Cardiovascular Risk Factors In Adolescents Research Articles

Serum concentrations of insulin-like growth factor-I, insulin-like growth factor binding protein-3 and cardiovascular risk factors in adolescents

The risk association between the insulin like growth factor-I (IGF-I) system and cardiovascular risk is inconclusive in adults and under-explored in adolescents. We aimed to investigate the associations between serum concentrations of IGF-I and IGF binding protein-3 (IGFBP-3) and cardiovascular risk factors in adolescents. This was a cross-sectional, population-based, observational study in a school setting with 2102 Hong Kong Chinese adolescents aged 12-19 years. Serum IGF-I and IGFBP-3 concentrations were measured by chemiluminescence immunoassays. Anthropometric indices and traditional cardiovascular risk factors were assessed. After excluding participants with abnormal thyroid and liver test results, 765 boys and 877 girls, mean (±SD) age of 15.3 (±2.0) and 15.7 (±2.0) years, respectively, were included in the analysis. Multivariable regression analyses revealed that both IGF-I and IGFBP-3 concentrations were independently associated with waist circumference, fasting insulin and haemoglobin concentrations in boys (all P < 0.05), systolic blood pressure, serum creatinine, fasting insulin and haemoglobin concentrations in girls (all P < 0.05). In girls, IGF-I was also associated with C-reactive protein concentration (P < 0.001) and IGFBP-3 was associated with fasting triglyceride concentration (P < 0.001). Compared with adolescents with the lowest tertile, the top tertile of both IGF-I and IGFBP-3 concentrations were associated with increased odds of having overweight/obesity, top tertiles of insulin and haemoglobin in both boys and girls (P for trend, all <0.05). The associations between serum IGF-I, IGFBP-3, obesity, cardiovascular risk factors, insulin and haemoglobin suggest that dysregulation of the IGF system may play a linking role for the clustering of cardiovascular risk factors.

Cardiometabolic risk factors as apolipoprotein B, triglyceride/HDL-cholesterol ratio and C-reactive protein, in adolescents with and without obesity: cross-sectional study in middle class suburban children

The prevalence of obesity (OB), overweight (OW), and metabolic syndrome (MS) has increased worldwide. That imposes a substantial risk for type 2 diabetes and premature cardiovascular disease. However, to date no unified criteria exist to asses risk or outcomes in children and adolescents. To establish the presence of OB/OW and MS and risk factors for cardiovascular disease in adolescents. Male (n = 514) and female (n = 429) adolescents from high school were studied (11-14 yr). Weight, height, body mass index (BMI), waist circumference (WC), and blood pressure were determined in all subjects. Glucose, lipoprotein profile, apolipoprotein B (apoB), and high-sensitivity C-reactive protein (hs-CRP) levels were measured. Triglyceride/high-density lipoprotein-cholesterol (TG/HDL-cholesterol) ratio was calculated. The frequency of OB/OW and MS were 22.2 and 3.7%, respectively. In comparison to healthy adolescents, TG/HDL-cholesterol ratio was increased in OB/OW (2.9 ± 2.5 vs. 1.6 ± 1.0) and MS groups (4.0 ± 2.5 vs. 1.6 ± 0.9), p < 0.001. OB/OW adolescents presented higher values of hs-CRP in comparison to non-obese, median (range): 1.9 (0.1-9.4) vs. 1.4 (0.1-9.9), mg/L, p < 0.001. ApoB (mean ± SD) was 71 ± 21 mg/dL in MS group and 59 ± 17 mg/dL in those without MS (p < 0.001). TG/HDL-cholesterol ratio positively correlated with BMI (r = 0.18, p < 0.001), WC (r = 0.24, p < 0.001), and apoB (r = 0.24, p < 0.001); hs-CRP correlated with WC (r = 0.14, p < 0.001) and BMI (r = 0.17, p < 0.001). Even when the frequency of OB, OW, and MS in adolescents was low, those subjects presented an atherogenic lipoprotein. These findings emphasize the importance to evaluate cardiovascular risk factors in adolescents to assess strategies to prevent future disease.

