Table 3

Longitudinal studies on predictive validity of physical fitness for CVD risk factors and disease in children and adolescents

Fitness component	Author/study quality score	Years of follow-up	Subjects	Age (years)	Fitness test	Outcome variables	Results
Low-quality studies
Cardiorespiratory fitness and body composition	Eisenmann et al49	∼11	Boys 36	15.9	Maximal treadmill test using the modified Balke protocol (expressed as duration of the treadmill test), BMI, WC and BF (estimated using equations)	TG, TC, HDLc, glucose and BP	Boys and girls
	The Aerobics Center Longitudinal Study		Girls 12	to 27.2			Adolescent CRF and ΔCRF showed moderate negative correlations with adult BF indicators (BMI, WC and %BF, r = −0.34 to −0.47) and ΔBF (r = −0.24 to −0.46), respectively. Adolescent CRF was not significantly related to CVD risk factors in adulthood. Adolescent WC was positively related to adult BP (r = 0.33–0.45), and BF variables during adolescence were negatively related to adult CRF (r = −0.32 to −0.44). The ΔWC was negatively related to ΔCRF (r = −0.46) and ΔHDLc (r = −0.51), and ΔBMI was negatively related to ΔBP (r = 0.45) and ΔHDLc (r = −0.34)
	Quality score 2
Cardiorespiratory fitness and body composition	McGavock et al 37	2	2089	5–19	20 mSRT (estimated Vo_2max expressed as ml/kg/min) and weight	BP, large-artery compliance and systemic vascular resistance	Boys and girls
	McGavock et al 37	2		to			Boys and girls
	Quality score 2	2004–6		7–21			Weight gain and changes in heart rate and stroke volume were independently associated with changes in SBP over time. Specifically, SBP increased 0.77 mm Hg for every kilogram of weight gain over the 2-year follow-up. CRF was not a significant predictor of the baseline or age-related change in SBP
Cardiorespiratory, motor and musculoskeletal fitness	Monyeki et al38	1	Boys 380	7–14	1600 m run, standing broad jump, bent arm hang, sit-ups, 4×5 m shuttle run and 50 m run	BMI, FFM, sum of four skinfolds, BF estimated with equations, arm muscle area, SS/SSF	Boys and girls
	The Ellisras Longitudinal Study	2001–2	Girls 322	to8–15			The changes in weight/age, BMI, sum of skinfolds, FFM and SS/SSF were inversely related with bent arm hang in the pre-adolescent and adolescent boys and girls. Changes in BMI were negatively associated with sit-ups in girls. Changes in height/age, weight/age, BMI, sum of skinfolds, BF and arm muscle area showed negative relationships with changes in shuttle run, 1600 m run and 50 m run
	Quality score 2	2001–2
Body composition	Raitakari et al50	21	3596	3–18	BMI, skinfold thickness	Insulin, glucose, blood pressure, carotid artery IMT and carotid artery elasticity	Boys and girls
	Cardiovascular Risk in Young Finns Study	1980	2283	to 24–39			BMI was positively associated with adult IMT (p<0.05). However, when adulthood BMI was entered into the model, the effect of childhood BMI became non-significant. The age and sex-adjusted multivariate correlates of carotid artery elasticity included childhood skinfold thickness (sum of biceps, triceps and subscapular; p<0.05). However, the effect of childhood skinfold thickness on carotid artery elasticity became non-significant (p = 0.16) when adjusted with adult BMI
	Quality score 2	2001–2
High-quality studies
Cardiorespiratory fitness	Andersen et al20	8	Boys 133	16–19	Maximal cycle ergometer test (measured Vo_2max expressed as l/min and l/kg/min)	TG, TC/HDLc, SBP, BF derived from skinfolds. The upper quartile was defined as being at risk. If the subject has two or more risk factors, she/he was defined as “a case”	Boys and girls
	Andersen et al20	8	Girls 172	to			Boys and girls
	Danish Youth and Sport Study	1983–91	Boys 98	24–27			ORs for having two or more risk factors between quartiles of CRF were 3.1, 3.8 and 4.9 for quartiles two to four, respectively. At the second examination, OR were 0.7, 3.5 and 4.9, respectively. The probability for “a case” at the first examination to be “a case” at the second was 6.0
	Quality score 3		Girls 137
Cardiorespiratory and musculoskeletal fitness	Hasselstrom et al18	8	Boys 133	15–19	Maximal cycle ergometer test (measured Vo_2max expressed as ml/kg/min). Isometric muscular strength index (calculated as the sum of the scores obtained in elbow flexors, knee extensors, trunk flexors and truck extensors relative to body weight)	TG, HDLc, BP, %BF and risk score (calculated as the sum of the measured outcomes)	Boys
			Girls 132	to 23–27			CRF changes were negatively correlated with the changes in TC, TG, HDLc/TC (p<0.05). Muscular strength changes were negatively correlated with the changes in WC and %BF (p<0.05).
