Clustered Cardiovascular Disease Risk Research Articles

The bidirectional longitudinal association between academic performance and cardiovascular disease risk factors in adolescents.

The limited prior research examining the association between academic performance and cardiovascular disease (CVD) risk factors in youth did not explore the reciprocal association between these constructs, and analyzed CVD risk factors individually. Thus, the aim of the present study was to explore the bidirectional longitudinal association between clustered CVD risk score and academic performance in adolescents over a 24-month interval. A total of 237 adolescents (45.6% girls), aged 13.9 ± 0.3 years old at baseline, from DADOS (Deporte, ADOlescencia y Salud) study were included in this study. A clustered CVD risk score was created by calculating the mean age- and gender-standardized z-scores of waist circumference, systolic blood pressure, total cholesterol to high-density lipoprotein cholesterol ratio, triglycerides, homeostatic model assessment of insulin resistance, and cardiorespiratory fitness (inversed). Academic performance was assessed through the final academic grades and the test of educational abilities. Our results showed that the clustered CVD risk score at baseline was not associated with academic performance 24 months later (all p > .05). Nevertheless, except for physical education, academic grades at baseline were inversely associated with clustered CVD risk score at follow-up in adolescents (β ranged from -0.140 to -0.102; all p < .05). No associations were found between academic abilities at baseline and clustered CVD risk score at follow-up (all p > .05). Academic grades could help predict CVD risk 24 months later during adolescence. Education professionals should foster adolescents' academic performance not only to improve academic results but also to maximize future cardiovascular health benefits.

Comparison of waist circumference and waist-to-height ratio as predictors of clustering of cardiovascular risk factors among middle-aged people in rural Khanh Hoa, Vietnam.

Given the population-level variation in stature, a universal cut-off for waist circumference (WC) may not be appropriate for some populations. We compared the performance of WC and waist-to-height ratio (WHtR) to detect the clustering of cardiovascular disease (CVD) risk factors in rural Vietnam. We obtained data from a baseline survey of the Khanh Hoa Cardiovascular Study comprising 2942 middle-aged residents (40-60 years). We used areas under the receiver operating characteristics curve (AUROC), net reclassification index (NRI), and integrated discrimination improvement (IDI) to compare the performance of WC and WHtR in predicting CVD risk clustering (≥2 of the following risk factors: hypertension, diabetes, dyslipidemia, and elevated C-reactive protein). The optimal cut-off values for WC were 81.8 and 80.7 cm for men and women, respectively. Regarding the clustering of CVD risk factors, the AUROC (95% CI) of WC and WHtR were 0.707 (0.676 to 0.739) and 0.719 (0.689 to 0.749) in men, and 0.682 (0.654 to 0.709) and 0.690 (0.663 to 0.717) in women, respectively. Compared with WC, WHtR had a better NRI (0.229; 0.102-0.344) and IDI (0.012; 0.004-0.020) in men and a better NRI (0.154; 0.050-0.257) in women. The optimal WC cut-off for Vietnamese men was approximately 10 cm below the recommended Asian cut-off. WHtR might perform slightly better in predicting the clustering of CVD risk factors among the rural population in Vietnam.

Associations between soil-transmitted helminth infections and physical activity, physical fitness, and cardiovascular disease risk in primary schoolchildren from Gqeberha, South Africa.

