Aerobic physical fitness in relation to blood lipids and fasting glycaemia in adolescents: Influence of weight status

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Abstract

Background and aims

We explored the associations between aerobic physical fitness with blood lipids and a composite index of blood lipids and fasting glycaemia in adolescents, analysing possible interactions with weight status.

Methods and results

Body mass index and aerobic physical fitness was measured in 2090 adolescents (1034 males and 1056 females) 13–18.5 years by using the 20-m shuttle run test. Plasma glucose, total, high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol, triglycerides, apolipoprotein (apo) A-I, apo B-100 and lipoprotein(a) [Lp(a)] were measured in 460 of the 2090 subjects. After adjustment for confounding factors, a continuously distributed summary score for blood lipids and fasting glycaemia was significantly related to aerobic fitness in males (P = 0.018) and females (P = 0.045, from the 2nd to the 4th quartile of aerobic fitness). After adjustment for gender, age, sexual maturation and economic status, aerobic fitness was related to the composite index of blood lipids and glycaemia in both overweight and non-overweight adolescents (P < 0.05). However, for the same level of aerobic fitness, the composite index of blood lipids and glycaemia was significantly higher in overweight adolescents (P = 0.001). After setting the minimal aerobic fitness standards to present a healthy lipid profile, about 50% of males did not reach such values.

Conclusion

Our data suggest that both aerobic fitness and weight management are associated with a composite index of blood lipids and glycaemia in adolescents. Our study also provides the minimal levels of aerobic physical fitness associated with a favourable lipid profile in male adolescents, a new tool which should be adopted by schools as “aerobic fitness standards”.

Introduction

Cardiovascular disease (CVD) is the leading cause of death in developed countries. Although the clinical manifestations of CVD occur in middle adulthood, pathological data have shown that atherosclerosis begins in childhood and adolescence [1], [2], [3]. Disturbed plasma lipid profile is an important cardiovascular risk factor, capable of inducing atherosclerotic development [4], [5]. This has been early shown in adults, but holds also for children and adolescents. In fact, it has been recently demonstrated that plasma low density lipoprotein (LDL) cholesterol levels measured in childhood are a consistent predictor of carotid artery intima-media thickness in young adults who are still too young to experience coronary events [6], [7]. These, and other findings [8], [9], suggest that a primary goal in CVD prevention should be to keep a healthy plasma lipid profile since childhood [10], [11].

Fasting glycaemia also deserves some attention. In fact, fasting glucose has been proposed as a marker of loss of beta cell function and insulin response [12], and there are noticeable similarities in the cardiovascular risk factor profile in subjects with impaired fasting glycaemia and in subjects with impaired glucose tolerance [13].

Regular aerobic physical activity leads to a significant cardiovascular risk reduction, by improving the plasma lipid profile [14], [15]. Along the same line, increased aerobic physical fitness (which is in part the result of regular practice of aerobic physical activity) during adolescence has been associated not only with healthier blood lipids during these years [16], [17], but also later in life [18]. Therefore, it seems reasonable to initiate regular aerobic physical activity in childhood in order to prevent metabolic risk and CVD in adulthood.

The previous studies did not analyse possible associations with a metabolic composite index, but with single blood lipids. Therefore, our first aim was to explore associations between aerobic physical fitness not only with single blood lipids, but also with a composite index of blood lipids and fasting glycaemia in adolescents. Of note, only one study [19] analysed interactions between obesity measures and aerobic physical fitness in relation to a metabolic composite index, so we also tested a similar interaction in our population. Finally, to the best of our knowledge there are no studies providing minimal criterion standards of aerobic fitness in adolescents, associated with healthy metabolic outcomes. Therefore, we secondly aimed to set minimal criterion standards of aerobic fitness associated with a favourable lipid profile in adolescents.

Section snippets

Study population and design

This research was part of the AVENA study (Análisis y Valoración del Estado Nutricional en Adolescentes españoles [Assessment of Nutritional Status in Spanish Adolescents]), a population-based cross-sectional multicentric study of the aetiology and pathogenesis of obesity and related metabolic disorders during adolescence. The general methodology of the study, as well as the sample inclusion criteria, has been published elsewhere [20], [21]. Briefly, 2851 Spanish adolescents (1354 males and

Results

As expected, aerobic physical fitness was significantly higher in males compared with females for all ages (P < 0.001) (Fig. 1).

After general linear model analysis adjusted for age, sexual maturation and economic status, aerobic physical fitness was related to triglycerides (P = 0.004), HDL cholesterol (P = 0.013), and Apo A-I (P = 0.028) in male adolescents (Table 2). In females, aerobic fitness was only significantly related to HDL cholesterol (P = 0.045) (Table 2).

A composite index of blood lipids and

Discussion

Previous studies in children [16], [17], [35], [36] have shown associations between aerobic physical fitness and blood lipids. We also show here associations between aerobic fitness and single blood lipids, mainly in males. The only association found in girls in our study was to HDL cholesterol levels, but even the first quartile of aerobic physical fitness had mean HDL cholesterol levels of 57.2 ± 10.6 mg/dl, quite acceptable. This discrepancy is also noted by Boreham et al. [17], who revealed

Acknowledgements

This study was supported by the Spanish Ministry of Health, FIS (00/0015) and FEDER-FSE funds, CSD grants 05/UPB32/01 and 09/UPB31/03, the Spanish Ministry of Education (AP2002-2920, AP2003-2128, AP2004-2745), and grants from Panrico S.A., Madaus S.A. and Procter & Gamble S.A.

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