			Girls 132	to 23–27			Girls
	Danish Youth and Sports Study	1983–91	Boys 45				CRF changes were negatively correlated with the changes in TG, SBP, %BF and risk score (p<0.05). Muscular strength was not associated with any of the outcome measures in girls
	Quality score 3	1983–91	Girls 57
Cardiorespiratory fitness	Psarra et al21	2	Boys 477	6–12	20 mSRT (no of completed laps)	BMI, WC, W/H and %BF estimated using an electronic body composition analyser (Tanita)	Boys and girls
	Psarra et al21	2000–1,	Girls 441	to			BMI at the baseline, parental obesity and low level of CRF were the main predictors of the 2-year tracking of BF. WC and CRF level were the only significant predictors of high WC after 2 years
	Quality score 3	2002–3		8–14
Cardiorespiratory, musculoskeletal and motor fitness	Twisk et al19	15	181	13	Maximal treadmill test (measured Vo_2max expressed as ml/min/kg^2/3). Neuromotor fitness index (muscle strength, speed of movement, and coordination)	TC, HDLc, TC/HDLc, SBP, DBP, sum of four skinfolds and W/H	Boys and girls
	The Amsterdam Growth and Health Longitudinal Study	1977–91		to 27			CRF was negatively related to TC, TC/HDL ratio and the sum of four skinfolds. Neuromotor fitness was positively related to SBP and DBP and inversely to the sum of four skinfolds (p<0.05)
	Quality score 3
Body composition	Srinivasan et al22	14	783	13–17	BMI, subscapular and triceps skinfolds	TG, TC, HDLc, TC/HDLc, LDLc, BP, insulin and glucose	Boys and girls
	The Bogalusa Heart Study			to 27–31			As young adults, the overweight individuals showed adverse levels of body fatness measures, SBP and DBP, lipid profile, insulin and glucose as compared with the lean individuals (p<0.01 to <0.001). The prevalence of clinically recognised hypertension and dyslipidaemia increased 8.5-fold and 3.1-fold to 8.3-fold, respectively, in the overweight individuals versus the lean individuals (p<0.05). Clustering of adverse values (>75th percentile) for the TC/HDLc, insulin level and SBP occurred only among the overweight individuals (p<0.001)
	Quality score 3
Cardiorespiratory and musculoskeletal fitness	Barnekow-Bergkvist et al23	18	Boys 220	15–18 to 33–36	1974: Run-walk test (score: distance covered in nine minutes)	BMI, WC, W/H, TC, HDLc and SBP	Boys and girls
	Barnekow-Bergkvist et al23	18	Girls 205		1992: Submaximal cycle ergometer test (estimated Vo_2max expressed as ml/kg/min)		CRF at the age of 16 years was not associated with any of the outcomes measures at the age of 34 years. Bench-press was negatively associated with BMI in boys/men, whereas two-hand lift was negatively associated with BMI in girls/women
	Quality score 4	1974–92	Boys 157		Muscular strength: no of sit-ups and no of lifts in the bench-press test. Maximal static lifting strength was measured with the two-hand lift test
	Quality score 4	1974–92	Girls 121
Cardiorespiratory fitness	Boreham et al26	8	Boys 251	12–15	Submaximal cycle ergometer test (estimated Vo_2max by extrapolation of Vo₂ at 170 bpm to the age-adjusted estimated maximal heart rate, and expressed as ml/kg/min)	Arterial stiffness	Boys and girls
	The Northern Ireland Young Hearts Project		Girls 203	to 20–25			CRF was inversely and significantly associated with pulse wave velocity of both the elastic aortoiliac segment and the muscular aortodorsalis pedis segment. These associations were only slightly stronger with the muscular segment and were independent of (ie, not confounded nor mediated by) lifestyle variables, BF and physical activity
	Quality score 4
