Cardiovascular Health In Youth Research Articles

Mediative role of body mass index in cardiorespiratory fitness-associated vascular remodeling in youth.

Data on fitness-associated arterial remodeling in children is limited. We assessed the relation between cardiorespiratory fitness (CRF) and intima-media thickness (IMT), diameter, IMT:diameter-ratio (IDR), and tensile stress of the common carotid artery (CCA) in 697 healthy German schoolchildren. Further, we explored how body mass index (BMI) may influence these associations. We measured the vascular parameters with a high-resolution ultrasound device. We determined CRF using the FITNESSGRAM® PACER test and calculated each child's allometrically scaled peak oxygen uptake capacity (VO2peak). VO2peak, reflecting CRF, showed positive direct effects on IMT (girls: p < 0.001; boys: p = 0.02) and diameter in girls (p < 0.001). Considering BMI as a mediator, higher CRF was indirectly linked to decreases in IMT (girls: p = 0.04; boys: p = 0.02) and diameter (both p < 0.001), reflecting a competitive mediation. CRF indirectly mitigated the BMI-associated decrease in IDR (both p < 0.001) and increase in tensile stress (both p < 0.001) without affecting any of these parameters directly. CRF appears to be linked to uniform arterial remodeling with balanced hemodynamics and to further alleviate BMI-associated, potentially adverse vascular alterations, highlighting its significant role in cardiovascular health in youth. Data on CRF-associated arterial remodeling in youth is limited. Higher VO2peak, reflecting higher CRF, was positively associated with IMT in girls and boys and diameter in girls. These direct effects were counteracted by the indirect BMI-mediated effect of CRF on IMT and diameter, reflecting a competitive mediation. A higher CRF indirectly mitigated the BMI-associated decrease in IDR and increase in tensile stress without directly affecting any of these parameters. Our findings indicate homogenous remodeling and balanced hemodynamics with increasing CRF-and opposite effects with increasing BMI.

Abstract P407: Sex and age differences in cardiovascular health in youth referred for hypertension disorders at baseline: A SUPERHERO Registry analysis

Background: The prevalence of hypertension (HTN) and other cardiovascular (CV) disease risk factors (e.g., target organ injury (TOI), obesity, dyslipidemia, hyperglycemia) are increasing steadily in youth. In adults, sex and age differences are established, but remain unknown in children (1–12 years) and adolescents (≥13 years). Objective: Determine sex and age differences in blood pressure (BP) severity, TOI, and CV health in youth referred for HTN disorders. Design/Methods: Cross-sectional analysis of baseline data from the Study of the Epidemiology of Pediatric Hypertension (SUPERHERO), a multisite retrospective Registry of youth referred to subspecialty care for HTN disorders using EHR data. Inclusion criteria were an initial subspecialty clinic visit for HTN disorders identified by ICD-10 codes from 1/1/2016–12/31/2023 and age &lt;19 years. Exclusion criteria were kidney failure on dialysis, kidney transplantation, or pregnancy by ICD-10 codes. The exposures were sex and age at the index visit. Outcomes were BP severity at the index visit based on age, sex, and height-based U.S. guidelines, obesity by BMI or weight-for-length percentiles, and dyslipidemia, hyperglycemia, and TOI (heart and kidney-specific) by ICD-10 codes. We estimated the associations with unadjusted generalized linear models; our directed acyclic graphs did not identify any open, biasing paths necessitating adjustment for confounding factors . Results: Of the 9,356 participants, mean age ± SD was 12.8 ±4.5 years, 36% (n=3,372) were female, 56% (n=5,261) were adolescents, 23% (n=2,162) had stage 2 HTN, 5% (n=451) had TOI (2% heart, 3% kidney), 60% (n=5,655) had obesity, 9% (n=834) had dyslipidemia, and 10% (n=944) had hyperglycemia. Despite less BP severity, females had a higher risk of kidney TOI (RR 1.49, CI: 1.19 to 1.86), hyperglycemia (RR 1.48, CI: 1.3 to 1.68), and number of CV health risk factors (RR 1.1, CI:1.01 to 1.19). Compared to children, adolescents were more likely to have worse BP severity (RR 1.7, CI: 1.6 to 1.8) and HTN (RR 1.1, CI:1.1 to 1.2), and less risk for dyslipidemia (RR: 0.8, 0.7 to 0.9) Conclusions: In a large multisite cohort of youth referred for HTN disorders, females had a 49% higher risk of TOI and 48% greater risk for hyperglycemia despite lower BP severity. Adolescents had more severe BP and HTN compared to children. Next steps in this study include investigating age and sex differences in ambulatory BP and laboratory and echocardiogram data.