School-aged children in low- and middle-income countries carry the highest burden of intestinal helminth infections, such as soil-transmitted helminths (STH). STH infections have been associated with negative consequences for child physical and cognitive development and wellbeing. With the epidemiological transition and rise in cardiovascular disease (CVD), studies have shown that helminth infections may influence glucose metabolism by preventing obesity. Thus, the aim of this study was to determine the association of STH infections in schoolchildren from Gqeberha, focusing on physical activity, physical fitness, and clustered CVD risk score. This cross-sectional study involved 680 schoolchildren (356 girls and 324 boys; mean age 8.19 years, SD±1.4) from disadvantaged communities in Gqeberha (formerly, Port Elizabeth), South Africa. Stool samples were collected and examined for STH infections using the Kato-Katz method. Physical activity (accelerometer) and physical fitness (grip strength, 20 m shuttle run) were measured using standard procedures. Furthermore, anthropometry, blood pressure, as well as glycated haemoglobin and lipid profile from capillary blood samples were assessed. We employed one-way ANOVAs to identify the associations of STH infections in terms of species and infection intensity with physical activity, physical fitness, and clustered CVD risk score. We found a low STH infection prevalence (7.2%) in our study, with participants infected with at least one intestinal helminth species. In comparison to their non-infected peers, children infected with STH had lower mean grip strength scores, but higher mean VO2max estimation and higher levels of MVPA (p < .001). When considering type and intensity of infection, a positive association of A. lumbricoides infection and MVPA was found. In contrast, light T. trichiura-infected children had significantly lower grip strength scores compared to non and heavily-infected children. VO2max and MVPA were positively associated with light T. trichiura infection. No significant association between the clustered CVD risk score and infection with any STH species was evident. STH-infected children had lower grip strength scores than their non-infected peers, yet, achieved higher VO2max and MVPA scores. Our study highlights that the type and intensity of STH infection is relevant in understanding the disease burden of STH infections on children's health. The findings of our study must be interpreted cautiously due to the low infection rate, and more research is needed in samples with higher prevalence rates or case-control designs.

Associations between cardiovascular disease risk factors and spinal pain may be moderated by sex and health-related physical activity (CHAMPS Study-DK).

Spinal pain has been previously linked with cardiovascular disease risk factors in children. This study investigated the prospective associations between cardiovascular disease risk factors and non-traumatic spinal pain occurrences in children, and examined the moderating role of sex and health-related physical activity in these relationships. We used prospective data from the Childhood Health, Activity, and Motor Performance School Study Denmark (CHAMPS Study-DK). The exposure variables were a clustered cardiovascular risk score and homeostasis assessment model-estimated insulin resistance (HOMA-IR) score collected in 2008 and 2010. The spinal pain outcome comprised the number of weeks of non-traumatic spinal pain from 2008-2010 and 2010-2012. Potential confounders included age, sex, and time spent in moderate-to-vigorous intensity physical activity. We constructed age-adjusted mixed negative binominal regression models to investigate the prospective associations of cardiovascular disease risk factors and non-traumatic spinal pain, while considering the potential moderating roles of sex and physical activity in these relationships. Girls with low HOMA-IR scores and boys with low clustered cardiovascular disease risk scores, who engaged in higher levels of moderate-to-vigorous physical activity, reported more weeks of spinal pain, compared to girls with high HOMA-IR scores (p = 0.001) and boys with high clustered cardiovascular disease risk scores (p = 0.024). whereas boys with higher clustered cardiovascular disease risk who had less time in moderate-to-vigorous physical activity reported more weeks of spinal pain than boys with low clustered cardiovascular disease risk score (p = 0.024). Our results show that cardiovascular disease risk factors are related to future occurrences of non-traumatic spinal pain. However, these relationships appear complex and dependent on the nature of the interactions with sex and physical activity.

Clustered cardiovascular disease risk among children aged 8–13 years from lower socioeconomic schools in Gqeberha, South Africa

ObjectivesTo determine the prevalence of individual cardiovascular disease (CVD) risk factors and clustered CVD risk among children attending schools in periurban areas of Gqeberha and to investigate the independent association...