Riscos cardiovasculares em adolescentes com diferentes graus de obesidade

FUNDAMENTO: Há poucos estudos sobre riscos cardiovasculares em adolescentes com diferentes graus de obesidade. OBJETIVO: Avaliar repercussões metabólicas associadas a diferentes graus de obesidade em adolescentes e seu impacto nos riscos cardiovasculares. MÉTODOS: Estudo transversal com 80 adolescentes obesos, divididos em dois grupos: 2<z-IMC<2,5 e z-IMC>2,5, denominados obesos com menor e maior grau de obesidade, respectivamente. Foram realizados exame físico e avaliação bioquímica e de composição corporal. Para a análise estatística, foram aplicados os testes t-Student e qui-quadrado, com a finalidade de comparar os dois grupos. Modelo logístico múltiplo foi utilizado para verificar as associações entre variáveis bioquímicas e grau de obesidade. Foram desenvolvidos escores de risco para doença cardiovascular, de acordo com o número de alterações encontradas nas seguintes variáveis: glicemia de jejum, triglicérides, HDL e PA. Foram verificadas associações entre esses escores e o grau de obesidade. RESULTADOS: Os dois grupos diferiram em valores de peso, circunferência da cintura, glicemia e insulina de jejum, HOMA-IR, triglicérides, HDL, PA e medidas de composição corporal (p<0,05). Os adolescentes com maior grau de obesidade apresentaram maiores frequências de alterações para glicemia, HOMA-IR, triglicérides, HDL e pressão arterial (p<0,05). O modelo logístico mostrou associações entre o grau de obesidade e as variáveis: HDL (OR=5,43), PA (OR=4,29), TG (OR=3,12). O escore de risco demonstrou que 57,7% dos adolescentes com maiores graus de obesidade tinham duas ou mais alterações metabólicas para 16,7% do outro grupo (p<0,001). CONCLUSÃO: O grau da obesidade influenciou no aparecimento de alterações que compõem a síndrome metabólica, aumentando o risco cardiovascular.

Impact of Lifestyles of Adolescents and Their Parents on Cardiovascular Risk Factors in Adolescents

The aim of this study was to determine the impact of the lifestyles of adolescents and their parents on the levels of cardiovascular (CV) risk factors in the adolescents. A total of 755 volunteers (331 male, 424 female) aged 15 to 18 years were included. Abdominal obesity, hypertension, elevated triglyceride levels, decreased high density lipoprotein-cholesterol levels, and hyperglycemia were considered to be CV risk factors. Self-reported lifestyle, including participation in school-based extracurricular (EC) physical activities, time spent on physical activity or watching television (TV), and average daily food intake were assessed. Parental information on weight status and lifestyle was also obtained. Multivariate regression analyses showed that participation in EC physical activities, time spent watching TV, regular breakfast consumption, total energy intake, fiber intake per 1,000 Kcal, and parental BMI were independently associated with the levels of one or more CV risk factors in adolescents. Among these, participation in EC physical activities had a profound effect on adolescent CV risk factor levels. The risk of male adolescent obesity was associated with paternal obesity, but not with maternal obesity. Conversely, the risk of female adolescent obesity was associated with maternal obesity but not with paternal obesity. Participation in EC physical activities may be the first-line approach for adolescents to maintain favorable CV risk factor levels. An association between paternal or maternal obesity and adolescent obesity differs between adolescent genders in Japan; thus, approaches focusing on parents should take the gender of the adolescent into consideration.

Fatores de risco para doenças cardiovasculares em adolescentes de Caxias do Sul-RS, Brasil

