Biological cardiovascular risk factors cluster in Danish children and adolescents: the European Youth Heart Study

doi:10.1016/S0091-7435(03)00145-2

Preventive Medicine

Volume 37, Issue 4, October 2003, Pages 363-367

https://doi.org/10.1016/S0091-7435(03)00145-2 Get rights and content

Abstract

Background

The aim of this study was to determine whether the number of participants with multiple coronary heart disease (CHD) risk factors exceeded the number expected from a random distribution.

Methods

A cross-sectional study of 1020 randomly selected boys and girls, 9 and 15 years old, was conducted. Risk factors were total cholesterol, HDL-cholesterol, triglyceride, serum insulin, and blood pressure. Physical fitness was assessed from a maximal cycle test and body fat from the sum of four skinfolds. Risk factors selected in the analysis were those related to the metabolic syndrome.

Results

More participants than expected had four or five CHD risk factors. Four risk factors were found in 3.03 (95% confidence interval (CI): 2.24–4.10) times as many participants as expected from a random distribution and five risk factors were found in 8.70 (95% CI: 4.35–17.4) times as many participants as expected. Fifty (5.4%) had four or five risk factors and in these individuals physical fitness was 1.2 standard deviation (SD) lower and body mass index (BMI) 1.6 SD higher than mean values for the population.

Conclusion

Clustering of risk factors for the metabolic syndrome was found in children and adolescents. Low levels of physical fitness and raised BMI in these individuals indicate that lifestyle factors such as physical activity and diet may influence the development of these unhealthy risk profiles.

Introduction

Rapidly increasing rates of obesity and type 2 diabetes mellitus have encouraged increased interest in the role of lifestyle in the development of coronary heart disease (CHD). In adults there is a substantial body of evidence that physical inactivity or low levels of physical fitness are strongly associated with the development of CHD and type 2 diabetes [1]. The protective effect of physical activity is thought to operate through modification of the biological risk factors for such disorders, including hypertension, hyperinsulinemia, elevated serum total cholesterol and triglyceride levels, low HDL-cholesterol, and glucose intolerance. Clustering of these risk factors in obese individuals (the metabolic syndrome) has been described in both children and adults. In adults the metabolic syndrome is associated with a greatly elevated risk of CHD, while in children and young adults there is a direct relationship between the number of CHD risk factors present and the severity of asymptomatic atherosclerosis [2].

In children many studies and review articles have investigated the relationship among physical activity, physical fitness, and CHD risk factors, yet the relationship remains less well established than in adults [3]. In some studies a weak relationship between physical activity or fitness and the risk factors of the metabolic syndrome has been described and interpreted as lack of evidence for the preventive effect of physical activity in relation to CHD [4]. However, heart attacks in adults are usually caused by high levels of many risk factors over years and it may be more logical to evaluate the level of risk and the association between the level of risk and lifestyle in relation to clustering of risk factors instead of levels of single risk factors in children. It is important to better understand this relationship, since if the roots of CHD are laid down in childhood, lifestyle modification during childhood and adolescence may be effective in lowering CHD risk in later life.

The aim of this study was to establish whether and to what extent clustering of risk factors occurs in Danish children and adolescents.

Section snippets

Participants and methods

This was a school-based study, with all measurements carried out in the schools that the participants attended. Eight to 12 individuals were examined per day, and the study took place throughout 1 whole school year from 1997 to 1998.

Descriptives

Mean values and SD of physical characteristics, blood parameters, and blood pressure are shown in Table 1. Significant gender differences were found in both children and adolescents for all measurements except HDL-cholesterol, diastolic blood pressure, and BMI. Similarly, all values were significantly different between age cohorts except for the ratio of HDL to total cholesterol. Significant interaction was found between gender and age only for skinfolds, HDL-cholesterol, the ratio of HDL to

Discussion

CVD risk factors in children and adolescents have been assessed in many previous studies; however, while most have looked a single risk factors or combinations of risk factors [7], few have looked for clustering of those factors contributing to the metabolic syndrome in a randomly selected population. In this study we investigated the clustering of CHD risk factors in a random sample of Danish children and adolescents and found 8–9 times as many individuals as expected from a random

Acknowledgements

The present study was supported with Grants from the Danish Heart Foundation, the Health Foundation, and the Danish Medical Research Council.

References (10)

G.S. Berenson et al.
Atherosclerosis of the aorta and coronary arteries and cardiovascular risk factors in persons 6 to 30 years and studied at necropsy (the Bogalusa Heart Study)
Am J Cardiol
(1992)
R.D. Moore
Effects of insulin upon ion transport
Biochim Biophys Acta
(1983)
U.S. Department of Health and Human Services. Physical activity and health: a report of the Surgeon General. U.S....
C. Riddoch et al.
The health-related physical activity of children
Sports Med
(1995)
H. Hasselstrøm et al.
Physical fitness and physical activity during adolescence as predictors of cardiovascular disease risk in young adulthood
Int J Sports Med
(2002)

There are more references available in the full text version of this article.

