Continuous Cardiometabolic Risk Score Research Articles

Exploring gait velocity as a predictor of cardiometabolic disease risk in young adults.

The association between poor gait and functional movement ability and metabolic syndrome (MetS) has been well established in older adults. A continuous cardiometabolic risk score, MetSindex, may more easily identify individuals at risk for cardiometabolic disease who do not yet meet the stringent criteria for a formal MetS diagnosis. Although the association between MetS and gait velocity is well established in older adults, no such relationship has been identified in younger adults; a group experiencing a rapid increase in the development of MetS. MetSindex was determined for 21 young adults using standard procedures. Gait velocity was measured as participants completed a ten-meter walk test. Spatiotemporal parameters of gait were also derived using a motion capture system. Simple linear regression was used to determine the relationship between MetSindex and gait velocity, as well as MetSindex and spatiotemporal parameters of gait. There was a large inverse relationship between MetSindex and gait velocity. A large inverse relationship was also observed between MetSindex and cadence, and a large positive relationship was observed between stance time and double limb support time. Gait velocity slows in young adults who do not necessarily meet the criterion for positive diagnosis of MetS-but demonstrate an increased risk for MetS and cardiovascular disease through higher MetSindex scores. The mechanism underlying reduced gait velocity may be fewer, but not shorter steps. Determining easy-to-use surrogates of MetS (e.g., gait velocity) may help combat the growing prevalence of MetS by increasing access to preventative approaches.

Physical activity intensity profiles associated with cardiometabolic risk in middle-aged to older men and women

Accelerometers provide detailed data about physical activity (PA) across the full intensity spectrum. However, when examining associations with health, results are often aggregated to only a few summary measures [e.g. time spent “sedentary” or “moderate-to-vigorous” intensity PA]. Using multivariate pattern analysis, which can handle collinear exposure variables, we examined associations between the full PA intensity spectrum and cardiometabolic risk (CMR) in a population-based sample of middle-aged to older adults. Participants (n = 3660; mean ± SD age = 69 ± 8y and BMI = 26.7 ± 4.2 kg/m2; 55% female) from the EPIC-Norfolk study (UK) with valid accelerometry (ActiGraph-GT1M) data were included. We used multivariate pattern analysis with partial least squares regression to examine cross-sectional multivariate associations (r) across the full PA intensity spectrum [minutes/day at 0–5000 counts-per-minute (cpm); 5 s epoch] with a continuous CMR score (reflecting waist, blood pressure, lipid, and glucose metabolism). Models were sex-stratified and adjusted for potential confounders. There was a positive (detrimental) association between PA and CMR at 0-12 cpm (maximally-adjusted r = 0.08 (95%CI 0.06–0.10). PA was negatively (favourably) associated with CMR at all intensities above 13 cpm ranging between r = −0.09 (0.07–0.12) at 800-999 cpm and r = −0.14 (0.11–0.16) at 75–99 and 4000-4999 cpm. The strongest favourable associations were from 50 to 800 cpm (r = 0.10–0.12) in men, but from ≥2500 cpm (r = 0.18–0.20) in women; with higher proportions of model explained variance for women (R2 = 7.4% vs. 2.3%). Most of the PA intensity spectrum was beneficially associated with CMR in middle-aged to older adults, even at intensities lower than what has traditionally been considered “sedentary” or “light-intensity” activity. This supports encouragement of PA at almost any intensity in this age-group.

Clustering of cardiometabolic risk factors and the continuous cardiometabolic risk score in children from Southern Brazil: a cross-sectional study.