Despite most part of cardiovascular diseases occur in adult life, the process frequently initiate in adolescence. The purpose was to analyze cardiovascular risk factors in adolescents from Caxias do Sul-RS. In this cross-sectional epidemiological study, 1.675 adolescents aged 11 to 17 years were analyzed selected in a proportional randomized conglomerates method by city sector, type of school, and school grade. Risk factors prevalences were: family history (82.4%), athrogenic diet (74.7%), low cardiorespiratory fitness (61.6%), sedentariness (55.8%), elevated blood pressure (28.4%), high waist circumference (27.7%), excess of body fat (26.5%), etilism (22.3%), overweight (19.7%), smoking (6.2%), and alcohol abusive use (4.3%). Boys presented higher prevalence of atherogenic diet (79.4%&gt;70.7%), while girls of sedentariness (66.8%&gt;43.2%), low cardiorespiratory fitness (69.4%&gt;53.0%), smoking (7.9%&gt;4.3%), high waist circumference (32.9%&gt;21.7%), and excess of fat (32.5%&gt;19.7%). In girls, it was associated to sedentariness the age of 15-17y (PR=1.30), living until four people at home (PR=1.17), and to present sedentary behaviours more than 14 hours/week (PR=1.21), to present atherogenic diet (PR=1.12) and low fitness (PR=1.21). In boys, sedentariness was associated to low fitness (PR=1.21). Low cardiorespiratory fitness was associated in girls to the age of 15-17y (PR=1.43), and to mother sedentariness (PR=1.13), and in boys to passive transport to school (PR=1.18). To girls and boys, respectively, sedentariness (PR=1.19 and PR=1.17), overweight (PR=1.16 and PR=1.24), and excess of body fat (PR=1.14 and PR=1.51) were associated to low fitness. Physical activity interventions must be focused on girls, aged 15 to 17 years, living until four people, and exposed to sedentary behaviours. It is recommended more attention to girls in interventions on physical activity, smoking, and excess of weight, and to boys, in food habits.

Changes in Ponderal Index and Body Mass Index across Childhood and Their Associations with Fat Mass and Cardiovascular Risk Factors at Age 15

BackgroundLittle is known about whether associations between childhood adiposity and later adverse cardiovascular health outcomes are driven by tracking of overweight from childhood to adulthood and/or by vascular and metabolic changes from childhood overweight that persist into adulthood. Our objective is to characterise associations between trajectories of adiposity across childhood and a wide range of cardiovascular risk factors measured in adolescence, and explore the extent to which these are mediated by fat mass at age 15.Methods and FindingsUsing data from the Avon Longitudinal Study of Parents and Children, we estimated individual trajectories of ponderal index (PI) from 0–2 years and BMI from 2–10 years using random-effects linear spline models (N = 4601). We explored associations between PI/BMI trajectories and DXA-determined total-body fat-mass and cardiovascular risk factors at 15 years (systolic and diastolic blood pressure, fasting LDL- and HDL-cholesterol, triglycerides, C-reactive protein, glucose, insulin) with and without adjustment for confounders. Changes in PI/BMI during all periods of infancy and childhood were associated with greater DXA-determined fat-mass at age 15. BMI changes in childhood, but not PI changes from 0–2 years, were associated with most cardiovascular risk factors in adolescence; associations tended to be strongest for BMI changes in later childhood (ages 8.5–10), and were largely mediated by fat mass at age 15.ConclusionChanges in PI/BMI from 0–10 years were associated with greater fat-mass at age 15. Greater increases in BMI from age 8.5–10 years are most strongly associated with cardiovascular risk factors at age 15, with much of these associations mediated by fat-mass at this age. We found little evidence supporting previous reports that rapid PI changes in infancy are associated with future cardiovascular risk. This study suggests that associations between early overweight and subsequent adverse cardiovascular health are largely due to overweight children tending to remain overweight.