A cross-sectional study of cardiovascular disease risk clustering at different socio-geographic levels in India

Despite its importance for the targeting of interventions, little is known about the degree to which cardiovascular disease (CVD) risk factors cluster within different socio-geographic levels in South Asia. Using two jointly nationally representative household surveys, which sampled 1,082,100 adults across India, we compute the intra-cluster correlation coefficients (ICCs) of five major CVD risk factors (raised blood glucose, raised blood pressure, smoking, overweight, and obesity) at the household, community, district, and state level. Here we show that except for smoking, the level of clustering is generally highest for households, followed by communities, districts, and then states. On average, more economically developed districts have a higher household ICC in rural areas. These findings provide critical information for sample size calculations of cluster-randomized trials and household surveys, and inform the targeting of policies and prevention programming aimed at reducing CVD in India.

Association of Fitness and Fatness with Clustered Cardiovascular Disease Risk Factors in Nigerian Adolescents.

Purpose: This study examinedthe independent and joint association of fitness and fatness with clustered cardiovascular disease risk (CVDrs) in 11–18 year-old Nigerian adolescents. Methods: A hundred and ninety seven adolescents (100 girls and 97 boys) were evaluated forfitness, fatness and CVDrs. Fitness was evaluated with the progressive aerobic cardiovascular endurance run test while fatness was assessed using body mass index. A clustered CVDrs was computed from the standardized residuals of total cholesterol, high density lipoprotein cholesterol, Low density lipoprotein cholesterol, triglycerides, plasma glucose, systolic blood pressure, and diastolic blood pressure. Regression models controlling for waist circumference assessed the association of fitness and fatness with CVDrs. Results: Prevalence of clustered CVD risk was 7.1% (girls = 3.0%; boys = 4.1%). Based on risk factor abnormalities, 52.8% of participants had one or more CVD risk factor abnormalities with more boys (27.4%) affected. Low fitness was associated with clustered CVDrs in both girls (R2 = 9.8%, β = −0.287, p = 0.05) and boys (R2 = 17%, β = −0.406, p < 0.0005). Fatness was not associated with the CVDrs in both sexes. After controlling for all the variables in the model, only fitness (R2 = 10.4%) and abdominal fat (R2 = 19.5%) were associated with CVDrs respectively. Unfit girls were 3.2 (95% CI = 1.31–7.91, p = 0.011) times likely to develop CVD risk abnormality compared to their fit counterparts. The likelihood of unfit boys developing CVD risk abnormality was 3.9 (95% CI = 1.15–10.08, p = 0.005) times compared to their fit peers. Conclusions: Fitness but not fatness was a better predictor of CVDrs in Nigerian boys and girls. The result of this study suggests that any public health strategies aimed at preventing or reversing the increasing trends of CVD risk in adolescents should emphasize promotion of aerobic fitness.

The influence of cardiorespiratory fitness on clustered cardiovascular disease risk factors and the mediator role of body mass index in youth: The UP&DOWN Study.

The combined effect of cardiorespiratory fitness (CRF) and body mass index (BMI) on cardiovascular disease (CVD) risk in young people remains to be fully determined. We examined the individual and combined associations of CRF and BMI with clustered CVD risk factors, and the mediator role of BMI in the association between CRF and clustered CVD risk factors in children and adolescents. 237 children (111 girls) and 260 adolescents (120 girls) were included in this cross-sectional study. Height and weight were assessed and BMI was calculated. A CVD risk factor index (CVDRF-I) was computed from: waist circumference, systolic blood pressure, triglycerides, high-density lipoprotein cholesterol and glucose. CRF was assessed using the 20-m shuttle run test. Regression analysis, analysis of covariance and mediation analysis (Baron and Kenny procedures) were used to test the independent and combined effect of CRF and BMI on CVDRF-I, and to test mediation hypothesis, respectively. CRF was negatively associated with CVDRF-I (all P < 0.05); however, after adjusting for BMI the associations were no longer significant in children and adolescents of both sex groups. Contrary, the association between BMI and CVDRF-I was independent of CRF (all P < 0.001). The effect of CRF on CVDRF-I was mediated by BMI. The percentage of the total effect of CRF on CVDRF-I mediated by BMI for boys and girls children and boys and girls adolescents were 79.5%, 100%, 81.2% and 55.7%, respectively. BMI is an independent predictor of CVDRF-I and a mediator of the association between CRF and CVDRF-I in children and adolescents. These results help to clarify the associations between CRF, weight status and cardiovascular health, suggesting that future CVD health would benefit from maintaining an optimal weight status.