The present study aimed to verify the clustering of cardiometabolic risk factors for cardiovascular diseases (CVD) and its relationship with the continuous cardiometabolic risk score (cMetS). Cross-sectional study with 631 children aged 6 to 9years. Cardiorespiratory fitness, glucose, systolic blood pressure, total cholesterol/high-density lipoprotein cholesterol ratio, triglycerides, and waist circumference were assessed. The number of children in whom the risk factors were not independently distributed was analyzed. Z-scores were computed for each risk factor to calculate the cMetS. There was a high proportion of children with clustering of risk factors for CVD. The clustering of risk factors was apparent in 11.3% of the children for four or more risk factors, and 21.9% had three or more risk factors. The cMetS showed a linear relationship with the increase in the number of risk factors. A cMetS value higher than 0.91 indicated clustering of cardiometabolic risk factors amongst children. The use of clustering of cardiometabolic risk factors identified a high proportion of children with the presence of relevant cardiometabolic alterations. A cMetS value higher than 0.91 (relative to an international standard) indicated higher clustering of cardiometabolic risk factors amongst children. The online version contains supplementary material available at 10.1007/s40200-021-00845-9.

Association between self-reported sleep duration and cardiometabolic risk in corporate executives.

This cross-sectional study aimed to compare the association between self-reported sleep duration and cardiometabolic risk among men and women corporate executives and investigate potential lifestyle, work- and stress-related mediators thereof. Self-reported sleep duration and lifestyle, occupational, psychological and measured anthropometrical, blood pressure (BP) and blood marker variables were obtained from health risk assessment data of 3583 corporate executives. Sex-stratified regression analyses investigated the relationships between occupational and psychological variables with self-reported sleep duration, and sleep duration with individual cardiometabolic risk factors. Mediation analyses investigated the effects of work, psychological and lifestyle factors on the relationships between self-reported sleep duration and cardiometabolic risk factors, as well as a continuous cardiometabolic risk score calculated from the sum of sex-stratified z-standardized scores of negative fasting serum HDL, and positive plasma Glu, serum TG, body mass index (BMI), waist circumference, systolic and diastolic BP. Longer work hours and work commute time, depression, anxiety and stress were associated with shorter sleep duration in both men and women (all p < 0.05). Shorter sleep duration was associated with higher BMI, larger waist circumference and greater cardiometabolic risk scores in both men and women (all p < 0.05), higher diastolic BP in men (p < 0.05) and lower HDL cholesterol in women (p < 0.05). Physical activity, working hours and stress significantly mediated the relationships between self-reported sleep duration and BMI, waist circumference, diastolic BP and cardiometabolic risk score in men only. In these corporate executives, shorter self-reported sleep duration is associated with poorer psychological, occupational and cardiometabolic risk outcomes in both men and women. Given that physical activity, working hours and stress mediate this association among the men, the case for sleep health interventions in workplace health programmes is warranted.

Association Between Diet Quality and Cardiometabolic Risk Factor Clustering Stratified by Socioeconomic Status Among Chinese Children

BackgroundFew studies have evaluated the long-term relationship between diet quality and cardiometabolic risk factor clustering among children. The moderating effect of socio-economic status (SES) is of interest. ObjectiveTo investigate the association between diet quality with cardiometabolic risk among Chinese children and to explore the moderating effect of SES. DesignIn this cohort study, 5 waves (1997-2009) of the China Health and Nutrition Survey were used. Diet quality was measured by a modified version of the Chinese Children Dietary Index (mCCDI) based on Dietary Guidelines for Chinese. ParticipantsChildren between the ages of 7 and 17 (n = 2903) who completed at least 2 surveys were included. Those who missed measures or had hypertension or diabetes at baseline were excluded. Main outcome measuresThe fasting blood samples were collected in 2009. Waist circumference (WC) and blood pressure (BP) were measured in each survey. Statistical analysis performedA continuous cardiometabolic risk score (MetScore) was derived by a confirmatory factor analysis of 5 components: WC, BP, glucose, triglycerides, and high-density lipoprotein cholesterol. Considering the latency period of the effect of behaviors, the mCCDI was lagged by the period between surveys. Linear regression was used to analyze the association of mCCDI with MetScore and its components. Mixed effect linear regression and lagged mCCDI were used for WC and BP models. ResultsHigher mCCDI was independently associated with a lower MetScore at follow-up (β: −.11; 95% CI: −.18 to −.04). Higher lagged mCCDI over time was associated with a lower WC z score overall (β: −.05; 95% CI: −.08 to −.01) and among children in the low SES group (β: −.09; 95% CI: −.14 to −.04) but not those in the high SES group. When examining the 15 mCDDI components separately, scores for 5 components: more grains, vegetables, soybeans and its products; less sugar-sweetened beverages; and more diet variety were significantly associated with a lower MetScore. ConclusionsAmong Chinese children, higher diet quality measured by mCCDI was independently associated with a lower MetScore at follow-up.