Abstract MP19: Hypertension Prevalence Among Youth aged 8–19 years in a National Survey — United States, 2017–2020

Hypertension in youth tracks into adulthood and has long-term negative health effects. In 2017, the American Academy of Pediatrics released new Clinical Practice Guidelines on pediatric hypertension. The guidelines updated blood pressure (BP) thresholds and age-sex-height percentile references for youth 1–17 years. Pediatric hypertension prevalence estimates since the new guideline are lacking. This study aims to provide the latest nationally representative prevalence estimates of elevated BP and hypertension in youth aged 8–19 years, total and stratified by age group, sex, race and ethnicity, and body mass index (BMI) category. For adolescents aged 13–17 years, both percentile-based thresholds and adult BP thresholds are available in the guidelines. We therefore compared adult BP thresholds for elevated BP (120–129/&lt;80 mmHg) and hypertension (≥130/≥80 mmHg) with percentile thresholds in adolescents. We used data from 2017–March 2020 National Health and Nutrition Examination Survey to obtain a sample of 2600 youth after excluding those with no BMI or BP measures. Prevalence estimates of elevated BP and hypertension were 8.7% (95% CI: 6.9-10.6) and 5.4% (95% CI: 4.0-6.7), respectively. Estimates were higher among males and increased with age (Table). Youth with severe obesity had the highest prevalence of hypertension. Hispanic youth had the lowest prevalence of elevated BP. In adolescents, elevated BP prevalence was similar using percentile thresholds (11.9%, 95% CI: 9.3-15.1) and the adult threshold (10.8%, 95% CI: 8.5-13.7). Hypertension prevalence in adolescents was also similar for percentile thresholds (4.8%, 95% CI: 3.1-7.6) and the adult threshold (4.8%, 95% CI: 2.0-7.5). Our findings suggest ongoing concern of elevated BP and hypertension among youth in the US. Either percentile or adult based thresholds for determining high BP could be used among adolescents by researchers. Knowledge of current national estimates can inform policies and interventions to support cardiovascular health in youth.

Association of Ideal Cardiovascular Health in Youth with Cancer Risk in Adulthood: A Cardiovascular Risk in Young Finns Study.

Lifestyle factors may affect cancer risk. This study aimed to identify whether the American Heart Association ideal cardiovascular health (ICH) score and its individual variables in youth are associated with subsequent cancer incidence. This study comprised participants of the Cardiovascular Risk in Young Finns Study free of cancer at the analysis baseline in 1986 (n = 1,873). The baseline age was 12 to 24 years, and the follow-up occurred between 1986 and 2018. Among 1,873 participants (mean age 17.3 ± 4.1 years; 53.4% females at baseline), 72 incident cancer cases occurred during the follow-up (mean follow-up time 31.4 ± 3.4 years). Baseline ICH score was not associated with future cancer risk (HR, 0.96; 95% confidence interval, 0.78-1.12 per 1-point increment). Of individual ICH score variables, ideal physical activity (PA) was inversely associated with cancer incidence [age- and sex-adjusted HR, 0.45 (0.23-0.88) per 1-category change (nonideal/ideal)] and remained significant in the multivariable-adjusted model, including body mass index, smoking, diet, and socioeconomic status. A continuous PA index at ages 9 to 24 years and moderate-to-vigorous PA in youth were also related to decreased cancer incidence (P < 0.05). Body mass index, smoking, diet, total cholesterol, glucose, and blood pressure were not related to cancer risk. Of the dietary components, meat consumption was associated with cancer incidence (P = 0.023). These findings indicate that higher PA levels in youth are associated with a reduced subsequent cancer incidence, whereas the American Heart Association's ICH score in youth does not. This finding supports efforts to promote a healthy lifestyle and encourages PA during childhood, yielding a subsequent healthier life.