A7116 Preventing excessive alcohol intake, smoking and obesity may reduce blood pressure results from the screening of 47000 adults in Emin, China

Objectives: Prehypertenion (PHT) has a higher risk of developing hypertension (37.3–49.5% over 4 years) the leading preventable cause of cardiovascular disease (CVD).Therefore, to coordinate more efforts to control hypertension and CVD, we estimated PHT prevalence, related factors and clustered CVD risk factors in Emin Xinjiang, where control of hypertension is lower than national average (10% vs 15.9%) in China. Methods: From 2014 to 2016, we surveyed1/3 of adult residents of Emin (population 160000) for hypertension screening. PHT was defined as not on anti-hypertensive medications and SBP of 120–139mmHg and /or DBP of 80–89mmHg. We compared the PHT prevalence with different gender, age groups, and area (urban, agricultural, stock-raising), and related factors and clustered CVD risk factors in PTH. Modifiable clustered risk factors included overall and abdominal obesity, smoking and drinking. Results: 47040 adult residents were screened; 48.5% were women. The overall prevalence of PHT and hypertension was 31.2%and 26.6%, respectively. The age-adjusted PHT prevalence was higher in men (37.4%) than in women (24.4%). PHT prevalence is the highest (37.9%) in 30–39 age groups and highest in urban area (31.6%). Overweight (OR = 1.85), overall and abdominal obesity (OR = 2.45 and 1.45), smoking (OR = 1.12), and alcohol intake (OR = 1.16) were associated with higher PHT prevalence. Compared to normotensive subjects, the prevalence of clustering 1 (23.0% vs 22.2%), 2 (32.4% vs 24.8%), 3 (8.3% vs 6.1%) and 4 (5.2% vs 3.8%) CVD risk factors were significantly higher in PHT. Conclusion: PHT is highly prevalent in Xinjiang, particularly in men, younger population and in those from urban area. Control of alcohol drinking, smoking and body weight may be at high priority of health promotion.

The Role of Adiposity in the Association between Muscular Fitness and Cardiovascular Disease

To test the associations of muscular fitness and body mass index (BMI), individually and combined, with clustered cardiovascular disease risk factors in children and adolescents and to analyze the mediator role of BMI in the association between muscular fitness and clustered cardiovascular disease risk factors. In total, 239 children (113 girls) and 270 adolescents (128 girls) participated in this cross-sectional study. Height and weight were assessed, and BMI was calculated. A cardiovascular disease risk factors index (CVDRF-I) was created from the combination of the following variables: waist circumference, systolic blood pressure, triglycerides, high-density lipoprotein cholesterol, and glucose. Handgrip strength/weight and standing long jump tests were used to assess muscular fitness. A muscular fitness index was computed from the combination of both tests. Muscular fitness index was associated with CVDRF-I in children of both sexes and adolescent boys; however, these associations disappeared after accounting for BMI. BMI was associated with CVDRF-I in both children and adolescents, even after adjusting for muscular fitness (all P < .001). In male and female children and in adolescent boys, the association between muscular fitness and CVDRF-I was mediated by BMI (all P < .001). Because there was no association between muscular fitness and CVDRF-I in adolescent girls, the mediation hypothesis was discarded. BMI is an independent predictor of CVDRF-I in children and adolescents of both sexes. Conversely, the effect of muscular fitness on CVDRF-I seems to be fully mediated by BMI levels in male and female children and in adolescent boys.