Body composition	Garnett et al39	7	342	7	BMI and WC	CVD risk clustering	Boys and girls
	Garnett et al39		290	to			Children who were overweight or obese at 8 years of age were 7 times (OR 6.9; 95% CI 2.5 to 19.0; p<0.001) as likely to have CVD risk clustering in adolescence than were their peers who were not overweight or obese. Those with an increased WC at 8 years were four times (95% CI 3.6; 1.0 to 12.9; p = 0.061) as likely to have CVD risk clustering in adolescence than were children with a smaller WC. Neither BMI nor WC were predictive of CVD risk clustering if adiposity was not included as a risk factor
	Quality score 4			14
Cardiorespiratory and musculoskeletal fitness	Janz et al25	5	Boys 63	10.5	Maximal cycle ergometer test (measured Vo_2max expressed as ml/min/kg^2/3). Maximum handgrip strength test (sum of right and left hand)	TC, HCLc, TC/HDLc, LDLc, sum of six skinfolds, WC and BP	Boys and girls
	The Muscatine Study		Girls 62	to 15			CRF changes were negatively correlated with changes in TC/HDLc, LDLc, sum of six skinfolds and WC (p<0.05) after controlling for age, gender, FFM and pubertal status. Muscular strength changes were negatively correlated with changes in SBP, sum of six skinfolds and WC (p<0.05) after controlling for age, gender, FFM and pubertal status
	Quality score 4
Cardiorespiratory fitness	Johnson et al24	3–5	White boys 17	4.6–11 to	Progressive walking treadmill test (measured Vo_2max expressed as l/min)	BF and lean tissue mass measured by DXA	Boys and girls
	Johnson et al24		White girls 55	8–16			Boys and girls
	Quality score 4		Black boys 19				CRF was negatively associated with increased adiposity. Children with a higher CRF at the start of the study had a lower rate of increase of adiposity over the course of the study
	Quality score 4		Black girls 24
Cardiorespiratory fitness	McMurray et al27	7	Boys 212	7–10	Submaximal cycle ergometry test (estimated Vo_2max expressed as ml/min/kg^FFM)	BMI, BP, BF estimated from triceps and subscapular skinfolds, blood lipids, metabolic syndrome	Boys and girls
	McMurray et al27	7	Boys 212	to			Children with low (first third) CRF (ml/kg/min) were 5.5–6 times more likely to have metabolic syndrome as an adolescent. When childhood CRF was expressed in terms of ml/kg^FFM/min, the OR for metabolic syndrome during adolescence comparing the low versus high Vo_2max was not significant (p<0.07); however, when the low CRF (mL/kg^FFM/min) was compared with the moderate (second third), the OR was significant (p<0.03)
	Quality score 4	1990–6	Girls 177	14–17
Self-perceived physical fitness	Pietilainen et al17	4	4840 (including 1870 twins pairs)	16–18	Self-perceived physical fitness. Alternatives were “very good, fairly good, satisfactory, rather poor, very poor”. The two first and two last alternatives were combined to yield good, satisfactory and poor fitness classes	BMI, WC, BF, FFM, %BF assessed by DXA	Boys and girls
	Pietilainen et al17	4		to			Those who perceived themselves as persistently unfit in adolescence had a marked risk of adult overall (5.1; 95% CI 2.0 to 12.7) and abdominal obesity (3.2; 95% CI 1.5 to 6.7). Adult obesity risk was also increased in those whose fitness declined from 16 to 18 years
	Quality score 4	1975–9		22–27
Cardiorespiratory fitness	Carnethon et al30	15	Men 2029	18–30 to	Maximal treadmill test according to a modified Balke protocol (expressed as duration of the treadmill test)	Incidence of type 2 diabetes, hypertension, the metabolic syndrome and hypercholesterolaemia	Boys and girls