The role of physical activity on cardiovascular risk factors in adolescents

Background Cardiovascular diseases remain the leading cause of death worldwide. Atherosclerotic process increases rapidly during adolescence. Physical activity is considered important in this period to modify cardiovascular risk factors, thus preventing disease in the future.Objective To determine whether different physical activity status in adolescence can influence body mass index (BMBMI), waist-to-hip ratio, blood pressure (BP), and blood lipid profile.Methods This was a cross-sectional descriptive study, conducted from December 2009 to January 2010. Adolescents who fulfilled the study criteria were classified into high and low physical activity category. Further examination including body mass index, waist-to-hip ratio, blood pressure, and blood lipid profile were performed.Results Adolescents with high physical activity had higher, but statistically insignificant, BMBMI compared to adolescents in the P=0.493] and significantly lower waist-to-hip ratio [0.80 (range 0.73-0.9) vs.. 0.82 (range 0.7-0.9), P=0.019]. Difference in BP was not statistically significant between both groups [diastolic BP (70 (range 60-90) mmHg vs. 70 (range 60-90) mmHg, P=0.148; systolic BP 100 (range 90-130) mmHg vs. 100 (range 90-140) mmHg, P=0.228)]. Blood lipid examination in the high activity group showed significantly higher HDL cholesterol and lower triglyceride compared to the low activity group [HDL 59.8 (SD 11.8) mg/dL vs. 54.7 (SD 8.9) mg/dL; p=0.044; triglyceride: 60 (range 32-203) mmHg vs. 82 (range 37-198) mmHg, P=0.014]. Total and LDL cholesterol [total cholesterol 169.8 (SD 28.6) mmHg vs. 181.2 (SD 30.8) mmHg, P=0.107; LDL 103.6 (SD 26.8) mmHg vs. 114.1 (SD 27.3) mmHg, P=0.100] were lower in the high activity group but not statistically different in both groups.Conclusions Adolescents with high physical activity show less cardiovascular risk factors compared to those in the low physical activity group.

Is exercise a therapeutic tool for improvement of cardiovascular risk factors in adolescents with type 1 diabetes mellitus? A randomised controlled trial

BackgroundType 1 diabetes mellitus (T1DM) is associated with a high risk for early atherosclerotic complications especially risk of coronary heart disease.ObjectiveTo evaluate the impact of six months exercise prgram on glycemic control, plasma lipids values, blood pressure, severity and frequency of hypoglycemia, anthropometric measurements and insulin dose in a sample of adolescents with T1DM.Research design and methodsA total of 196 type 1 diabetic patients participated in the study. They were classified into three groups: Group (A) did not join the exercise program(n = 48), group (B) attended the exercise sessions once/week (n = 75), group (C) attended the exercise sessions three times/week (n = 73). Studied parameters were evaluated before and six months after exercise programe.ResultsExercise improved glycemic control by reducing HbA1c values in exercise groups (P = 0.03, P = 0.01 respectively) and no change in those who were not physically active (P = 0.2). Higher levels of HbA1c were associated with higher levels of cholesterol, LDL-c, and triglycerides (P = 0.000 each). In both groups, B and C, frequent exercise improved dyslipidemia and reduced insulin requirements significantly (P = 0.00 both), as well as a reduction in BMI (P = 0.05, P = 0.00 respectively) and waist circumference(P = 0.02, P = 0.00 respectively). The frequency of hypoglycemic attacks were not statistically different between the control group and both intervention groups (4.7 ± 3.56 and 4.82 ± 4.23, P = 0.888 respectively). Reduction of blood pressure was statistically insignificant apart from the diastolic blood presure in group C (P = 0.04).ConclusionExercise is an indispensable component in the medical treatment of patients with T1DM as it improves glycemic control and decreases cardiovascular risk factors among them.

Anthropometric screening for silent cardiovascular risk factors in adolescents: The PEP Family Heart Study

Background Central obesity is associated with an increased risk of cardiovascular disease (CVD), but community-wide screening in adolescents is inadequate. Therefore, we examined six simple anthropometric measures for their utility in screening adolescents for seven silent CVD risk factors. Methods A representative community-based sample of 3038 German adolescents (1639 males) aged 12–18 years participated in the study. The association between hypertension, dyslipoproteinemia, fasting hyperglycemia, body mass index, waist circumference (WC), hip circumference, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and skinfold thickness was assessed. Results The prevalence of central obesity, defined as elevated WC and/or elevated WHtR, was 13.7% and 13.4% in male and female adolescents, respectively. Among these 412 adolescents, risk factor clustering was 3–4 times more frequent than in the 2626 adolescents without central obesity. Central obesity was the only anthropometric variable that significantly predicted increased risk for all seven non-anthropometric CVD risk factors: hypertension (OR 2.5), elevated triglycerides (OR 4.9), LDL-C (OR 2.0), non-HDL-C (OR 2.1), triglyceride/HDL-C ratio ≥3.5 (OR 7.2), low HDL-C (OR 1.6), fasting glucose (OR 1.3), and risk factor clustering (OR 3.8). General adiposity only detected hyperglycemia (OR 1.8) and hypertension (OR 4.9), whereas skinfold thickness in or above the 90th percentile predicted risk factor clustering (OR 1.9), elevated triglycerides (OR 2.3), and triglyceride/HDL-C (OR 3.9). WHR indicated hypertriglycridemia (OR 2.3). Conclusions Cardiovascular risk factors in adolescents are easily identified by central adiposity.