Physical activity, sedentary time, TV viewing, physical fitness and cardiovascular disease risk in adolescents: The HELENA study

BackgroundTo examine the independent associations between physical activity (PA) intensities, sedentary time (ST), TV viewing, cardiorespiratory fitness (CRF) and muscular fitness (MF) with cardiovascular disease (CVD) risk in youth. MethodsA cross-sectional study on 534 European adolescents (252 males, 282 females, 12.5–17.5years). Minutes per day of light (LPA), moderate (MPA) and vigorous (VPA) PA and total ST were measured using accelerometers. TV viewing time was measured using a questionnaire. CRF and MF were measured using the 20m shuttle run test and a hand dynamometer respectively. CVD outcomes included markers of body composition (body mass index (BMI), waist circumference (WC), WC/height (Ht) and sum of skinfolds (SumSF)), blood pressure, blood lipids and insulin resistance (HOMA-IR). Clustered CVD risk was calculated using SumSF, HOMA-IR, blood lipids and blood pressure. ResultsLPA had a significant positive independent relationship with all body composition outcomes (P<0.001) and clustered CVD risk (P=0.046). VPA was negatively related to SumSF (P<0.001), BMI (P=0.018), WC/Ht (P=0.013) and clustered CVD risk (P=0.001), but was non-significant for all when other exposures were considered (P>0.10). MPA had a negative independent relationship with only WC (P=0.029) and ST was not significantly related to CVD risk (P>0.16). TV viewing had a significant positive independent relationship with HOMA-IR (P<0.001) and clustered CVD risk (P=0.019). CRF (all P<0.002) and MF (all P<0.009) had a negative independent relationship with body composition outcomes and clustered CVD risk. ConclusionsPublic health guidelines should prioritize on increasing levels of CRF, MF and VPA, and reducing TV viewing time to lower CVD risk in youth.

Neck circumference and clustered cardiovascular risk factors in children and adolescents: cross-sectional study

ObjectiveEarly detection of cardiovascular disease (CVD) risk factors, such as obesity, is crucial to prevent adverse long-term effects on individuals’ health. Therefore, the aims were: (1) to explore the robustness...

Validity of noninvasive composite scores to assess cardiovascular risk in 10‐year‐old children

Agreement between and classification accuracy of six different noninvasive composite scores and a cardiovascular disease (CVD) risk factor score were investigated in 911 (466 boys and 445 girls) 10-year-old Norwegian children. A CVD risk factor score (triglyceride, total cholesterol/HDL ratio, homeostasis model assessment of insulin resistance, systolic blood pressure (SBP), waist-to-height ratio (WHtR), and cardiorespiratory fitness) and six noninvasive risk scores (fitness+three different measurements of fatness (body mass index (BMI), WHtR, and skinfolds), with and without inclusion of SBP) were calculated (mean z-score by gender). Agreement was assessed using Bland-Altman plots. The ability of noninvasive scores to correctly classify children with clustered CVD risk was examined by receiver operating characteristic (ROC) analysis and Cohen's kappa coefficient (κ). For both sexes, the noninvasive scores without SBP showed excellent AUC values (AUC=0.93-0.94, 95% CI=0.88-0.98) and moderate kappa values (κ=0.49-0.64) and had limits of agreement of 0.0±0.78-0.89 (arbitrary unit). Inclusion of SBP increased AUC values (AUC=0.96-0.97, 95% CI=0.94-0.99), kappa values (κ=0.58-0.69), and reduced limits of agreement (0.0±0.68-0.76). Noninvasive scores that include fitness and fatness provide acceptable agreement and classification accuracy, allowing for widespread early identification of children that might be at risk for developing CVD later in life. SBP should be included in the noninvasive score to improve classification accuracy if possible.

Types of Obesity and Its Association with the Clustering of Cardiovascular Disease Risk Factors in Jilin Province of China.