	Carnethon et al30	1985–6	Women 2458	43–45			Boys and girls
	Coronary Artery Risk Development in Young Adults	1992–3	2478				Participants with low CRF (<20th percentile) were 3 to 6-fold more likely to develop diabetes, hypertension and the metabolic syndrome than participants with high CRF (⩾60th percentile; all p<0.001). Adjusting for baseline BMI diminished the strength of these associations to 2-fold (all p<0.001). In contrast, the association between low CRF and hypercholesterolaemia was modest (HR 1.4; 95% CI 1.1 to 1.7; p = 0.02) and attenuated to marginal significance after BMI adjustment (p = 0.13). Improved CRF over 7 years was associated with a reduced risk of developing diabetes (HR 0.4; 95% CI 0.2 to 1.0; p = 0.04) and the metabolic syndrome (HR 0.5; 95% CI 0.3 to 0.7; p<0.001), but the strength and significance of these associations was reduced after accounting for changes in weight
	Quality score 5	2000–1	3550
Cardiorespiratory fitness	Boreham et al29	10	Boys 229	12 and 15 to 22.5	20 mSRT (no of completed laps)	TC, HCLc, BP, sum of four skinfolds	Boys
	Boreham et al29	1989–90–1992–3–1997–9	Boys 229	12 and 15 to 22.5			CRF changes were modestly and negatively associated with TC, HDLc and SBP (p>0.5)
	The Northern Ireland Young Hearts Project		Girls 230				Girls
	Quality score 5						CRF changes were modestly and negatively associated with TC, HDLc and skinfold thicknesses (p>0.17), and significantly (negatively) associated with DBP (p = 0.03)
Cardiorespiratory fitness	Byrd-Williams et al34	4	Boys 84	11 to 15	Maximal treadmill test (measured Vo_2max expressed as l/min)	BF, soft lean tissue mass, and %BF measured by DXA	Boys
	Byrd-Williams et al34	4	Boys 84	11 to 15			CRF was a significant predictor of change in BF after adjusting for changes in lean tissue mass, Tanner stage, and age (β = −0.001, p = 0.03). That is, higher initial CRF was associated with less subsequent gain in body fat
	Study of Latino Adolescents at Risk	2001–5	Girls 76				Girls
	Quality score		Girls 76				CRF was not a significant predictor of change in BF after controlling for changes in Tanner stage, lean tissue mass and age (β = 0.0005, p = 0.37)
Cardiorespiratory fitness	Ferreira et al31	24	Boys 75	13–16	Maximal treadmill test (measured Vo_2max expressed as ml/min, as ml/kg/min and as ml/min/kg^2/3)	Carotid IMT and stiffness of the carotid, femoral and brachial arteries	Boys and girls
				to
				36
				and 21–26
				to
				36
Cardiorespiratory fitness and body composition	Ferreira et al33	23	Boys 175	13	Maximal treadmill test (measured Vo_2max expressed as ml/min/kg). BMI, WC, sum of four skinfolds. Subcutaneous trunk fat (subscapular plus the suprailiac to the sum of skinfolds)	Prevalence of the metabolic syndrome	Boys and girls
	The Amsterdam Growth and Health Longitudinal Study	1977–91	Girls 189	to			Subjects with the metabolic syndrome at the age of 36 years, compared with those without the syndrome, had (from adolescence to the age of 36 years) a more marked increase in BF and in subcutaneous trunk fat, and a more marked decrease in CRF
	Quality score 5			36
Cardiorespiratory fitness	Koutedakis et al32	2 three time point	210	12.3	20 mSRT (estimated Vo_2max (expressed as ml/kg/min)	%BF estimated from skinfolds (triceps and medial calf)	Boys and girls
			204	13.3			Vo_2max was inversely associated with changes in BF (β = −0.09; p⩽0.05)
			198	14.3