Sedentary Behavior, Adiposity, and Cardiovascular Risk Factors in Adolescents. The AFINOS Study

To investigate the association between objective measures of sedentary behavior and cardiovascular risk factors (CRFs) in adolescents. A secondary aim was to evaluate the degree of association between overall and abdominal adiposity and CRFs. This cross-sectional study involved 210 adolescents aged 13-17 years. Measurements were made of the sum of the skinfold thicknesses at six locations (sum6), waist circumference (WC), systolic (SBP) and diastolic blood pressure (DBP), glucose, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and apolipoproteins A-1 and B-100. A CRF score was calculated from the mean arterial pressure (MAP) and TG, HDL-C and glucose levels. Sedentary behavior was assessed over 7 days using an accelerometer. Participants were divided into tertiles according to sedentary behavior and into low and high levels of overall (sum6) and abdominal (WC) adiposity. Adolescents with a high level of sedentary behavior had less favorable SBP, TG and glucose levels and CRF scores. Adolescents with a high level of overall adiposity demonstrated significant differences in five of the 11 variables analyzed (i.e. DBP, LDL-C, TC, apolipoprotein B-100 and CRF score), while adolescents with a high level of abdominal adiposity had differences in eight (i.e. SBP, MAP, HDL-C, LDL-C, TG, TC, apolipoprotein B-100 and CRF score). Adolescents with high levels of both overall and abdominal adiposity and sedentary behavior had the least favorable CRF scores. Sedentary behavior was associated with CRFs in adolescents, especially in obese adolescents. Abdominal adiposity seemed to play a more significant role in the development of CRFs than overall adiposity.

Association between general and central adiposity in childhood, and change in these, with cardiovascular risk factors in adolescence: prospective cohort study

Objectives To examine the prospective associations between body mass index (BMI), waist circumference, and fat mass in childhood and cardiovascular risk factors at age 15-16.Design Prospective cohort study.Setting Avon Longitudinal...

Impact of having One Cardiovascular Risk Factor on Other Cardiovascular Risk Factor Levels in Adolescents

Little is known about the impact of having one cardiovascular (CV) risk factor on the levels of other CV risk factors in the general adolescent population. We hypothesized that when adolescents have one CV risk factor, the levels of other CV risk factors worsen simultaneously. Subjects consisted of 1,257 healthy adolescent volunteers (549 males and 708 females) aged 15-18 years. Abdominal obesity, hypertension, raised triglyceride levels, decreased HDL-cholesterol levels and hyperglycemia were used as CV risk factors. Homeostasis assessment of insulin resistance (HOMA-IR) was used as a surrogate marker of insulin resistance. Levels of four biomarkers, leptin, adiponectin, high-sensitive C-reactive protein, and desacyl-ghrelin, were also determined. Cut-offs for gender-specific individual CV risk factor levels were based on the 90th (or 10th) percentile values of the subjects in the present study. The levels of all CV risk factors and HOMA-IR significantly and simultaneously worsened when adolescents had one CV risk factor in both genders. Having any one CV risk factor indicated the development of other CV risk factors in adolescents; in particular, we found that the development of abdominal obesity in male subjects had a harmful effect on the levels of other CV risk factors and was associated with the worsening of all four biomarkers examined. It is important to determine the presence or absence of these CV risk factors before and/or during adolescence, because having one CV risk factor indicates the start of an accumulation of CV risk factors in the general adolescent population.

