio-metabolic risk factors are becoming more prevalent in children and adolescents. A lack of moderate-to-vigorous intensity physical activity (MVPA) is an established determinant of cardio-metabolic risk factors in children and adolescents. Less is known about the relationship between sedentary behavior and cardio-metabolic health. Therefore, the objective was to examine the independent associations between volume, patterns, and types of sedentary behavior with cardio-metabolic risk factors among children and adolescents.MethodsThe results are based on 2527 children and adolescents (6-19 years old) from the 2003/04 and 2005/06 National Health and Nutrition Examination Surveys (NHANES). A cardio-metabolic risk score (CRS) was calculated based on age- and sex-adjusted waist circumference, systolic blood pressure, non-high-density lipoprotein cholesterol, and C-reactive protein values. Volume and patterns of sedentary behavior and moderate-to-vigorous physical activity (MVPA) were measured objectively using accelerometers. Types of sedentary behavior were measured by questionnaire. A series of logistic regression models were used to examine associations.ResultsVolume and patterns of sedentary behavior were not predictors of high CRS after adjusting for MVPA and other confounders (P > 0.1). For types of sedentary behavior, high TV use, but not high computer use, was a predictor of high CRS after adjustment for MVPA and other confounders. Children and adolescents who watched ≥4 hours per day of TV were 2.53 (95% confidence interval: 1.45-4.42) times more likely to have high CRS than those who watched <1 hour per day. MVPA predicted high CRS after adjusting for all sedentary behavior measures and other confounders. After adjustment for waist circumference, MVPA also predicted high non-obesity CRS; however, the same relationship was not seen with TV use.ConclusionNo association was observed between overall volume and patterns of sedentary behavior with cardio-metabolic risk factors in this large sample of children and adolescents. Conversely, high TV use and low MVPA were independently associated with cardio-metabolic risk factors. However, the association between high TV use and clustered cardio-metabolic risk factors appears to be mediated or confounded by obesity. Thus, TV and MVPA appear to be two separate behaviors that need to be targeted with different interventions and policies.

Healthy lifestyle factors associated with reduced cardiometabolic risk

Minimal data are available regarding the cumulative effects of healthy lifestyle behaviours on cardiometabolic risk. The objective of the present study was to examine a combination of healthy lifestyle behaviours associated with cardiometabolic risk reduction. The analysis was based on a cross-sectional study of 1454 participants from the population-based Lipid Research Clinic's Princeton Follow-up Study. The healthy lifestyle factors included fruit and vegetable intake≥5servings/d, meat intake≤2servings/d, never smoking, consuming 2-6 alcoholic drinks/week, television (TV) viewing time≤2h/d and moderate to vigorous physical activity≥4h/week. The combination of healthy lifestyle behaviours was strongly and negatively associated with the presence of cardiometabolic risk, as well as with a composite cardiometabolic risk score after adjustment for race, age, generation and sex. With each additional healthy lifestyle factor, cardiometabolic risk decreased by 31% (OR 0·69; 95% CI 0·61, 0·78). A higher healthy lifestyle score was associated with a lower prevalence of cardiometabolic risk (P for trend<0·001). Compared with individuals having 0-1 healthy lifestyle behaviours, those with 5 or 6 healthy lifestyle behaviours had a 70% lower prevalence of cardiometabolic risk (OR 0·30; 95% CI 0·13, 0·67). Healthy lifestyle behaviours including sufficient fruit and vegetable intake, less meat intake, less TV viewing time, abstinence from smoking, modest alcohol intake and regular exercise are associated with reduced cardiometabolic risk.

Regular Physical Activity Moderates Cardiometabolic Risk in Alzheimer's Caregivers