Cardiorespiratory, motor and musculoskeletal fitness	Twisk et al28	20	Boys 132	13	Maximal treadmill test (measured Vo_2max expressed as l/min, ml/kg/min and the maximal slope), motor fitness (index of muscular strength, flexibility, speed of movement and coordination)	TC, HDLc, SBP, DBP, sum of four skinfolds and W/H	Boys and girls
			Girls 145	to			CRF (expressed as ml/kg/min) in 13–16-year-old group was negatively associated with sum of skinfolds, TC/HDLc and with SBP at 32 years of age in men and women
			Girls 145	32			CRF (expressed as ml/min) was negatively associated with BP in men, TC, sum of four skinfolds and W/H (p<0.05)
	The Amsterdam Growth and Health Longitudinal Study	1985	Boys 80	13–16 to 32
							CRF (expressed as maximal slope) in 13-year-old group was negatively associated with sum of skinfolds and TC at 32 years of age in men and women

	Quality score 5	1996–7	Girls 96				Neuromotor fitness was positively related to SBP (β = 0.11; p<0.01) and inversely to the sum of four skinfolds (β = 0.21; p<0.01). Neuromotor fitness was not associated with TC, HDLc or TC/HDLc
Body composition	Baker et al44	5	Boys 139 857	7–13 to	BMI	CHD events	Boys and girls
	Quality score 5	1955–60	Girls 136 978	⩾23			The risk of any CHD event, a non-fatal event and a fatal event among adults was positively associated with BMI at 7–13 years of age for boys and 10–13 years of age for girls. Adjustment for birth weight strengthened the results

Body composition	Bjorge et al53	34.9	226 682	14–19	BMI	Mortality	Adolescent obesity was related to increased mortality in middle age from several important causes. Higher BMI at adolescence was associated with an increased relative risk of death from endocrine, nutritional and metabolic diseases and from diseases of the circulatory system. The relative risks of death from diseases of the respiratory system and symptoms, signs, abnormal findings and ill-defined causes were increased in the group with higher BMI (>85th percentile)
	Quality score 5			to
				58–63
Body composition	Engeland et al54	31.5	227 003	14–19	BMI	Mortality	An increasing risk of death by increasing BMI in adolescence was observed. Mortality among men whose baseline BMI was between the 85th and 95th percentiles and above the 95th percentile in the US reference population was 30% and 80% higher, respectively, than that among those whose baseline BMI was between the 25th and 75th percentiles. The corresponding rates among women were 30% and 100%
	Quality score 5			to
				45–50
Body composition	Franks et al48	∼9	1604	5–19	BMI and WC	Incidence of type 2 diabetes	Boys and girls
	Quality score 5			to			In 5–9-year-old subjects, WC was the strongest and single significant modifiable predictor of diabetes. In 10–14-year-old subjects, the strongest independent modifiable predictors were 2-h glucose, BMI and A1C, whereas in the 15–19-year-old subjects, the strongest predictors were 2-h glucose, WC and A1C. When the age groups were combined (ie, 5–19 years) the independent modifiable predictors were BMI, fasting glucose, 2-h glucose and HDLc
				14–28
Body composition	Gunnell et al51	57	Boys 1165	2–14 to	BMI	Mortality	Boys and girls
	The Boyd Orr Cohort		Girls 1234	59–71			All-cause and cardiovascular mortality were associated with higher childhood BMI. Compared with those with BMI between the 25th and 49th centiles, the HR (95% CI) for all-cause mortality in those above the 75th BMI centile for their age and sex was 1.5 (1.1 to 2.2) and for ischaemic heart disease it was 2.0 (1.0 to 3.9). There was also a suggestion of a non-linear association with overall mortality; those in the 25–49th centile of the BMI distribution had the lowest mortality rates