Carotid intima-media thickness, dietary intake, and cardiovascular phenotypes in adolescents: relation to metabolic syndrome

Little is known about the interrelationships between metabolic syndrome (MS), uric acid, and early carotid atherosclerosis with diet in adolescents. We investigated associations among diet, carotid intima-media thickness (cIMT), MS, uric acid, and other cardiovascular risk factors in adolescents. Two hundred forty-nine adolescents from 3 high schools in Central California—a predominately Hispanic (n = 119, 16.1 ± 0.9 years old, 94% Hispanic), a mixed-ethnicity (n = 94, 15.7 ± 1.2 years old), and a Seventh-day Adventist (SDA) (n = 33, 17.0 ± 1.3 years old) high school—were assessed for cIMT, blood lipids, uric acid, blood glucose, systolic and diastolic blood pressure, body mass index (BMI), and dietary intake. Compared with SDA adolescents, the predominately Hispanic and mixed-ethnicity high school adolescents exhibited higher low-density lipoprotein and BMI percentile, whereas adolescents from the SDA and mixed-ethnicity high schools exhibited lower uric acid and fasting glucose levels than those from the Hispanic high school. After adjusting for age and sex, cIMT was only correlated with systolic blood pressure percentile ( r = 0.16, P < .01). Controlling for age, levels of uric acid were correlated with BMI percentile (males: r = 0.59, P < .001; females: r = 0.24, P < .01), low-density lipoprotein (males: r = 0.40, P < .001; females: r = 0.20, P < .01), and total cholesterol in males ( r = 0.38, P < .001). Despite no significant differences in the high school frequency of MS risk factors, 59% of adolescents had one or more MS risk factors. A relationship was noted between the number of MS risk factors and uric acid ( P < .002). Most of the adolescents presented MS risk factors independent of ethnicity or a purportedly healthier lifestyle (SDA). Uric acid association with MS and its risk factors suggests its potentially heightened importance for the assessment of adolescent cardiovascular health.

Cardiovascular disease risk factors in Caxias do Sul-RS, Brazil adolescents

Despite most part of cardiovascular diseases occur in adult life, the process frequently initiate in adolescence. The purpose was to analyze cardiovascular risk factors in adolescents from Caxias do Sul-RS. In this cross-sectional epidemiological study, 1.675 adolescents aged 11 to 17 years were analyzed selected in a proportional randomized conglomerates method by city sector, type of school, and school grade. Risk factors prevalences were: family history (82.4%), athrogenic diet (74.7%), low cardiorespiratory fitness (61.6%), sedentariness (55.8%), elevated blood pressure (28.4%), high waist circumference (27.7%), excess of body fat (26.5%), etilism (22.3%), overweight (19.7%), smoking (6.2%), and alcohol abusive use (4.3%). Boys presented higher prevalence of atherogenic diet (79.4%>70.7%), while girls of sedentariness (66.8%>43.2%), low cardiorespiratory fitness (69.4%>53.0%), smoking (7.9%>4.3%), high waist circumference (32.9%>21.7%), and excess of fat (32.5%>19.7%). In girls, it was associated to sedentariness the age of 15-17y (PR=1.30), living until four people at home (PR=1.17), and to present sedentary behaviours more than 14 hours/week (PR=1.21), to present atherogenic diet (PR=1.12) and low fitness (PR=1.21). In boys, sedentariness was associated to low fitness (PR=1.21). Low cardiorespiratory fitness was associated in girls to the age of 15-17y (PR=1.43), and to mother sedentariness (PR=1.13), and in boys to passive transport to school (PR=1.18). To girls and boys, respectively, sedentariness (PR=1.19 and PR=1.17), overweight (PR=1.16 and PR=1.24), and excess of body fat (PR=1.14 and PR=1.51) were associated to low fitness. Physical activity interventions must be focused on girls, aged 15 to 17 years, living until four people, and exposed to sedentary behaviours. It is recommended more attention to girls in interventions on physical activity, smoking, and excess of weight, and to boys, in food habits.