Abstract P406: Screen Time and Behavioral Cardiovascular Health in Youth by Age: The Young Hearts Study

Background: Research suggests that screen time is associated with negative health outcomes, including cardiovascular health (CVH) factors (BP, lipids, glucose, BMI) but seldom include CVH behaviors (diet, physical activity, nicotine exposure, and sleep). Methods: Young Hearts is an observational study of CVH trajectories in youth aged 0-20. This analysis includes 1749 participants aged 6-18 with complete baseline surveys. Parents (for 6-17 year olds) and adolescents aged 12+ (for themselves) completed surveys on CVH behaviors, medical history, and social context. Participants (stratified by age groups: 6-9, 10-14, and 15-18) reported hours spent on screens during a typical weekday and weekend day, excluding schoolwork and video calls. For 12-17-year-olds, we calculated the average reported screen time. We calculated CVH using the 4 health behaviors in the AHA’s Life’s Essential 8. Each behavior was assigned a score of 0 to 100 and averaged to create the behavioral CVH score. Linear regression assessed the association between screen time (continuous) and CVH score, adjusting for age, sex, race, ethnicity, income, parental education, chronic disease, insurance type, and depressive symptoms. Results: The mean age of 1749 participants was 12, 47% were female, 46% non-Hispanic White, 26% Hispanic, 20% non-Hispanic Black, and 9% identified as other. For participants aged 10-14, a 1-hour screen time increase was associated with a -0.9 CVH score (95% CI -1.4, -0.4). Inverse associations between screen time and sleep score were observed among youth aged 10-14 and 15-18 (-1.4; 95% CI -2.6, -0.2). Screen time was inversely related to diet across age groups. Among children aged 6-9, screen time was positively associated with physical activity (1.2; 95% CI 0.2 - 2.1). The findings were consistent by race/ethnicity. Conclusion: Higher screen time was associated with less favorable CVH scores due to sleep and diet scores. Future research is needed to better understand the relationship between screen time and physical activity among youth.

Abstract 17653: Neighborhood Deprivation and Cardiovascular Health in US Adolescents, National Health and Nutrition Examination Survey 2007-2018

Introduction: AHA “Life’s Essential 8” scores cardiovascular health (CVH) as good, intermediate or poor based on diet, physical activity, sleep, tobacco exposure, cholesterol, blood pressure, blood glucose, and body mass index. CVH of the US population remains suboptimal, and the relationship between neighborhood deprivation and CVH in youth has not been fully explored. Hypothesis: We hypothesize that high neighborhood deprivation is associated with intermediate/poor CVH in adolescents. Methods: Using 2007-2018 National Health and Nutrition Examination Survey data, we examined the relationship between neighborhood deprivation index (NDI) and CVH status in adolescents. NDI was created from 2010 US Census data and reflects neighborhood level income, housing, education, and poverty status. Higher NDI indicates greater neighborhood deprivation. NDI values were divided into tertiles for analysis. We used proc survey logistic to assess the odds of poor/intermediate CVH status among youth living within high and intermediate compared to low deprivation communities. The model was adjusted for age, sex, ethnicity-race, household reference education and marital status, family poverty, rural vs urban residence and Citizenship status. All analyses were conducted using SAS 9.4, p&lt;0.05 . Results: We evaluated data from 3894 individuals, representative of 57,195,556 US adolescents 13 to 18 years of age. Most adolescents were non-Hispanic white (67%), male (51%), US Citizens (96%), mean age of 15 years, with an even distribution of youth living within low, intermediate and high deprivation neighborhoods (Table 1). We identified 31% greater odds of intermediate/poor CVH status among youth living within the most deprived communities (Table 2). Conclusions: Greater NDI associates with worse CVH in US adolescents. Public health initiatives should consider using NDI to tailor efforts in designing intervention strategies to preserve CVH status in US adolescents.