	Quality score 5
Body composition	Juonala et al41	21	1081	3–18	BMI	Carotid artery ITM and obesity	Boys and girls
	The Cardiovascular Risk in Young Finns Study			to 24–39			Being overweight or obese in adolescence carried about a 4-fold increased risk of being obese in adulthood. Subjects who had been overweight/obese in youth had significantly higher carotid IMT values in adulthood compared with subjects who had been lean in youth. Subjects who had been obese in youth but were non-obese as adults had comparable IMT values as subjects who had remained consistently non-obese. On the other hand, gaining weight and being consistently obese/overweight from youth to adulthood were both associated with increased IMT in adulthood
	Quality score 5
Body composition	Juonala et al40	21	2255	10.7	Skinfold thickness	Carotid artery compliance, Young’s elastic modulus and stiffness index	Boys and girls
	The Cardiovascular Risk in Young Finns Study			to 37.1			Childhood obesity (above age and sex-specific 80th percentile for skinfold thickness) predicted decreased carotid artery compliance, increased Young’s elastic modulus and increased stiffness index in adulthood
	Quality score 5
Body composition	Lawlor and Leon45	23	11 106	4.9	BMI	Risk of CHD and stroke	Boys and girls
	Aberdeen Children of the 1950s Prospective Cohort Study	1981–2004		to 28			There was no association between childhood BMI and CHD risk. There was no linear association between childhood BMI and stroke risk, but those who were obese in childhood (top 2.5% of the BMI distribution) compared with all others had an increased risk of stroke; the adjusted (for gender, father’s occupational social class at birth, no of siblings and birth weight) HR was 2.41 (95% CI 1.00 to 5.86)
	Quality score 5
Body composition	Lawlor et al46	∼16	Boyd Orr Cohort	2–15	BMI	Risk of adult ischaemic heart disease and stroke	Boys and girls
			Boys 1344
			Girls 1242
	Boyd Orr cohort Christ’s Hospital Glasgow Alumni	∼1988–2004	Christ’s Hospital	9–18			BMI was not associated with future risk of ischaemic heart disease or stroke in any cohort. The pooled (all three cohorts) adjusted HR per SD of early life BMI was 1.09 (95% CI 1.01 to 1.19) for ischaemic heart disease and 0.94 (95% CI 0.82 to 1.08) for stroke. The pooled HR of ischaemic heart disease when participants who were overweight or obese for their age were compared with all other participants was 1.34 (95% CI 0.95 to 1.91), and no association was found between overweight or obesity and stroke risk. The effects of BMI did not vary by cohort or by age
	Boyd Orr cohort Christ’s Hospital Glasgow Alumni	∼1988–2004	Boys 1440	9–18
	Quality score 5		Glasgow Alumni	16–22
			Boys 2637
			Girls 7918
Body composition	Must et al52	∼60	508	13–18	BMI	Risk of mortality from all causes and disease-specific mortality	Boys and girls
	Quality score 5	1922–35,		to			Overweight in adolescents was associated with an increased risk of mortality from all causes and disease-specific mortality among men, but not among women. The relative risks among men were 1.8 (95% CI 1.2 to 2.7; p = 0.004) for mortality from all causes and 2.3 (95% CI 1.4 to 4.1; p = 0.002) for mortality from CHD. The risk of morbidity from CHD and atherosclerosis was increased among men and women who had been overweight in adolescence
		1988		73–78
Body composition	Oren et al47	∼15	750	12–16	BMI	Carotid IMT	Boys and girls