Impact of obstructive sleep apnea on cardiometabolic health in a random sample of older adults in rural South Africa: building the case for the treatment of sleep disorders in underresourced settings.

The association between obstructive sleep apnea (OSA) and increased cardiometabolic risk (CMR) has been well documented in higher-income countries. However, OSA and its association with CMR have not yet been investigated, based on objective measures, in southern Africa. We measured polysomnography-derived sleep characteristics, OSA prevalence, and its association with cardiometabolic diseases in a rural, low-income, African-ancestry sample of older adult participants in South Africa. Seventy-five participants completed the study. Body mass index, hypertension, diabetes, dyslipidemia, and HIV status were determined. A continuous CMR score was calculated using waist circumference, random glucose, high-density-lipoprotein cholesterol, triglycerides, and mean arterial blood pressure. Sleep architecture, arousal index, and apnea-hypopnea index for detection of the OSA (apnea-hypopnea index ≥ 15 events/h) were assessed by home-based polysomnography. Associations between CMR score and age, sex, socioeconomic status, apnea-hypopnea index, and total sleep time were investigated by multivariable analysis. In our sample (53 women, age 66.1 ± 10.7 years, 12 HIV+), 60.7% of participants were overweight/obese, 61.3% were hypertensive, and 29.3% had undiagnosed OSA. Being older (P = .02) and having a higher body mass index (P = .02) and higher waist circumference (P < .01) were associated with OSA. Apnea-hypopnea index severity (β = 0.011; P = .01) and being a woman (β = 0.369; P = .01) were independently associated with a higher CMR score in socioeconomic status- and age-adjusted analyses. In this South African community with older adults with obesity and hypertension, OSA prevalence is alarming and associated with CMR. We show the feasibility of detecting OSA in a rural setting using polysomnography. Our results highlight the necessity for actively promoting health education and systematic screening and treatment of OSA in this population to prevent future cardiovascular morbidity, especially among women.

Cardiometabolic health in adolescence and its association with educational outcomes

AimTo explore the association of selected cardiometabolic biomarkers and metabolic syndrome (MetS) with educational outcomes in adolescents from Chile.MethodsOf 678 participants, 632 (52% males) met criteria for the study. At...

Associations of Accumulated Time in Bouts of Sedentary Behavior and Moderate-to-Vigorous Physical Activity With Cardiometabolic Health in 10- to 13-Year-Old Boys.

Little is known about the impact of sedentary and moderate-to-vigorous physical activity (MVPA) bouts on cardiometabolic health. The aim was to examine how the accumulation of bouts of sedentary time and MVPA associates to cardiometabolic health in children independently of total sedentary and MVPA time. In a cross-sectional study with 123 boys (10-13y), sedentary and MVPA bouts were determined using 7-day accelerometry. Each bout was compared with cardiometabolic risk factors and with the risk score that was calculated using standardized values of body mass index, waist circumference, homeostasis model assessment for insulin resistance, triglycerides, and total cholesterol/high-density cholesterol ratio. Time in 10- to 14-minute sedentary bouts was negatively associated with continuous cardiometabolic risk score in weekdays and weekend days and with triglycerides in a weekend (P < .05). Time accumulated in ≥30-minute sedentary bouts was associated with higher insulin and homeostasis model assessment for insulin resistance values in weekend (P < .05). Weekday total MVPA and time accumulated in ≥10-minute MVPA bouts were negatively associated with continuous cardiometabolic risk score and body mass index in weekdays (P < .05). No associations were found between total sedentary time and metabolic health. Significant associations between sedentary and MVPA bouts with cardiometabolic risk factors suggest the need of the more detailed analysis for sedentary behavior and its effects on health risks.

Continuous cardiometabolic risk score definitions in early childhood: a scoping review.