Toward a Roadmap for Best Practices in Pediatric Preventive Cardiology: A Science Advisory From the American Heart Association.

Cardiovascular disease risk factors are highly prevalent among youth in the United States and Canada. Pediatric preventive cardiology programs have independently developed and proliferated to address cardiovascular risk factors in youth, but there is a general lack of clarity on best practices to optimize and sustain desired outcomes. We conducted surveys of pediatric cardiology division directors and pediatric preventive cardiology clinicians across the United States and Canada to describe the current landscape and perspectives on future directions for the field. We summarize the data and conclude with a call to action for various audiences who seek to improve cardiovascular health in youth, reduce the burden of premature cardiovascular disease, and increase healthy longevity. We call on heart centers, hospitals, payers, and policymakers to invest resources in the important work of pediatric preventive cardiology programs. We urge professional societies to advocate for pediatric preventive cardiology and provide opportunities for training and cross-pollination across programs. We encourage researchers to close evidence gaps. Last, we invite pediatric preventive cardiology clinicians to collaborate and innovate to advance the practice of pediatric preventive cardiology.

Family Meals and Cardiometabolic Risk Factors in Young Children.

Family meals represent a novel strategy for improving cardiovascular health in youth. The purpose of this paper is to describe the association between family meals, dietary patterns, and weight status in youth. According to the American Heart Association's Life's Essential 8, poor diet quality and overweight/obesity status are key contributors to suboptimal cardiovascular health. Current literature highlights a positive correlation between the number of family meals and healthier eating patterns, including greater consumption of fruits and vegetables, and a reduced risk of obesity in youth. However, to date, the role of family meals in improving cardiovascular health in youth has been largely observational and prospective studies are needed to assess causality. Family meals may be an effective strategy for improved dietary patterns and weight status in youth.

The Power of Patient Stories to Inspire Us to Prevent Cardiovascular Disease and Death: Personal Reflections on the AHA's Scientific Sessions 2021.

The Power of Patient Stories to Inspire Us to Prevent Cardiovascular Disease and Death: Personal Reflections on the AHA's Scientific Sessions 2021.

Abstract P034: Family Lifestyles And Home Environments Associated With Youth Cardiovascular Health: The Multidimensional Assessment Of Preschoolers Study

Introduction: The importance of healthy family lifestyles and home environments (e.g. environments that support healthy choices for food, physical activity, and sleep) on health behaviors and obesity risks are well-recognized. Less is known about the association of family factors with cardiovascular health (CVH) in youth. We examined the cross-sectional association of family factors (reported by youth and their parents) with youths’ CVH. Methods: Analyses included data from the Multidimensional Assessment of Preschoolers Study. Parents and youth (11.3± 0.7 years old) reported the frequency of ten family factors (e.g. breakfast intake, monitoring of screen time, etc.). The outcome was a 10-point score of youths’ CVH that included 5 CVH metrics (diet, physical activity, smoking, BMI, and blood pressure) summed using the AHA criteria. Pearson correlations were used to compare youth and parents’ reports of family factors and adjusted multivariable linear regression models to examine the association of both reports with youths’ CVH scores. Results: Study included 177 parent-youth dyads, and 22% of youth had ideal, 74% intermediate, and 5% poor CVH. Correlations between parents and youths’ reports of family factors were moderate. Based on parents’ reports, support of healthy beverage choices (i.e. limit sweet and soda beverages and support low fat dairy intake) associated with youths’ CVH scores (β= -0.10, p&lt;0.01). The association of family’ support of youths’ physical activity (i.e. encourage youth's physical activity during leisure time and support enrollment in organized sports/activities) with youths’ CVH scores was nearly significant based on parents’ reports (β= 0.04, p=0.055) and significant based on youths’ reports (β= 0.05, p=0.04). Youths’ CVH scores were not associated with other family factors. Conclusion: Youths’ CVH scores were associated with healthy beverage choices and family support of youths’ physical activity, but not other family factors. These important family factors require further research.

Longitudinal Effects of Transportation Vulnerability on the Association Between Racial/Ethnic Segregation and Youth Cardiovascular Health.

