Disease Risk In Adolescents Research Articles

Visceral adiposity index, fitness and clustered cardiovascular disease risk in adolescents.

Clustering of cardiovascular disease (CVD) risk factors have been observed in children and adolescents, but its association with visceral adiposity index (VAI) and cardiorespiratory fitness (CRF) in adolescents has rarely been studied. This study determines the independent associations of VAI and CRF with the clustering of cardiovascular disease risk (CVDr) among Nigerian adolescents. Adolescents from specific secondary schools in Kogi East, North Central Nigeria participated in the study. A cross-sectional sample of 403 adolescents (202 boys and 201 girls) aged 11 years - 19 years were evaluated for VAI, CRF and CVDr. Using identified risk factors, a clustered CVDr score was generated. The association between VAI, CRF and clustered CVDr was evaluated using regression models that controlled for age, gender and maturity status. Fitness was negatively associated with CVDr (β= -0.268,p 0.001), while VAI was positively correlated with CVDr (β= 0.379,p 0.001). After CRF or VAI adjustment, the independent association with the dependent variable remained significant. The odds of an adolescent with elevated VAI being at risk of CVD was 4.7 times higher than his peers. Unfit adolescents were 2.1 times more likely to develop CVDr. Both VAI and CRF were independently associated with the clustering of CVDr in Nigerian adolescents. The findings suggest that health promotion efforts focusing on healthy diet and aerobic-type physical activity programmes should be encouraged among the youth to reduce the risk of CVD.Contribution:This study shows that improving visceral adipose tissue and fitness may lower CVD risk factors in adolescents, which is significant for public health.

Long-term outcomes after severe childhood malnutrition in adolescents in Malawi (LOSCM): a prospective observational cohort study

Research on long-term outcomes of severe childhood malnutrition is scarce. Existing evidence suggests potential associations with cardiometabolic disease and impaired cognition. We aimed to assess outcomes in adolescents who were exposed to severe childhood malnutrition compared with peers not exposed to severe childhood malnutrition. In Long-term Outcomes after Severe Childhood Malnutrition (LOCSM), we followed up adolescents who had 15 years earlier received treatment for severe childhood malnutrition at Queen Elizabeth Central Hospital in Blantyre, Malawi. Adolescents with previous severe childhood malnutrition included in LOCSM had participated in an earlier follow-up study (ChroSAM) at 7 years after treatment for severe childhood malnutrition, where they were compared to siblings and age-matched children in the community without previous severe childhood malnutrition. We measured anthropometry, body composition, strength, glucose tolerance, cognition, behaviour, and mental health during follow-up visits between Sept 9, 2021, and July 22, 2022, comparing outcomes in adolescents exposed to previous severe childhood malnutrition with unexposed siblings and adolescents from the community assessed previously (for ChroSAM) and newly recruited during current follow-up. We used a linear regression model to adjust for age, sex, disability, HIV, and socioeconomic status. This study is registered with the International Standard Randomised Controlled Trial Number Registry (ISRCTN17238083). We followed up 168 previously malnourished adolescents (median age 17·1 years [IQR 16·5 to 18·0]), alongside 123 siblings (18·2 years [15·0 to 20·5]), and 89 community adolescents (17·1 years [16·3 to 18·1]). Since last measured 8 years previously, mean height-for-age Z (HAZ) scores had improved in previously malnourished adolescents (difference 0·33 [95% CI 0·20 to 0·46]) and siblings (0·32 [0·09 to 0·55]), but not in community adolescents (difference -0·01 [-0·24 to 0·23]). Previously malnourished adolescents had sustained lower HAZ scores compared with siblings (adjusted difference -0·32 [-0·58 to -0·05]) and community adolescents (-0·21 [-0·52 to 0·10]). The adjusted difference in hand-grip strength between previously malnourished adolescents and community adolescents was -2·0 kg (-4·2 to 0·3). For child behaviour checklist internalising symptom scores, the adjusted difference for previously malnourished adolescents was 2·8 (0·0 to 5·5) compared with siblings and 2·1 (-0·1 to 4·3) compared with community adolescents. No evidence of differences between previously malnourished adolescents and unexposed groups were found in any of the other variables measured. Catch-up growth into adolescence was modest compared with the rapid improvement seen in childhood, but provides optimism for ongoing recovery of height deficits. We found little evidence of heightened non-communicable disease risk in adolescents exposed to severe childhood malnutrition, although long-term health implications need to be monitored. Further investigation of associated home and environmental factors influencing long-term outcomes is needed to tailor preventive and treatment interventions. The Wellcome Trust.