Cardiovascular disease (CVD) has become a serious public health problem in recent years in China. Aggregation of CVD risk factors in one individual increases the risk of CVD and the risk increases substantially with each additional risk factor. This study aims to explore the relationship between the number of clustered CVD risk factors and different types of obesity. A multistage stratified random cluster sampling design was used in this population-based cross-sectional study in 2012. Information was collected by face to face interviews. One-way analysis of variance (ANOVA), chi-square test, Kruskal-Wallis test and multiple logistic regression were used in this study. The prevalence of general obesity, central obesity and compound obesity were 0.3%, 36.1% and 14.7%, respectively. The prevalence of hypertension, hyperlipidemia and diabetes in the compound obesity group were higher than those in other groups (compound obesity > central obesity > general obesity > non-obesity), while smoking rate in the non-obesity group was higher than those in other groups (non-obesity > general obesity > central obesity > compound obesity). People with obesity were more likely to have one or more CVD risk factor compared with non-obesity subjects (general obesity (OR: 2.27, 95% CI: 1.13–4.56), central obesity (OR: 2.64, 95% CI: 2.41–2.89), compound obesity (OR: 5.09, 95% CI: 4.38–5.90). The results were similar when the number of clustered CVD risk factors was ≥ 2 and ≥ 3. As a conclusion, more than half of the residents in Jilin Province have a problem of obesity, especially central obesity. Government and health department should take measures to improve people’s awareness of central obesity in Jilin Province of China. The prevalence of hypertension, hyperlipidemia and diabetes are associated with obesity types. Compound obesity has a greater risk to cluster multiple CVD risk factors than central obesity and general obesity. Taking measures to control obesity will reduce the prevalence of CVD in Jilin Province.

Objectively Measured Aerobic and Resistance Exercise and Cardiovascular Disease Risk Factor Response

PURPOSE: To examine the effects of objectively measured weekly exercise weight (EW) lifted and exercise heart beats (EHB) during exercise training on changes in cardiovascular disease (CVD) risk factors. METHODS: We randomized 31 pre-to-stage 1 hypertensive (not on medication), overweight/obese, and sedentary non-smokers (58±8 years) into an aerobic training (AT) only (n=16) or a resistance training (RT) only (n=15) 8 week exercise intervention. Participants exercised 3 days/week for 60 min/session. An innovative exercise training system and software (TechnoGym) captured EW lifted and EHB automatically each session. Total weekly EW lifted was calculated as the sum of weight x repetitions x sets for each exercise, averaged over 8 weeks, then divided by body weight (lbs). Total weekly EHB were calculated by the sum of exercise heart rate x min/session/week, with resting heart rate x minutes of exercise subtracted. We measured peripheral and central blood pressure (BP), % body fat, cardiorespiratory fitness, bench and leg press 1 repetition maximum (1RM), and blood lipids at baseline and 8-weeks. Individual CVD risk factors were standardized as sex specific z-scores for each participant and the mean was used to establish an overall clustered CVD risk score. Data was analyzed using Pearson correlation and linear mixed models adjusting for age, sex, and average daily steps. RESULTS: The average weekly EW and EHB were 220±68 lbs and 7004±1419 beats, respectively. Regression analysis showed a reduction in overall CVD risk score by -0.25 (p = 0.06) per 100 lbs lifted relative to body weight with RT and -0.1 (p=0.16) per 1000 beats with AT. With RT, we found strong correlations between total EW and changes in peripheral systolic (r=-0.45, p=0.09) and diastolic BP (r=-0.59, p=0.02), central systolic (r=-0.47, p=0.08) and diastolic BP (r=-0.53, p=0.04), and leg press 1RM (r=0.62, p=0.01). With AT, strong correlations with total EHB were noted with change in triglyceride levels (r=-0.50, p=0.049). CONCLUSIONS: In individuals at high risk of developing CVD, increased total EW lifted and EHB are associated with improved overall CVD risk, especially peripheral and central BP with greater EW lifted, and triglyceride levels for additional EHB. Supported by Iowa State University College of Human Sciences seed grant.

The reliability of a single protocol to determine endothelial, microvascular and autonomic functions in adolescents.