Dementia caregivers have an increased risk of cardiovascular disease, and it is possible that metabolic disturbances contribute to this risk. Regular physical exercise reduces cardiometabolic risk, but caregivers may have less opportunity to engage in such activity. We hypothesized that regular physical activity would moderate cardiometabolic risk in dementia caregivers. One hundred and fifteen Alzheimer's caregivers and 54 noncaregiving controls were assessed for medical history and health habits. Physical activity was defined as the number of days per week participants performed light (score = 0-4), moderate (score = 0-4), or vigorous (score = 0-4) exercise (total score = 0-12). A cardiometabolic risk score was calculated by adding standardized z-scores of five metabolic syndrome components: body mass index, triglycerides, HDL cholesterol, systolic blood pressure, and glucose. Caregivers were less physically active than noncaregivers (mean ± SD = 5.1 ± 3.0 vs 6.3 ± 2.7, P = 0.008). A significant caregiver status × physical activity interaction was found for the standardized cardiometabolic risk score controlling for gender, age, education, smoking, alcohol consumption, health problems, cholesterol-lowering medication, negative affect, role overload, and fasting state (P = 0.035). Among participants with low levels of physical activity, caregivers had greater cardiometabolic risk score than noncaregivers (0.58 ± 0.31 vs -1.23 ± 0.54, P = 0.017); no group difference emerged in participants with high levels of physical activity (P = 0.81). Cardiometabolic risk was particularly high in caregivers reporting reduced levels of regular physical activity. Intervention studies aimed at increasing physical activity in caregivers seem warranted to examine whether that would possibly lower cardiometabolic risk to the level of noncaregivers.

032 Relative importance of smoking, physical activity and screen-based entertainment in explaining socio-economic inequalities in cardiovascular disease risk

ObjectiveTo assess the extent to which smoking, moderate-to-vigorous physical activity (MVPA), and screen-based entertainment (SBE) explain the association between socio-economic position (SEP) and CVD risk.DesignCross-sectional health examination survey linked to...

Increased Cardiometabolic Risk Is Associated with Increased TV Viewing Time

Television viewing time, independent of leisure time physical activity, has cross-sectional relationships with the metabolic syndrome and its individual components. We examined whether baseline and 5-yr changes in self-reported television viewing time are associated with changes in continuous biomarkers of cardiometabolic risk (waist circumference, triglycerides, HDL-cholesterol, systolic and diastolic blood pressure, fasting plasma glucose, and a clustered cardiometabolic risk score) in Australian adults. The Australian Diabetes, Obesity and Lifestyle Study (AusDiab) is a prospective, population-based cohort study with biological, behavioral, and demographic measures collected in 1999-2000 and 2004-2005. Noninstitutionalized adults aged > or =25 yr were measured at baseline (11,247; 55% of those completing an initial household interview); 6400 took part in the 5-yr follow-up biomedical examination, and 3846 met the inclusion criteria for this analysis. Multiple linear regression analysis was used, and unstandardized B coefficients (95% confidence intervals (CI)) are provided. Baseline television viewing time (10 h.wk-1 unit) was not significantly associated with change in any of the biomarkers of cardiometabolic risk. Increases in television viewing time over 5 yr (10 h.wk-1 unit) were associated with increases in waist circumference (men: 0.43 cm, 95% CI = 0.08-0.78 cm, P = 0.02; women: 0.68 cm, 95% CI = 0.30-1.05, P < 0.001), diastolic blood pressure (women: 0.47 mm Hg, 95% CI = 0.02-0.92 mm Hg, P = 0.04), and the clustered cardiometabolic risk score (women: 0.03, 95% CI = 0.01-0.05, P = 0.007). These associations were independent of baseline television viewing time and baseline and change in physical activity and other potential confounders. These findings indicate that an increase in television viewing time is associated with adverse cardiometabolic biomarker changes. Further prospective studies using objective measures of several sedentary behaviors are required to confirm causality of the associations found.

Sagittal Abdominal Diameter as a Screening Tool in Clinical Research: Cutoffs for Cardiometabolic Risk

Background. Waist girth and BMI are commonly used as markers of cardiometabolic risk. Accumulating data however suggest that sagittal abdominal diameter (SAD) or “abdominal height” may be a better marker of intra-abdominal adiposity and cardiometabolic risk. We aimed to identify cutoffs for SAD using a cardiometabolic risk score. Design. A population-based cross-sectional study. Methods. In 4032 subjects (1936 men and 2096 women) at age 60, different anthropometric variables (SAD, BMI, waist girth, and waist-to-hip ratio) were measured and cardiometabolic risk score calculated. ROC curves were used to assess cutoffs. Results. Among men SAD showed the strongest correlations to the majority of the individual risk factors; whereas in women SAD was equal to that of waist girth. In the whole sample, the area under the ROC curve was highest for SAD. The optimal SAD cutoff for an elevated cardiometabolic risk score in men was ∼22 cm (95%CI; 21.6 to 22.8) and in women ∼20 cm (95%CI; 19.4 to 20.8). These cutoffs were similar if the Framingham risk score was used. Conclusions. These cutoffs may be used in research and screening to identify “metabolically obese” men who would benefit from lifestyle and pharmacological interventions. These results need to be verified in younger age groups.