Genetic and Environmental Factors and Cardiovascular Disease Risk in Adolescents

Cardiovascular risk factors in youth have been associated with future cardiovascular disease (CVD), but conventional observational studies are vulnerable to genetic and environmental confounding. To examine the role of genetic and environmental factors shared by full siblings in the association of adolescent cardiovascular risk factors with future CVD. This is a nationwide cohort study with full sibling comparisons. All men who underwent mandatory military conscription examinations in Sweden between 1972 and 1995 were followed up until December 31, 2016. Data analysis was performed from May 1 to November 10, 2022. Body mass index (BMI), cardiorespiratory fitness, blood pressure, handgrip strength, and a combined risk z score in late adolescence. The primary outcome was fatal or nonfatal CVD, as recorded in the National Inpatient Register or the Cause of Death Register before 2017. A total of 1 138 833 men (mean [SD] age, 18.3 [0.8] years), of whom 463 995 were full brothers, were followed up for a median (IQR) of 32.1 (26.7-37.7) years, during which 48 606 experienced a CVD outcome (18 598 among full brothers). All risk factors were associated with CVD, but the effect of controlling for unobserved genetic and environmental factors shared by full siblings varied. In the sibling analysis, hazard ratios for CVD (top vs bottom decile) were 2.10 (95% CI, 1.90-2.32) for BMI, 0.77 (95% CI, 0.68-0.88) for cardiorespiratory fitness, 1.45 (95% CI, 1.32-1.60) for systolic blood pressure, 0.90 (95% CI, 0.82-0.99) for handgrip strength, and 2.19 (95% CI, 1.96-2.46) for the combined z score. The percentage attenuation in these hazard ratios in the sibling vs total cohort analysis ranged from 1.1% for handgrip strength to 40.0% for cardiorespiratory fitness. Consequently, in the sibling analysis, the difference in cumulative CVD incidence at age 60 years (top vs bottom decile) was 7.2% (95% CI, 5.9%-8.6%) for BMI and 1.8% (95% CI, 1.0%-2.5%) for cardiorespiratory fitness. Similarly, in the sibling analysis, hypothetically shifting everyone in the worst deciles of BMI to the middle decile would prevent 14.9% of CVD at age 60 years, whereas the corresponding number for cardiorespiratory fitness was 5.3%. In this Swedish national cohort study, cardiovascular risk factors in late adolescence, especially a high BMI, were important targets for CVD prevention, independently of unobserved genetic and environmental factors shared by full siblings. However, the role of adolescent cardiorespiratory fitness in CVD may have been overstated by conventional observational studies.

Are obesity and physical fitness associated with cardiovascular disease risk in adolescents with Down syndrome? The longitudinal UP&DOWN study

ABSTRACT Introduction The aims of this study were to examine cross-sectional, and longitudinal association of different measures of obesity and physical fitness with cardiovascular disease (CVD) risk factors in adolescents with Down syndrome. Methods Longitudinal analysis included 90 adolescents with Down syndrome. Obesity and physical fitness were measured following the ALPHA battery. Blood pressure and blood samplings (glucose, total cholesterol, high-density lipoprotein cholesterol, and serum lipid triglycerides levels (mg/dl) were determinated. Results In cross-sectional analyses, obesity was positively associated with single CVD risk factors and CVD risk factor index (all p < .05). In the prospective analyses, obesity was not associated with single CVD risk factors, but components of physical fitness at baseline impact in some single CVD risk factors (all p < .05). Conclusion Obesity might be more strongly related to current cardiovascular-health, while components of physical fitness might be more related to future cardiovascular-health in adolescents with Down syndrome.