Transportation vulnerability (defined as lack of personal/public transportation access) is particularly prevalent in areas with high racial/ethnic segregation where communities typically lack proximity to quality education, jobs, healthy food, playgrounds, and medical care. Prior research has shown an association between residential segregation and youth cardiovascular health, although little work has examined the effects of transportation vulnerability on this relationship. Longitudinal mixed methods were used to compare the effects of transportation vulnerability on the association between changes in exposure to residential segregation (defined as the uneven geographic distribution of minorities) and five cardiovascular health outcomes across sex in minority youth for up to four consecutive years of participation in an afterschool fitness program during 2010-2018 (n = 2742; Miami-Dade County, Florida, US). After accounting for child race/ethnicity, age, year, and poverty, girls with high transportation vulnerability and reduced exposure to segregation (vs. increased or no change in segregation) showed the most improvements across all outcomes, including body mass index percentile (26% (95% CI 23.84, 28.30)), sum of skinfold thicknesses (18% (95% CI 14.90, 20.46)), run time (17% (95% CI 14.88, 18.64)), systolic blood pressure percentile (15% (95% CI 11.96, 17.08)), and diastolic blood pressure percentile (12% (95% CI 9.09, 14.61)). Transportation inequities related to concentrated racial/ethnic segregation may be an important factor in reducing disparities in youth cardiovascular health, particularly among girls. These study findings provide important longitudinal evidence in support of health interventions to reduce transportation vulnerability for racial/ethnic minority youth in underserved areas.

The association of low-density lipoprotein cholesterol with elevated arterial stiffness in adolescents and young adults with type 1 and type 2 diabetes: The SEARCH for Diabetes in Youth study.

Our aim was to explore the relationship of Low-Density Lipoprotein Cholesterol (LDL-C) with subclinical cardiovascular disease (CVD) in youth with T1D and T2D. We hypothesized the association of LDL-C with elevated arterial stiffness (AS) would be partially accounted by the co-occurrence of other CVD factors. We included 1376 youth with T1D and 157 with T2D from the SEARCH study. CVD risk factors including LDL-C, waist to height ratio (WHtR), mean arterial pressure (MAP), HbA1c, albumin to creatinine ratio (ACR), and insulin sensitivity (IS) score were measured at both visits. At follow up, elevated carotid-femoral AS was defined as levels above 6.8 m/s. Multivariable logistic regression evaluated the odds of elevated AS as a function of the average CVD risk factors. At follow up, age was 18.0 ± 4.1 and 21.6 ± 3.5 years and duration of diabetes was 7.8 ± 1.9 and 7.7 ± 1.9 years in T1D and T2D, respectively. Elevated AS was found in 8.4% of T1D and 49.0% of T2D participants. Each SD increase in LDL-C was associated with 1.28 increased odds (95% CI 1.05-1.54, P = .013) of elevated AS in youth with T1D. The association was similar but not statistically significant in T2D. WHtR, IS, and MAP were associated with elevated AS in both groups. Adjustment for WHtR or IS attenuated to non-significance the relationship between LDL-C and AS in T1D. Obesity and insulin resistance attenuate the association of high LDL-C with AS suggesting they partially account for the adverse effects of LDL-C on cardiovascular health in youth with T1D.

Systematic Review on the Associations between Objectively Measured Breaks in Sitting Time and Cardiovascular Health in Youth

The aim of this systematic review was to summarize the literature on the associations between breaks in sitting time and cardiovascular health, in children and adolescents. The search was conducted using five databases (MEDLINE, SCOPUS, WEB OF SCIENCE, PSYCINFO and CINAHL) through to 01 October 2019. Due to heterogeneity of the data, meta-analyses were not possible. We screened 2577 studies, and 15 studies were included, representing 9116 participants, from six different countries. Five observational studies and four experimental studies showed associations between breaks in sitting time and cardiovascular health, i.e. an increased number of breaks in sitting time was negatively associated with a cardiovascular health outcome. No associations between number of breaks in sitting time and cardiovascular health outcomes were found in the six remaining studies. Studies examining associations between breaks in sitting time and cardiovascular health in children have shown some favorable associations. More epidemiological evidence is required, to inform lifestyle interventions and public health policies, which could translate into long-term implications on population health.