Cardiometabolic risk (CMR) in young children has been measured using various approaches, including a continuous summary score that incorporates components such as adiposity, lipids, metabolic factors and blood pressure. The objective of this study was to comprehensively review definitions of continuous CMR scores in children <10years of age. A scoping review was conducted using a systematic search of four scientific databases up to June 2016. Inclusion criteria were children <10years of age and report of a continuous CMR score. Ninety-one articles were included. Most studies were published from 2007 to 2016 (96%). Nearly all continuous CMR scores (90%) were calculated using the sum or the mean of z-scores, and many articles age-standardized and sex-standardized components within their own population. The mean number of variables included in the risk scores was 5 with a range of 3-11. The most commonly included score components were waist circumference (52%), triglycerides (87%), high-density lipoprotein cholesterol (67%), glucose (43%) and systolic blood pressure (52%). Continuous CMR scores are emerging frequently in the child health literature and are calculated using numerous methods with diverse components. This heterogeneity limits comparability across studies. A harmonized definition of CMR in childhood is needed.

Investigating Cortisol Production and Pattern as Mediators in the Relationship Between Shift Work and Cardiometabolic Risk

BackgroundShift work is a risk factor for many diseases, including cardiovascular disease. Although the biological pathways are still unclear, it is hypothesized that cortisol disruption during night work is an intermediate. The objective of this study is to determine whether total cortisol production and cortisol pattern mediate the relationship between current shift work and cardiometabolic risk (CMR) among female hospital employees. MethodsA cross-sectional study was conducted among 326 female employees (166 rotating shift workers, 160 day workers), recruited from a hospital in Southeastern Ontario, Canada, during 2011 to 2014. Participants completed a baseline interview, questionnaire, and clinical exam. Urine samples were collected over two 24-hour periods and used to analyze creatinine-adjusted cortisol, which was then used to calculate total cortisol production (AUCG), and pattern (AUCI). Mediation analysis was performed to test the mediating effect of cortisol in the relationship between shift work and a continuous CMR score. ResultsCurrent shift work is associated with a 0.52 higher CMR score (95% CI: 0.15, 0.89), a lower cortisol output (AUCG), and a flatter pattern (AUCI) over a 2-day period. AUCG is a partial mediator in the relationship between shift work and CMR, whereas AUCI is not. AUCG is also associated with CMR while controlling for shift work, suggesting that lower total cortisol production is also linked to CMR in non-shift workers. ConclusionsTotal cortisol production is a partial mediator in the relationship between rotating shift work and CMR among female hospital employees, whereas cortisol pattern is not a mediator.

Cross-sectional associations of plasma fatty acid composition and estimated desaturase and elongase activities with cardiometabolic risk in Finnish children—The PANIC study

Knowledge on the association of plasma fatty acid (FA) composition in triacylglycerol (TG) and phospholipid (PL) fractions with cardiometabolic risk in population-based samples of children is lacking. We investigated the associations of proportions of FA in plasma TG and PL fractions as well as estimated desaturase and elongase activities with cardiometabolic risk in a population sample of 384 children aged 6-8 years. Plasma FA composition was analyzed by gas chromatography. Desaturase and elongase activities were estimated as product-to-precursor FA ratios. Cardiometabolic risk was assessed using a continuous cardiometabolic risk score (CRS) variable. Higher proportions of myristic and palmitoleic acids in plasma TG and PL were associated with a higher CRS. A lower proportion of linoleic acid in plasma TG was related to a higher CRS. Estimated stearoyl-CoA-desaturase and Δ6-desaturase activities in plasma TG and PL were directly associated with CRS, whereas estimated elongase activity in plasma TG and PL was inversely related to CRS. Greater proportions of myristic and palmitoleic acids and a smaller proportion of linoleic acid in plasma, as well as higher estimated stearoyl-CoA-desaturase and Δ6-desaturase activities and a lower estimated elongase activity, are associated with cardiometabolic risk factors among children. These findings reinforce the evidence that FA metabolism is closely associated with cardiometabolic risk, starting already from childhood.

Cardiometabolic risk factor response to a lifestyle intervention: a randomized trial.