Effect of in-utero polysubstance exposure on adolescent cardiovascular disease risk: Results from the Maternal Lifestyle Study

BackgroundPolysubstance use during pregnancy typically includes use of one or more illicit substances in addition to tobacco and/or alcohol. Rates of polysubstance use during pregnancy range from 5 to 10% and continue to rise. However, to date, there are no studies using longitudinal data exploring cardiovascular disease risk in adolescents exposed to polysubstances in utero. ObjectiveThe objective of this analysis was to discover the possible association between maternal substance use and cardiovascular disease risk (i.e., increased blood pressure) in adolescence. MethodsThe National Institute on Drug Abuse (NIDA)-funded Maternal Lifestyle Study (MLS) cohort was used for this analysis. Briefly, in 1993 MLS enrolled mothers by substance use during pregnancy status (Y/N) at four US locations (Detroit, MI; Miami, FL; Providence, RI; and Memphis, TN) and followed offspring until 2011. Generalized linear modeling assessed cardiovascular disease risk in offspring via systolic blood pressure (mm Hg) at age 16 comparing those prenatally exposed and unexposed to maternal substance use. ResultsThe most prevalent singular substance used during pregnancy in this sample (n = 910) was alcohol (n = 121, 16%), while the most common polysubstance used during pregnancy was a combination of tobacco, alcohol, and cocaine (n = 123, 16%). Those born normal birthweight (≥2500 g) and exposed to tobacco, alcohol, and opioids in utero had 22 mm Hg higher systolic blood pressure at age 16 compared to those not exposed to any substances (β coefficient = 22.44, 95% CI: 10.53–34.35). ConclusionSingularly, tobacco, alcohol, and opioids are among the most used during pregnancy and when used in combination, pose great risk for cardiovascular disease in offspring. Given its recent rise and high prevalence, targeting maternal substance use is critical for cardiovascular disease prevention.

Editorial introductions.

Editorial introductions.

Editorial introductions

Editorial introductions

Relationship between abdominal adiposity, cardiovascular fitness, and biomarkers of cardiovascular risk in British adolescents

BackgroundPuberty is a critical time in the development of overweight and obesity. The aim of this study was to examine relationships between measures of adiposity, cardiovascular fitness, and biomarkers of cardiovascular disease risk in adolescents. MethodsIn a cross-sectional study design, 129 girls and 95 boys aged 12.9–14.4 years at various stages of puberty were included, along with their mothers (n = 217) and fathers (n = 207). Anthropometric assessments of adiposity were made, along with cardiovascular physical fitness, using the 20-m shuttle run test, and biomarkers associated with cardiovascular risk, including glucose, insulin, triglyceride, fibrinogen, and C-reactive protein (CRP) concentrations. ResultsWaist-to-height ratio values were similar in boys and girls and correlated positively with diastolic blood pressure, insulin, triglyceride, fibrinogen, and CRP concentrations, and inversely with cardiovascular fitness scores. Skinfold thickness measurements were higher in girls. High-molecular-weight adiponectin concentrations were lower in boys than girls, particularly in late puberty, and CRP levels were higher. Cardiovascular fitness, maternal body mass index (BMI), and paternal BMI contributed independently to the variance in waist measurements in girls and boys. Gender, triceps skinfold thickness, and weight-to-height ratio, but not parental BMI, contributed independently to the variance in cardiovascular fitness. ConclusionThere is a relationship between measures of adolescent adiposity and parental weight that involves factors other than cardiovascular fitness. Adolescent boys have relatively more abdominal fat than girls and a tendency to have a proinflammatory profile of biomarkers. These observations suggest that family and social environmental interventions are best undertaken earlier in childhood, particularly among boys.

Elevated Fasting Plasma ApoB-lipoprotein Remnants are Associated with MetS and PCOS: Early Cardiovascular Disease Risk in Adolescents

Elevated Fasting Plasma ApoB-lipoprotein Remnants are Associated with MetS and PCOS: Early Cardiovascular Disease Risk in Adolescents

Diets Rich in Fruits and Vegetables Are Associated with Lower Cardiovascular Disease Risk in Adolescents.