Youth cardiorespiratory fitness: evidence, myths and misconceptions.

Rigorously determined peak oxygen uptake is internationally recognized as the criterion measure of youth cardiorespiratory fitness. The assessment and interpretation of children’s and adolescents’ peak oxygen uptake and the relationship of the measure with other health-related variables are well documented. There has been a recent resurgence of interest in the prediction of peak oxygen uptake from field performance tests in young people. However, coupled with ratio-scaling of data and the raising of clinical red flags, these practices risk clouding our understanding of youth cardiorespiratory fitness and its relationship with current and future health. We believe these methods have the potential to mislead clinical practice and misguide recommendations for the promotion of youth cardiovascular health. We discuss relevant scientific evidence and interpretations that have emerged from predicting youth cardiorespiratory fitness from performance test scores. We argue that children deserve to have health care founded on evidence-based science and not on myths and misconceptions.

Changes in cardiovascular health and physical fitness in ethnic youth with intellectual disabilities participating in a park-based afterschool programme for two years.

Youth with intellectual disabilities are more likely to be an unhealthy weight and less physically active than youth without intellectual disability. The effects of Fit2Play, a park-based afterschool programme on cardiovascular/fitness health outcomes among youth with intellectual disability, were prospectively assessed. Youth ages 6 to 22 with intellectual disability who participated in Fit2Play for either one or two school years between 2010 and 2016 (N=297, mean age 14.1years, 70% Hispanic, 20% non-Hispanic black, 72% male) were examined via a fitness battery at the beginning/end of the school year(s). Effects of length of Fit2Play participation on body mass index (BMI) %ile, skinfold thicknesses, systolic/diastolic blood pressure (SBP/DBP) %iles, fitness tests, and health and wellness knowledge) were evaluated via two-level repeated measures analysis adjusted for child gender, age, ethnicity and area-level poverty. Adjusted models showed that up to two years of Fit2Play participation was significantly associated with improved BMI %ile, skinfold thicknesses, SPB/DBP %iles and PACER scores (p<0.05 for all). One and two years of programme participation was associated with a 6% [95% CI: 0.92, 0.96] and 10% [95% CI: 0.87, 0.93] reduction in SBP%ile, respectively (p<0.001), and a 36% [95% CI: 1.28, 1.45] and 57% [95% CI: 1.44, 1.70] increase in PACER score laps, respectively, compared to baseline. Results here suggest that park-based, structured afterschool programmes with a focus on health and wellness can be a rich resource for this nation by offering both exclusive and immersion programmes for children with intellectual disability to foster cardiovascular health in all youth.

Does transportation vulnerability explain the relationship between changes in exposure to segregation and youth cardiovascular health?

Transportation vulnerability (lack of community/personal access to transportation that in turn increases the risk for health or financial consequences in the event of hardship/disease/disasters) may be an important mechanistic factor linking residential segregation to youth cardiovascular health inequities. This natural experiment examined the impact of transportation vulnerability on the association between changes in exposure to residential segregation and cardiovascular health among minority youth (n = 2,129, mean age 9.1 years, 54% male; 52% Hispanic, 48% non-Hispanic black [NHB]; 49% high area poverty) over two years. Two-level generalized linear mixed models with random intercepts were fit to test the effects of transportation vulnerability on the association between changes in segregation and cardiovascular health (body mass index percentile (BMIP), sum of skinfold thicknesses, 400 m run time, systolic and diastolic blood pressure percentiles (SBPP and DBPP, respectively) over two school years and across gender. After adjusting for potential confounders (individual-level race/ethnicity, age, time, and park-area poverty), improvements in cardiovascular health were greatest for girls exposed to reduced segregation with high compared with low transportation vulnerability for all outcomes. Specifically, BMIP and SBPP decreased 29% (IRR 95% CI: 0.69, 0.73) and 13% (IRR 95% CI: 0.85, 0.90) vs. 10% (IRR 95% CI: 0.84, 0.96) and no significant change (IRR 95% CI: 0.88, 1.00), for high and low transportation vulnerability, respectively. Adjusted models showed the greatest improvements in cardiovascular health for boys exposed to reduced segregation and low compared with high transportation vulnerability for BMIP and skinfold thicknesses. Specifically, BMIP and skinfold thicknesses decreased 33% (IRR 95% CI: 0.73, 0.81) and 21% (IRR 95% CI: 0.74, 0.84) vs. increased 8% (IRR 95% CI: 1.05, 1.11) and no significant change (IRR 95% CI: 0.96, 1.03), for low and high transportation vulnerability, respectively. Policy interventions that promote transportation equity should be further studied as a means to reduce youth cardiovascular health disparities, particularly for girls living in areas with high racial/ethnic segregation.