Impairments in macrovascular, microvascular and autonomic function are present in asymptomatic youths with clustered cardiovascular disease risk factors. This study determines the within-day reliability and between-day reliability of a single protocol to non-invasively assess these outcomes in adolescents. Forty 12- to 15-year-old adolescents (20 boys) visited the laboratory in a fasted state on two occasions, approximately 1week apart. One hour after a standardized cereal breakfast, macrovascular function was determined via flow-mediated dilation (FMD). Heart rate variability (root mean square of successive R-R intervals; RMSSD) was determined from the ECG-gated ultrasound images acquired during the FMD protocol prior to cuff occlusion. Microvascular function was simultaneously quantified as the peak (PRH) and total (TRH) hyperaemic response to occlusion in the cutaneous circulation of the forearm via laser Doppler imaging. To address within-day reliability, a subset of twenty adolescents (10 boys) repeated these measures 90min afterwards on one occasion. The within-day typical error and between-day typical error expressed as a coefficient of variation of these outcomes are as follows: ratio-scaled FMD, 5·1% and 10·6%; allometrically scaled FMD, 4·4% and 9·4%; PRH, 11% and 13·3%; TRH, 29·9% and 23·1%; and RMSSD, 17·6% and 17·6%. The within- and between-day test-retest correlation coefficients for these outcomes were all significant (r>0·54 for all). Macrovascular, microvascular and autonomic functions can be simultaneously and non-invasively determined in adolescents using a single protocol with an appropriate degree of reproducibility. Determining these outcomes may provide greater understanding of the progression of cardiovascular disease and aid early intervention.

Screen-Based Behaviors of Children and Cardiovascular Risk Factors

To determine whether the amount of time spent in screen-based behaviors (SBBs; television viewing, computer use, and playing electronic games) is independently associated with individual and clustered cardiovascular disease (CVD) risk factors among elementary school children. Baseline data were used from 264 children (age 7-10 years) participating in the Transform-Us! cluster-randomized controlled trial. Time (h/d) spent in SBBs was obtained using a parent proxy-report questionnaire. Anthropometrics, blood pressure (BP), and lipids were measured using standard techniques. A clustered CVD risk score was calculated as the average of the standardized values of the subcomponents (waist circumference [WC], systolic BP, diastolic BP, and lipids). After adjusting for sex, parent education, physical activity (accelerometry), diet, and WC (when adiposity was not the outcome), television viewing time was positively associated with body mass index z-score (P = .002), WC (P = .02), and systolic BP (P = .05). Electronic games was positively associated with low density lipoprotein levels (P = .05), and total screen-time was positively associated with body mass index (P = .02). Differential associations were observed between types of SBBs and CVD risk factors, indicating that not all SBBs are adversely associated with obesity and CVD risk. There is a need to differentiate between types of SBBs when evaluating the CVD risk associated with screen behaviors in children. International Standard Randomized Controlled Trial: ISRCTN83725066; Australian New Zealand Clinical Trials Registry: ACTRN12609000715279.

Resting Heart Rate Is Not a Good Predictor of a Clustered Cardiovascular Risk Score in Adolescents: The HELENA Study.

BackgroundResting heart rate (RHR) reflects sympathetic nerve activity a significant association between RHR and all-cause and cardiovascular mortality has been reported in some epidemiologic studies.MethodsTo analyze the predictive power and accuracy of RHR as a screening measure for individual and clustered cardiovascular risk in adolescents. The study comprised 769 European adolescents (376 boys) participating in the HELENA cross-sectional study (2006–2008) were included in this study. Measurements on systolic blood pressure, HOMA index, triglycerides, TC/HDL-c, VO2máx and the sum of four skinfolds were obtained, and a clustered cardiovascular disease (CVD) risk index was computed. The receiver operating characteristics curve was applied to calculate the power and accuracy of RHR to predict individual and clustered CVD risk factors.ResultsRHR showed low accuracy for screening CVD risk factors in both sexes (range 38.5%–54.4% in boys and 45.5%–54.3% in girls). Low specificity’s (15.6%–19.7% in boys; 18.1%–20.0% in girls) were also found. Nevertheless, the sensitivities were moderate-to-high (61.4%–89.1% in boys; 72.9%–90.3% in girls).ConclusionRHR is a poor predictor of individual CVD risk factors and of clustered CVD and the estimates based on RHR are not accurate. The use of RHR as an indicator of CVD risk in adolescents may produce a biased screening of cardiovascular health in both sexes.