Prevalência de fatores de risco cardiovascular em adolescentes

The aim of this study was to determine the prevalence of cardiovascular risk factors in adolescents and to verify its association with age and gender. 644 high school students from public schools in the city of Londrina, Paraná State, Brazil, participated in the study. A two-step sampling process was used. Behavioral risk factors (physical inactivity, inadequate consumption of fruits and vegetables, and smoking) and biological risk factors (overweight and high blood pressure) were investigated. Nearly 90% of adolescents showed at least one risk factor. Inadequate consumption of fruits (56.7%) and vegetables (43.9%) and physical inactivity (39.2%) were the most prevalent risk factors. Prevalence rates for high blood pressure and overweight were 18.6 and 12.7%, respectively. Cardiovascular risk factors were more frequent among boys (PR = 1.20; 95%CI = 1.01-1.42). In conclusion, cardiovascular risk factors are a prevalent health issue among students in the city of Londrina.

Fatores de risco cardiovascular em adolescentes com diferentes níveis de gasto energético

Physical inactivity in adolescence is related to body fat accumulation, which apparently can increase the probability of onset and development of metabolic changes. To verify the predisposition to cardiovascular risk factors in adolescents with different levels of energy expenditure. A total of 108 young men and 132 young women aged between 12 and 16 years were selected. Daily energy expenditure was obtained using the questionnaire proposed by Bouchard et al. The sample was previously divided according to the quartiles of energy expenditure (Kcal/kg/day) into three groups: sedentary (SG), moderately active (MG), and active (AG). The enzyme-colorimetric method was used to determine the total cholesterol (TC), HDL-C, and triglycerides (TG) levels. LDL-C was calculated using the Friedewald et al's formula. The one-factor analysis of variance was used for statistical analysis, considering p<0.05. For the male gender, significant differences were found between the groups for the TC variable (mg/dl); AG (121.56+/-19.15) was different from MG (142.70+/-27.65) and from SG (145.63+/-36.54). Likewise, MG was different from SG (F=3.70 and p=0.03). For the TG variable (mg/dl), AG (65.69+/-18.95) was different from MG (82.25+/-33.73) and from SG (97.44+/-45.95). Also, MG was different from SG (F=3.40 and p=0.04). For the female gender, no significant differences were found in relation to daily energy expenditure. More active young men show lower TC and TG levels in comparison with their moderately active and sedentary peers.

Smoking and Metabolic Control in Adolescents with Type 1 Diabetes

To relate self-reported smoking frequency to metabolic control and other cardiovascular risk factors in adolescents with type 1 diabetes. In the multicenter Diabetes Patienten Verlaufsdokumentationssystem database from Germany and Austria, anonymized records on 27 561 patients < 20 years of age with documented smoking status were available for analysis. Self-reported smoking was negligible in patients younger than 11 years (0.1%), increasing to 5% in 11- to 15-year-old patients, and 28.4% in the 15- to 20-year-old age group. Multivariate analysis with adjustment for age, diabetes duration, sex, insulin therapy, and center differences, revealed that smokers had higher HbA1c-levels compared with non-smokers (9.1% vs 8.0%, P < .0001). Diastolic blood pressure was higher (68.2 vs 67.6 mm Hg, P < .0001), and the lipid profile was unfavorable in patients who smoke: Triglycerides and total cholesterol were higher and high-density lipoprotein-cholesterol was lower (all P < .0001). Smokers display significantly worse metabolic control and a higher cardiovascular risk profile. Although not attested in trials, we state that education about smoking, smoking prevention, and psychological help for smoking cessation should be an integral part of comprehensive pediatric care for adolescent patients with type 1 diabetes.

Serum phospholipid and cholesteryl ester fatty acids and estimated desaturase activities are related to overweight and cardiovascular risk factors in adolescents.