Obesity and cardiovascular disease (CVD) risk are public health concerns in adolescents, yet few studies have examined the association of their diet to CVD risk factors. This study investigated associations between diet, body mass index (BMI), waist circumference (WC), blood pressure (BP), and blood lipids in 163 16–17 year olds. Diet recall data were converted into Healthy Eating Index-2010 (HEI) to assess diet quality. Differences in diet between groups with normal or obese BMI, normal or hypertensive BP, and normal or altered lipids were determined. Associations between diet and BMI, WC, BP, and lipids, controlling for race, gender, and socioeconomic status, were examined. Mean HEI was 49.2 (±12.0), with no differences observed between groups. HEI was not associated with any CVD risk. Sweetened beverage consumption was higher in obese adolescents, and positively related to total cholesterol (TC). Fruit intake was negatively related to BMI and diastolic BP. Total vegetable intake was negatively related to systolic BP. Greens and beans were negatively related to TC and LDL. Whole grains were negatively related to HDL. This research suggests a cardioprotective effect of diets rich in fruits and vegetables, as well as low in sweetened beverages in adolescents.

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.

Liver: BMI, diabetes and liver disease risk in adolescents.

Liver: BMI, diabetes and liver disease risk in adolescents.

Abstract MP52: Increased Intake of Non-Dairy Sugars in Foods and Beverages is Positively Associated with Annual Increases in Waist Circumference among Overweight and Obese Adolescent Females

Introduction: Waist circumference (WC) is an important measure of adiposity that predicts cardiovascular disease risk in adolescents. Previous studies have shown a positive association between sugar-sweetened beverages and WC in adolescents but it is unknown if this effect differs when sugars are consumed in foods vs. beverages. Hypothesis: Increased sugar consumption from both foods and beverages is associated with increased WC. Methods: NHLBI’s Growth and Health Study was a 10-year cohort study of Caucasian (n=1,166) and African-American (n=1,213) girls aged 9 and 10 at baseline who were recruited from three sites in the US in 1987 and 1988. Minimum WC was measured annually except at baseline. Diet was assessed using a three-day food record in eight of ten years; nutrient content was determined using the Nutrient Data System for Research. Girls were grouped by weight status (normal vs. overweight or obese). One-year changes in WC and in consumption of liquid and solid non-dairy sugars were calculated by subtracting each year’s measure from its value for the subsequent year. A linear mixed model was used to accommodate multiple observations per individual. After modeling change in sugar consumption as quintiles, a linear trend was observed and further modeling was conducted using continuous change in sugars consumption. Model I adjusted for race, age, puberty stage, initial WC, initial BMI, change in height, dieting status, initial and change in physical activity, initial and change in % energy from fat and % energy from carbohydrates, and initial consumption of sugars. Model II additionally adjusted for initial and change in total energy. Results: Among normal weight girls using Model I, significant increases in WC were observed with each additional teaspoon of liquid, 0.19mm (0.05, 0.33) (p=0.006), but not solid sugars 0.11mm (-0.02, 0.24) (p=0.11). These increases were no longer significant after adjusting for total energy in Model II. Among overweight and obese girls in Model I, increases in WC were observed with each additional teaspoon of solid sugars, 0.42 mm (0.22, 0.62) (p&lt;0.0001) and liquid sugars, 0.26 mm (0.09, 0.44) (p=0.004). This association was slightly attenuated but still significant after controlling for total energy with WC increases of 0.31 mm (0.10, 0.52) (p=0.005) with each teaspoon of solid sugars and 0.19 mm (0.005, 0.37) (p=0.049) with each teaspoon of liquid sugars. Conclusions: Increases in non-dairy sugars from both foods and beverage were associated with increased WC among overweight and obese adolescents, both before and after adjusting for total energy intake.