Abstract P125: Cardiovascular Health Improves in High Transportation Vulnerable Girls With Decreased Exposures to Residential Segregation

Introduction: Transportation equity ensures that all citizens benefit from a clean, fair, safe and healthy environment. Residential segregation also impacts health, and transportation disadvantage is particularly high in areas with high segregation, where residents typically lack proximity to quality education, jobs, healthy food, safe playgrounds, and medical care. Recent research demonstrates improvements in cardiovascular risk profiles among minority girls after reduced exposure to segregation. There is a need to examine differences in the segregation-youth cardiovascular health association across transportation vulnerability and gender to inform health equity interventions. Hypothesis: It was hypothesized that girls with reduced segregation exposure and low transportation vulnerability would have the most improved cardiovascular health. Methods: Data for these analyses were drawn from the Fit2Play dataset (2010-2018; N=2742). Youth were followed over 4 consecutive years of participation in a year-long afterschool physical activity program. Change in segregation exposure was based on concentration of minorities living in block groups from the participant’s home to program areas using the 2010 Census. Transportation vulnerability was based on percent of households in the participant’s home zip code with vehicle access (0, 1, 2, or ≥3 vehicles) drawn from the American Community Survey (2012-16). Longitudinal mixed models were used to compare the association between change in residential segregation and five cardiovascular health risk measures (body mass index, systolic and diastolic blood pressure, skinfold thickness and 400 meter run tests) stratified by transportation vulnerability and gender. Results: Participants were 54% male, 51% Hispanic, 49% non-Hispanic black, and 52% high poverty (mean age 9.5 years). After accounting for child age, race/ethnicity, poverty, and year, girls with high transportation vulnerability and reduced segregation exposure showed the most reduced cardiovascular health risk profiles, including improvements in body mass index (26%, 95% CI: 23.84, 28.30), skinfold thicknesses (18%, 95% CI: 14.90, 20.46), run time (17%, 95% CI: 14.88, 18.64), systolic blood pressure (15%, 95% CI: 11.96, 17.08), and diastolic blood pressure (12%, 95% CI: 9.09, 14.61). In contrast, no clear patterns emerged for low transportation vulnerable girls, and high or low transportation vulnerable boys. Conclusions: In conclusion, high transportation vulnerable girls exposed to reduced segregation had greater improvements in all cardiovascular health risk outcomes compared with low transportation vulnerable girls, and both high and low transportation vulnerable boys. Transportation equity interventions may provide a means to reduce youth cardiovascular health disparities, particularly for girls living highly segregated areas.

Associations between active commuting to school, sleep duration, and breakfast consumption in Ecuadorian young people