	The Atherosclerosis Risk in Young Adults Study			to 27–30			One SD increase in adolescent BMI was associated with 2.3 mm (95% CI 1.3 to 3.3) increase in mean common carotid IMT in young adults after adjustment for gender, adolescent age, adolescent BP, puberty stage and lumen diameter. Further adjustment for adult CVD risk factors did not change the relationship, whereas adjustment for adult BMI attenuated the association. Subjects who remained in the upper BMI distribution from adolescence into young adulthood had a significantly higher common carotid IMT compared with those who showed relative weight loss over time
	Quality score 5
Body composition	Raitakari et al4	21	3596	3–18	BMI	Carotid artery IMT	Boys and girls
	Cardiovascular Risk in Young Finns Study	1980	2283	24–39			In multivariable models adjusted for age and sex, IMT in adulthood was significantly associated with childhood BMI (p = 0.007) and with adult BMI (p<0.001). High levels (ie, extreme age and sex-specific 80th percentile) of BMI in 12–18-year-old adolescents was directly related to carotid IMT measured in young adults at ages 33–39 years (p<0.001 for both men and women), and remained significant after adjustment for contemporaneous risk variables
	Quality score 5	2001–2
Body composition	van Lenthe et al42	23	Boys 84	13–27	S/T and sum of four skinfolds	BP, TC, HDLc and TC/HDLc	Boys and girls
	The Amsterdam Growth and Health Longitudinal Study	1977–91	Girls 98	to 36–50			Increase in the S/T ratio was significantly associated with increase in SBP. After adjustment for sum of skinfolds and the behavioural variables (physical activity, smoking and alcohol intake), the association remained statistically significant
	Quality score 5						In men, the increase of the S/T was significantly associated with a decrease in TC level. However, after adjustment for sum of skinfolds, this association no longer remained statistically significant. The increase in the S/T ratio was statistically significantly associated with decrease in level of HDLc, also after adjustment for confounders
Body composition	Sivanandam et al43	14	231	13	BMI, FFM and BF (measured with DXA)	Left ventricular mass	Boys and girls
	Quality score 5	1985–6	132	to 27			BMI at 13 years was highly correlated with LVMI at 13 and 27 years. The cross-sectional correlation of LVMI and BMI at 13 years (r = 0.38, p<0.001) had strengthened considerably by 27 years (r = 0.55, p<0.001)
	Quality score 5	1999–2000					A BMI increase >5.5 kg/m² from 13 to 27 years was associated with a significantly greater increase in the LVMI (p<0.001) than a BMI change <5.5 kg/m², and this relation was similar in children who were thin and heavy at baseline. In young adulthood, the relation of LVMI to FFM was weaker than that of LVMI to BF

BF, body fat; %BF, percentage of body fat; BMI, body mass index; BP, blood pressure; CHD, coronary heart disease; CRF, cardiorespiratory fitness (also refers to maximum oxygen consumption (Vo_2max)); CVD, cardiovascular disease; DBP, diastolic blood pressure; DXA, dual energy x ray absorptiometry; FFM, fat-free mass; HDLc, high-density lipoprotein cholesterol; HR, hazard ratio; IMT, intima media thickness; LDLc, low-density lipoprotein cholesterol; LVMI, left ventricular mass index; OR, odds ratio; SS/SSF, subscapular plus supraespinale skinfold/subscapular plus supraespinale lus biceps plus triceps skinfolds; S/T, subscapular/triceps skinfolds ratio; TC, total cholesterol; TG, triglycerides; 20 mSRT; 20 m shuttle run test; WC, waist circumference; W/H, waist to hip ratio.