Cited by (196)

Confirmatory factor analysis of the infant feeding styles questionnaire in infant and toddler child care teachers
2023, Appetite
Early childhood is a critical time of development. Caregiver feeding style, including of child care providers, has been implicated in influencing children's food preferences and obesity. A better understanding of the determinants of child care providers' feeding styles is important as children increasingly receive daily care and nutrition in child care centers. Valid instruments to measure provider feeding styles specifically for infants are needed. This study's objective was to validate, for use with child care providers, the Infant Feeding Styles Questionnaire (IFSQ), an instrument originally designed for parents of infants and toddlers. Study data came from the Baby Nutrition and Physical Activity Self-Assessment for Child Care (Baby NAP SACC) study, a cluster randomized trial, designed to evaluate the efficacy of a six-month-long obesity prevention intervention in child care centers. The IFSQ was administered at baseline and follow-up to infant and toddler teacher participants (n = 244). Scores for baseline IFSQ teacher responses (n = 219) were calculated for the 13 sub-constructs across the five feeding styles. We tested reliability with Cronbach's alpha coefficients and performed confirmatory factor analysis to examine factor loadings and goodness of fit characteristics, modifying constructs to achieve best fit. Reliability coefficients ranged from 0.42 to 0.82 for all sub-constructs. Goodness of fit indices for the final model ranged from: root mean square error of approximation (RMSEA) 0.000–0.082; comparative fit index (CFI) 0.943–1.000; Tucker–Lewis index (TLI) 0.906–1.000; and standardized root mean squared error (SRMR) 0.006–0.130. In a sample of racially diverse infant and toddler child care teachers, final models of the laissez-faire, pressuring, and responsive constructs and the restrictive-diet quality sub-construct performed well. Overall model fit was poor for the indulgence construct, but good for solely its corresponding belief items.
Serum leptin as a mediator of the influence of insulin resistance on hepatic steatosis in youths with excess adiposity
2021, Nutrition, Metabolism and Cardiovascular Diseases
The relationship between insulin resistance (IR) and hepatic steatosis (fatty liver) is well known; however, the extent to which the satiety hormone leptin acts as a confounder or mediator in this relationship is uncertain. We examined whether the association between IR and hepatic steatosis is mediated by leptin in Colombian adolescents with excess adiposity.
A total of 122 adolescents (mean age: 13.4 years; 68% girls) participated in the study. We assessed body composition, hepatic steatosis (as defined by the controlled attenuation parameter [CAP]), cardiometabolic risk factors (body mass index, waist circumference, body composition), biochemical variables (leptin, insulin, glucose, lipid profile, cardiometabolic Z-score, transaminases, etc.), and physical fitness (cardiorespiratory fitness and grip strength). Partial correlation, regression, and mediation analyses were conducted using the Barron and Kenny framework.
Ninety-two youths (75.4%) had IR. Mediation analysis revealed a positive relationship between Homeostasis Model Assessment-IR (HOMA-IR) and CAP (β_dir = 3.414, 95% confidence interval [CI]: 1.012 to 5.816, p < 0.001), which was attenuated when leptin was included in the model, thus indicating that leptin mediates this relationship (β_ind = 1.074, 95% CI: 0.349 to 2.686, p < 0.001). The percentage of the total effect mediated by leptin was 21%. Regarding sex, the mediation effect of leptin remains significant among boys (β_ind = 0.962, 95% CI: 0.009 to 2.615, p < 0.001), but not in girls (β_ind = 0.991, 95% CI: 1.263 to 5.483, p = 0.477).
The findings are clinically relevant to consider leptin levels as a surrogate marker of insulin sensitivity when assessing youths with excess adiposity and/or suspected Nonalcoholic hepatic steatosis or nonalcoholic fatty liver disease (NAFLD).
The Genetic Architecture of the Clustering of Cardiometabolic Risk Factors: A Study of 8- To 17-Year-Old Chinese Twins
2020, Twin Research and Human Genetics
Curvilinear association between waist-to-height ratio and cardiorespiratory fitness: a cross-sectional study based on nationwide data from Chinese children and adolescents
2024, BMC Sports Science, Medicine and Rehabilitation
Objective measured physical activity and metabolic syndrome score in children and adolescents: The UP&DOWN longitudinal study
2023, Scandinavian Journal of Medicine and Science in Sports
Fitness, body composition, and metabolic risk scores in children and adolescents: the UP&DOWN study
2023, European Journal of Pediatrics

View all citing articles on Scopus

View full text

Regular articleBiological cardiovascular risk factors cluster in Danish children and adolescents: the European Youth Heart Study

Abstract

Background

Methods

Results

Conclusion

Introduction

Section snippets

Participants and methods

Descriptives

Discussion

Acknowledgements

Am J Cardiol

Biochim Biophys Acta

The health-related physical activity of children

Sports Med

Physical fitness and physical activity during adolescence as predictors of cardiovascular disease risk in young adulthood

Int J Sports Med

Regular article
Biological cardiovascular risk factors cluster in Danish children and adolescents: the European Youth Heart Study