Physical activity and clustered cardiovascular disease risk factors in young children: a cross-sectional study (the IDEFICS study)

BackgroundThe relevance of physical activity (PA) for combating cardiovascular disease (CVD) risk in children has been highlighted, but to date there has been no large-scale study analyzing that association in children aged ≤9 years of age. This study sought to evaluate the associations between objectively-measured PA and clustered CVD risk factors in a large sample of European children, and to provide evidence for gender-specific recommendations of PA.MethodsCross-sectional data from a longitudinal study in 16,224 children aged 2 to 9 were collected. Of these, 3,120 (1,016 between 2 to 6 years, 2,104 between 6 to 9 years) had sufficient data for inclusion in the current analyses. Two different age-specific and gender-specific clustered CVD risk scores associated with PA were determined. First, a CVD risk factor (CRF) continuous score was computed using the following variables: systolic blood pressure (SBP), total triglycerides (TG), total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-c) ratio, homeostasis model assessment of insulin resistance (HOMA-IR), and sum of two skinfolds (score CRFs). Secondly, another CVD risk score was obtained for older children containing the score CRFs + the cardiorespiratory fitness variable (termed score CRFs + fit). Data used in the current analysis were derived from the IDEFICS (‘Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS’) study.ResultsIn boys <6 years, the odds ratios (OR) for CVD risk were elevated in the least active quintile of PA (OR: 2.58) compared with the most active quintile as well as the second quintile for vigorous PA (OR: 2.91). Compared with the most active quintile, older children in the first, second and third quintiles had OR for CVD risk score CRFs + fit ranging from OR 2.69 to 5.40 in boys, and from OR 2.85 to 7.05 in girls.ConclusionsPA is important to protect against clustering of CVD risk factors in young children, being more consistent in those older than 6 years. Healthcare professionals should recommend around 60 and 85 min/day of moderate-to-vigorous PA, including 20 min/day of vigorous PA.Please see related commentary: http://www.biomedcentral.com/1741-7015/11/173.

Is dairy consumption associated with low cardiovascular disease risk in European adolescents? Results from the HELENA Study

To identify those food groups best discriminating individuals at high/low cardiovascular disease (CVD) risk and to investigate the relationship between dairy consumption and CVD risk factors (individual and scores) in adolescents (12.5-17.5 years) from eight European cities participating in the cross-sectional (2006-2007) HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) project. Diet, waist circumference, skin-folds thickness, systolic blood pressure, insulin resistance, triglycerides, total cholesterol/high-density lipoprotein ratio and cardiorespiratory fitness (CRF) were assessed in 511 (49.9% boys) adolescents. Individual z-scores of CVD risk factors were summed to compute sex-specific clustered CVD risk scores. Dairy emerged as the food group best discriminating adolescents at low/high CVD risk. In both genders, waist circumference and sum of skin-folds were inversely associated with consumption of milk and yogurt, and milk- and yogurt-based beverages, whereas a positive association was observed with CRF. Moreover, CVD risk score (β = -0.230, P = 0.001) was also inversely associated with overall dairy consumption only in girls. Dairy consumption is associated with lower adiposity and higher CRF in these adolescents. An inverse association between CVD risk score and dairy consumption is also depicted in girls. The study adds further evidence to the scarce literature on the influence of milk and dairy products on adolescents' cardiovascular health.