The objective of this study was to describe the relation of serum fatty acids and desaturase activity (DA) to overweight, insulin sensitivity and cardiovascular disease (CVD) risk factors in adolescents. The relations of % serum phospholipid (PL) and cholesteryl ester (CE) fatty acids and estimated DA with CVD risk factors were examined in 264 adolescents (average age 15 years). Fatty acids were determined by gas liquid chromotography. Surrogate measures of DA were expressed as ratios of serum fatty acids: Delta9 DA=16:0/16:1; Delta6 DA=20:3,n6/18:2,n6 (PL) or 18:3,n6/18:2,n6 (CE); and Delta5 DA=20:4,n6/20:3,n6. Spearman partial correlations of fatty acids (%) and DA ratios with CVD risk factors were reported, adjusting for age, sex, race, Tanner stage, energy intake and physical activity. Overweight adolescents compared to normal weight had more adverse levels of CVD risk factors, composition of PL and CE fatty acids in serum, and Delta6 DA and Delta5 DA ratios. Linoleic acid was inversely related to body mass index (BMI), waist circumference and triglycerides (P<or=0.01). Dihomo-gamma-linolenic acid was positively related to BMI, waist, insulin, and triglycerides, and inversely related to high-density lipoprotein-cholesterol levels (P<or=0.01). Delta6 DA was adversely associated with most of the risk factors (P<or=0.01), whereas triglycerides and fasting insulin were beneficially related to Delta5 DA (P<or=0.01). These findings support those observed in adults, that factors, such as type of dietary fat, physical activity, and obesity, may influence fatty acid metabolism and are important in the development of adverse CVD risk factors as early as adolescence.

Association of age at menarche with cardiovascular risk factors, vascular structure, and function in adulthood: the Cardiovascular Risk in Young Finns study

BackgroundIt is unclear whether age at menarche is an independent determinant of future cardiovascular risk. ObjectiveWe aimed to determine whether menarcheal age is an independent predictor of body mass index (BMI) and a wide range of cardiovascular risk factors in adolescence and adulthood. DesignWe examined the associations of menarcheal age with BMI (in kg/m2) and other cardiovascular risk factors in adolescence and adulthood in a population-based sample of 794 female adolescents aged 9–18 y at baseline. Their age at first menstruation was requested at baseline and again 3 and 6 y later. Cardiovascular risk factors were assessed at baseline and at age 30–39 y. ResultsA 1-y decrease in menarcheal age was associated with 0.81 (95% CI: 0.53, 1.08) higher adult BMI as well as greater waist circumference and waist-to-hip ratio, elevated systolic blood pressure, higher insulin resistance, and greater risk of metabolic syndrome (P < 0.05 for all). In multivariable analysis in which these adult risk factors were mutually adjusted for, only the inverse association between age at menarche and adult BMI remained. However, this inverse association was lost after adjustment for premenarcheal BMI (β: −0.16; 95% CI −0.55, 0.23; P = 0.42). Higher premenarcheal BMI predicted earlier menarche, and the strong association between premenarcheal BMI and adult BMI was robust to adjustment for age at menarche. ConclusionsThese findings suggest that early menarche is only a risk marker. Greater childhood BMI seems to contribute to earlier age at menarche and, because of tracking, greater adult BMI and associated cardiovascular risk. An independent effect of early menarche on adult adiposity cannot be excluded, but it is likely to be small at best.

The effect of birthweight upon insulin resistance and associated cardiovascular risk factors in adolescence is not explained by fetal growth velocity in the third trimester as measured by repeated ultrasound fetometry

Smallness for gestational age (SGA) is associated with increased risk of developing components of the metabolic syndrome. Although SGA can imply intrauterine growth restriction (IUGR), more information is required to link specific fetal growth patterns to adult outcomes. We examined the impact of fetal growth velocity during the third trimester (FGV) vs birthweight for gestational age on early markers of the metabolic syndrome in 123 healthy men and women (mean age 17.5 years) born at term. FGV was determined by ultrasound measurements. After correction for confounders including current BMI, SGA was significantly associated with raised basal plasma insulin (+19% above appropriate for gestational age), homeostasis model assessment of insulin resistance (+21%), cholesterol:HDL-cholesterol ratio (+13%) and systolic BP (+4.8%) (all p < 0.05). Furthermore SGA was associated with increased fat mass (+9.6%) and trunk-fat per cent (+6.8%) and with reduced lean body mass as determined by dual-energy X-ray absorptiometry scans (-4.1% below appropriate for gestational age) (all p < 0.05). In contrast, IUGR in the third trimester was associated only with an elevated cholesterol:HDL-cholesterol ratio (+11% above not-IUGR). In the present study, FGV did not explain the impact of birthweight upon the metabolic phenotype in adolescence. This suggests that fetal growth prior to the third trimester or postnatal catch-up growth plays a more important role.