Sex Differences in Cardiovascular Disease Risk in Adolescents With Type 1 Diabetes

Cardiovascular disease is seen at a younger age and at a higher prevalence in patients with type 1 diabetes than in the general population. It is well described that women with type 1 diabetes have a higher relative risk of cardiovascular disease than men with type 1 diabetes, unlike that seen in the general population. The pathophysiology behind this is unknown. We performed a cross-sectional study to examine sex differences in cardiovascular disease risk factors in adolescents with type 1 diabetes between ages 13 and 20 years, compared with children of a similar age without type 1 diabetes. All patients underwent a dual energy x-ray absorptiometry scan to measure body composition and a pulse wave test measure of arterial elasticity. Fasting serum lipid levels, apolipoprotein B, and apolipoprotein C-III levels were measured in each patient. Twenty-nine children with type 1 diabetes (10 girls, 19 boys) and 37 healthy children (18 girls, 19 boys) participated. Although no sex differences for body mass index (P = 0.91) and glycosylated hemoglobin (P = 0.69) were seen, girls with type 1 diabetes had a significantly higher percent trunk fat compared with boys (P = 0.004). No sex differences were found (P > 0.05) for percent trunk fat in adolescents without diabetes. There was no sex difference among any other cardiovascular risk factors in either children with or without diabetes. Female adolescents with type 1 diabetes have more centrally distributed fat, which may contribute to their relatively higher cardiovascular disease risk. Attenuation of the central distribution of fat through exercise and dietary modifications may help ameliorate their subsequent cardiovascular disease burden.

TRANSMISSION OF Porphyromonas gingivalis FROM CAREGIVERS TO CHILDREN

SUMMARY: Periodontal diseases are socially significant diseases, which occur in adults but in children and adolescents as well. Despite a low prevalence of aggressive periodontitis at a young age, its severity is a challenge for pediatric dentistry. The goal of this study is to find if the prevalence of Porphyromonas gingivalis among children whose parents suffer from periodontal diseases is greater than among children with healthy parents. Methods: · Polymerase chain reaction (PCR). · Culture method. When PCR was used P.gingivalis was found in 35.5% of parents with periodontitis and in 6,5% of their children, children with healthy parents and their parents. No statistically significant relation (P>0.05) between periodontal parents and their children was found. When culture method was used P.gingivalis was not detected. Studying such correlations and standardizing methods of detection could contribute the evaluation of periodontal disease risk in adolescents.

Are We There Yet? Pediatric Screening for Inflammatory Biomarkers and Low Cardiorespiratory Fitness to Identify Youth at Increased Risk of Cardiovascular Disease

Are We There Yet? Pediatric Screening for Inflammatory Biomarkers and Low Cardiorespiratory Fitness to Identify Youth at Increased Risk of Cardiovascular Disease

Cardiovascular risk assessment and cholesterol management in adolescents: getting to the heart of the matter.

Adolescence is a common time for the identification of cardiovascular disease risk factors, including elevated cholesterol. Guidelines for the detection and treatment of hypercholesterolemia differ for children and adults. This review highlights these differences and discusses special considerations for cholesterol management in the adolescent population. Several longitudinal studies have confirmed that the number of cardiovascular risk factors present in adolescence, including elevated cholesterol, lead to atherosclerosis in adults. There is increased awareness that other chronic medical conditions, including diabetes, congenital heart disease, inflammatory diseases, and childhood cancer, can accelerate this process. There is a move to screen and treat more young patients with elevated cholesterol to prevent future cardiovascular disease. New markers of atherosclerosis are being used to quantify cardiovascular disease risk in adolescents in research populations. The safety and efficacy of several interventions, including drug therapy, is increasingly established. Comprehensive cardiovascular risk assessment is important for adolescent health and includes assessment of family history and tobacco use along with measurement of body mass index and blood pressure. Additionally, cholesterol screening is recommended for overweight adolescents or those with an unknown family history and for all patients by the age of 20. Providers caring for adolescents should be familiar with both the pediatric and adult cholesterol screening and treatment guidelines as well as how common adolescent conditions affect cholesterol levels.