Strategies to increase adherence to national dietary and physical activity (PA) guidelines to improve the health in regions such as the Lower Mississippi Delta (LMD) of the United States are needed. Here we explore the cardiometabolic responses to an education and behavior change intervention among overweight and obese adults that adapted the 2010 Dietary Guidelines (DG), with and without a PA component. White and African American overweight and obese adults were randomized to a DG group (n=61) or a DG+PA group (n=60). Both groups received a 12-week dietary education and behavior change intervention, and the DG+PA group also received a PA education and behavior change intervention with a pedometer. Changes in individual risk factors (blood pressure, fasting glucose, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol) and a continuous cardiometabolic risk score were determined. General linear models compared mean changes between groups, adjusting for covariates. No main effect of intervention group was found in completers (n=99) and those who engaged with ≥80% of the intervention (n=83) for individual risk factors or the continuous risk score. Pooling both groups, those with higher baseline risk factor values realized greater improvements in individual risk factors. Adapting DG did not produce any cardiometabolic benefits, even with a PA component. Although the sample was ostensibly healthy, they were all overweight to mildly obese (body mass index of 25-34.9 kg/m(2)) and participants with higher baseline risk factor values showed more improvements. Adherence to longer-term behavior change may elicit changes in risk profile, so this should be explored.

Liver enzymes and clustering cardiometabolic risk factors in European adolescents: the HELENA study.

This study aimed to explore the associations of liver biomarkers with cardiometabolic risk factors and their clustering, and to provide reference values (percentiles) and cut-off points for liver biomarkers associated with high cardiometabolic risk in European adolescents. Alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT), aspartate aminotransferase to ALT ratio (AST/ALT), waist circumference, blood pressure, triglycerides, high-density lipoprotein cholesterol and insulin were measured in 1084 adolescents. We computed a continuous cardiometabolic risk score and defined the high cardiometabolic risk. Higher ALT and GGT and lower AST/ALT were associated with adiposity and with the number of adverse cardiometabolic risk factors (Ps < 0.05). Higher GGT and lower AST/ALT were associated with higher cardiometabolic risk score (Ps < 0.001) in males and females, and ALT only in males (Ps < 0.001). Gender- and age-specific percentiles for liver biomarkers were provided. Receiver operating characteristic analyses showed a significant discriminatory accuracy of AST/ALT in identifying the low/high cardiometabolic risk (Ps < 0.01) and thresholds were provided. Higher GGT and lower AST/ALT are associated with higher cardiometabolic risk factors and their clustering in male and female European adolescents, whereas the associations of ALT were gender dependent. Our results suggest the usefulness of AST/ALT as a screening test in the assessment of adolescents with high cardiometabolic risk and provide gender- and age-specific thresholds that might be of clinical interest.

Sleep Duration Predicts Cardiometabolic Risk in Obese Adolescents

To examine the independent contributions of objectively measured sleep duration and fragmentation on cardiometabolic risk accumulation in free-living obese adolescents. Characteristics of metabolic syndrome (waist circumference, mean arterial pressure, fasting high-density lipoprotein cholesterol, triglycerides, glucose) were measured in obese adolescents and standardized residuals (z-scores) were summed (inverse high-density lipoprotein cholesterol) to create a continuous cardiometabolic risk score (cMetScore), adjusted for age, sex, and race. Sleep and physical activity were objectively measured in habitual, free-living conditions for 7 days (SenseWear Pro3, BodyMedia, Pittsburgh, Pennsylvania; n = 37; 54% female, ages 11-17 years). Associations between sleep duration and cMetScore were assessed via multiple linear regression. Body mass index, total sleep time, and sleep session length were each correlated with cMetScore (P < .05 all). Total sleep time was inversely and independently associated with cMetScore (r = -0.535, P = .001) and was the best independent predictor of metabolic risk. Sleep duration inversely predicts cardiometabolic risk in obese adolescents, even when we controlled for various measures of physical activity, anthropometry, and adiposity. Further research should investigate the biological mechanism of this relationship and the potential treatment effect of sleep intervention in decreasing cardiometabolic risk in this population.

Metabolic Syndrome in Youth: Chimera or Useful Concept?

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