BackgroundDaily behaviours such as active commuting to school (ACS) could be a source of physical activity, contributing to the improvement of youth cardiovascular health, however, the relationship between ACS and other aspects of a youth’s health, such as sleep duration and breakfast consumption, require further clarification. The aims of this study were therefore: 1) to analyse the prevalence of modes of commuting to school, sleep duration, and breakfast consumption by age groups and gender, and 2) to analyse the association between ACS, sleep duration recommendations, and breakfast consumption by age groups and gender.MethodThis cross-sectional study included 732 school-aged students of low-middle socioeconomic status, categorised into children (10-12 yr), young adolescents (13-15 yr), and older adolescents (16-18 yr). Modes of commuting to/from school, sleep duration, and breakfast consumption were self-reported. Logistic regression models were fitted to examine the association between ACS, sleep duration and breakfast consumption, analysed according to age groups and gender.ResultsThe percentage of students meeting sleep duration and daily breakfast recommendations was lowest in older adolescents, and highest in children (6.3% versus 50.8% p < 0.001, and 62.1%, versus 76.8%, p = 0.001, respectively). Young adolescents and girls who met the sleep duration recommendations were more likely to be active commuters than their counterparts (OR = 4.25; 95% CI = 1.81 to 9.92, p = 0.001 and OR = 2.89; 95%CI = 1.01 to 8.27, p = 0.04, respectively).ConclusionYoung adolescents (13-15 yr) and girls who met the sleep duration recommendations during school days displayed a positive association with ACS. There was no association between ACS and breakfast consumption for any of the age groups or gender. Children (10-12 yr) were those that best meet with the adequate sleep duration and breakfast consumption recommendations.

Muscle Fitness Cut Points for Early Assessment of Cardiovascular Risk in Children and Adolescents

To study the cross-sectional and longitudinal (2-year follow-up) association between muscle fitness and cardiovascular disease (CVD) risk factors in youth; whether there are muscle fitness cut points associated with CVD risk (cross-sectional); and whether the health-related muscle fitness cut points identified at baseline are associated with CVD risk 2 years later. In total, 237 children (110 girls) aged 6-10 years and 274 adolescents (131 girls) aged 12-16 years with complete data were included in the study (10.3% drop out). The handgrip strength and the standing long jump tests were used to assess muscle fitness. CVD risk score was computed with sum of 2 skinfolds, systolic blood pressure, insulin, glucose, triglycerides, and total cholesterol/high density lipoprotein cholesterol. Muscle fitness at baseline was associated inversely with single CVD risk factors and CVD risk score at baseline and 2-year follow-up (all P < .05). Receiver operating characteristics curve analyses showed a significant discriminating accuracy of handgrip strength in identifying CVD risk in children and adolescents (boys: ≥ 0.367 and ≥0.473; girls: ≥ 0.306 and ≥0.423 kg/kg body mass, respectively, all P < .001). Similarly, the standing long jump cut points for children and adolescents were ≥104.5 and ≥140.5 in boys, and ≥81.5 and ≥120.5 cm in girls, respectively (all P < .05). These cut points were associated with CVD risk 2 years later (all P < .01). Muscle fitness is associated with present and future cardiovascular health in youth, and is independent of cardiorespiratory fitness. It should be monitored to identify youth at risk who could benefit from intervention programs.

Relationships of Anxiety and Depression with Cardiovascular Health in Youth with Normal Weight to Severe Obesity

To evaluate the relationships of depression and anxiety symptoms with cardiovascular disease (CVD) risk factors and measures of vascular health in youth. Participants (n = 202) were 8- to 18-year-olds from a cross-sectional study evaluating cardiovascular health across a wide range of body mass index values (normal weight to severe obesity). CVD risk measurement included blood pressure, fasting lipids, glucose, insulin, carotid artery intima-media thickness, compliance and distensibility, brachial artery flow-mediated dilation, carotid-radial artery pulse wave velocity, body fat percentage, and a metabolic syndrome cluster score. Anxiety and depression symptoms were self-reported on the Screen for Child Anxiety Related Disorders and Center for Epidemiological Studies Depression Scale for Children. Two sets of adjustment variables were used in evaluation of differences between those with and without anxiety or depression symptomatology for the CVD risk factor and vascular outcomes. The first set included adjustment for Tanner stage, sex, and race; the second was additionally adjusted for percent body fat. Anxiety was not significantly associated with CVD risk factors or vascular health in either model. Depression was associated with high-density lipoprotein cholesterol, triglycerides, and metabolic syndrome cluster score; these relationships were attenuated when accounting for percent body fat. When accounting for body fat, we found no clear relationship of self-reported depression or anxiety symptoms with CVD risk factors or vascular health in youth.