Racial differences in central adiposity in a longitudinal cohort of black and white adolescent females

BackgroundCentral adiposity is related to chronic disease risk in adolescents. Racial differences in waist circumference have been identified using cross-sectional data from this age group. We tested for racial differences in age-related growth in waist circumference in a longitudinal cohort of black and white adolescent girls.MethodsWe analyzed 9 years of publicly available data from the National Heart, Lung, and Blood Institute Growth and Health Study, for 2379 girls (1213 black and 1166 white) enrolled at age 9-10 years in 1987-1988 and followed annually. Individual growth trajectories of waist circumference were constructed for girls with >3 annual measures. Mixed models were used to compare changes in waist circumference during adolescence between black and white females. BMI and age at menarche were included in the models.ResultsAt each age, black females had significantly higher waist circumference. Mean annual increase in waist circumference was significantly higher for black females compared to white females (1.46 cm/yr vs. 1.36 cm/yr, respectively). After adjusting for BMI, the mean annual increase in waist circumference for white females was significantly higher than for black females (0.08 cm/yr vs. -0.07 cm/yr, respectively). These relationships remained significant after adjusting for age at menarche.ConclusionsBlack females had significantly steeper increases in waist circumference over adolescence than white females. After adjusting for BMI and age at menarche, however, the annual increase in waist circumference for black females was significantly shallower than for their white peers. These data suggest racial differences in the deposition of fat over the adolescent period.

Associated Changes In Body Weight, Fat Distribution, And Physical Fitness With Chronic Disease Risk In Adolescents

Body weights (BW) in the U.S. have increased over the past two decades. 35%of Hispanic and African American, and 20%of Caucasian children are overweight. Studies have evaluated the relationship between obesity, fat distribution, and risk of chronic disease in adults, but few studies have examined these issues in at risk (particularly Hispanic) youth. PURPOSE To determine if change in BW, adiposity, body fat distribution, and physical fitness over two years are related to change in type 2 diabetes risk and cardiovascular disease (CVD) risk in adolescents. METHODS Subjects were 26 male and 57 female high school students (13–18 yrs) (74%Hispanic, 21%Caucasian). Most were overweight (29.1% ± 9.9% body fat). Body composition by BIA, waist circumference (WC), one mile walk-run test (WR), fasting glucose and insulin (for Type 2 diabetes risk), and fasting total cholesterol, HDL, and triglycerides (for CVD risk) were measured at the schools. T-tests were used to test differences in change from baseline in the variables. Pearson correlations, controlling for school, gender and race, were used to test the relationships between the independent variables and the dependent variables of disease risk change (change in glucose, insulin, cholesterol, triglyceride, HDL). Significance set at p<0.05. RESULTS BW (p<0.001), WC (p<0.001), BMI (p<0.001), and fasting glucose (p<0.01) increased, and fitness (WR) decreased (p<0.05) over 2 yrs. BW change was positively related with change in insulin (.276, p = 0.025), total cholesterol (.373, p = 0.002), and triglycerides (.468, p<0.01). There was a negative trend between change in BW and change in HDL (p = 0.071). Change in WC was positively related to change in total cholesterol (.302, p = 0.015), and triglycerides (.247, p = 0.047) over the two years. Change in BMI was associated with increases in insulin (.264, p = 0.032), total cholesterol (.369, p = .002), and triglycerides (.416, p = 0.001). Change in fitness, as assessed by WR, was not significantly related to change in any chronic disease risk factors. CONCLUSIONS The results of this study indicate that BMI, WC, and BW change over a two-year period are good predictors of a concurrent change in disease risk, and that change in chronic disease risk is apparent as early as adolescence. It is imperative that public health professionals address the issue of increasing adiposity during youth before we develop a generation of individuals who have to live with lifestyle-related chronic disease beginning early in life. Supported by NIH R01 DK48159, NIH M01RR00051 and NIH M01RR00069.

Associated Changes In Body Weight, Fat Distribution, And Physical Fitness With Chronic Disease Risk In Adolescents

Associated Changes In Body Weight, Fat Distribution, And Physical Fitness With Chronic Disease Risk In Adolescents