Low cardiorespiratory fitness is a strong predictor for clustering of cardiovascular disease risk factors in children independent of country,age and sex
Restricted accessResearch articleFirst published online August, 2007
Low cardiorespiratory fitness is a strong predictor for clustering of cardiovascular disease risk factors in children independent of country,age and sex
Few studies have investigated the association between maximal cardiorespiratory capacity (fitness) and the clustered cardiovascular disease (CVD) risk in children and youth from culturally diverse countries. This cross-sectional study examined the association between fitness and clustered CVD risk in children and adolescents from three European countries.
Methods
Participants were 2845 randomly selected school children aged 9 or 15 years from Portugal (n = 944), Denmark (n = 849) and Estonia (n = 1052). Cardiorespiratory fitness was determined during a maximal test on a cycle ergometer. CVD risk factors selected to assess the degree of clustering were the total cholesterol/high-density lipoprotein cholesterol ratio, plasma triglycerides, insulin resistance (homeostasis model assessment), sum of four skinfolds, and systolic blood pressure.
Results
There was a strong association between cardiorespiratory fitness and the clustering of CVD risk factors. The odds ratios for clustering in each quartile of fitness, using the quartile with the highest fitness as reference, were 13.0 [95% confidence interval (CI) 8.8-19.1]; 4.8 (95% CI 3.2-7.1) and 2.5 (95% CI 1.6-3.8), respectively, after adjusting for country, age, sex, socio-economic status, pubertal stage, family history of CVD and diabetes. In stratified analyses by age group, sex and country, similar strong patterns were observed.
Conclusion
Low cardiorespiratory fitness is strongly associated with the clustering of CVD risk factors in children independent of country, age and sex.
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AndersenLBWedderkoppNRiddochCFrobergKHansenHS.Biological cardiovascular risk factors cluster in Danish children and adolescents. Danish part of the European Heart Study. Prev Med2003; 37:363–367.
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SinaikoARDonahueRPJacobsDRJrPrineasRJ.Relation of weight and rate of increase in weight during childhood and adolescence to body size, blood pressure, fasting insulin, and lipids in young adults. The Minneapolis Children's Blood Pressure Study. Circulation1999; 99:1471–1476.
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McGillHCMcMahanAZieskeAWTracyREMalcolmGTHerderickEE. Association of coronary heart disease risk factors with microscopic qualities of coronary atherosclerosis in youth. Circulation2000; 102: 374–379.
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BerensonGSSrinivasanSRBaoWHNewmanWPTracyREWattigneyWA.Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. N Engl J Med1998; 338:1650–1656.
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BorehamCTwiskJNevilleCSavageMMurrayLGallagherA.Associations between physical fitness and activity patterns during adolescence and cardiovascular risk factors in young adulthood: the Northern Ireland Young Hearts Project. Int J Sports Med2002; 23 (Suppl 1):S22–S26.
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TörökKSzelenyiZPórszászJMolnárD.Low physical performance in obese adolescent boys with metabolic syndrome. Int J Obesity2001; 25:966–970.
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ShaibiGQCruzMLBallGDWeigensbergMJKobaissiHASalemGJ. Cardiovascular fitness and the metabolic syndrome in overweight latino youths. MSSE2005; 37:922–928.
16.
MoranAJacobsDRJrSteinbergerJHongCPPrineasRLuepkerR. Insulin resistance during puberty: results from clamp studies in 357 children. Diabetes1999; 48:2039–2044.
17.
AndersenLBHenckelPSaltinB.Maximal oxygen uptake in Danish adolescents 16-19 years of age. Eur J Appl Physiol1987; 56:74–82.
18.
RiddochCEdwardsDPageAFrobergKAnderssenSAWedderkoppN. The European Youth Heart Study –cardiovascular disease risk factors in children: rationale, aims, design and validation of methods. J Physical Activity Health2005; 2:115–129.
19.
TannerJM.Growth at adolescence. Oxford: Blackwell; 1962.
20.
RadziukJ.Insulin sensitivity and its measurement: structural commonalities among methods. J Clin Endocrinol Metab2000; 85:4426–4433.
21.
BorehamCTwiskJWRMurrayLSavageMStrainJJCranG.Fitness, fatness, and coronary heart disease risk in adolescents: the Northern Ireland Young Hearts Project. MSSE2001; 33:270–274.
22.
RaitakariOTPorkkaKVKTaimelaSTelemaRRasanenLViikariSA.Effects of persistent physical activity and inactivity on coronary risk factors in children and young adults. Am J Epidemiol1994; 140:195–205.
23.
HardinDSHebertJDBaydenTDehartMMazurL.Treatment of childhood syndrome X. Pediatrics1997; 100:E5.
24.
FergusonMAGutinBLeN-AKarpWLitakerMHumphriesM. Effects of exercise training and its cessation on components of the insulin resistance syndrome in obese children. Int J Obesity1999; 22:889–895.
25.
KangH-SGutinBBarbeauPOwensSLemmonCRAllisonJ. Physical training improves insulin resistance syndrome markers in obese adolescents. MSSE2002; 34:1920–1927.
26.
GoodmanEDolanLMMorrisonJADanielsSR.Factor analysis of clustered cardiovascular risks in adolescence: obesity is the predominant correlate of risk among youth. Circulation2005; 111:1970–1977.
27.
SjølAGrunnetKSchrollM.Secular trends in serum cholesterol, high density lipoproteins and triglycerides 1964-1987. Int J Epidemiol1991; 20:105–113.
28.
WisloffUNajjarSMEllingsenOHaramPMSwoapSAl ShareQ. Cardiovascular risk factors emerge after artificial selection for low aerobic capacity. Science2005; 307:418–420.
29.
PyöräläKDe BackerGGrahamIPoole-WilsonPWoodD.Prevention of coronary heart disease in clinical practice. Recommendations of the Task Force of the European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension. Eur Heart J1994; 15:1300–1331.
30.
AlbertiKGZimmetPZ.Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med1998; 15:539–553.
31.
BaoWSrinivasanSRWattigneyWABerensonGS.Persistence of multiple cardiovascular risk clustering related to syndrome X from childhood to young adulthood. The Bogalusa Heart Study. Arch Intern Med1994; 154:1842–1847.
32.
AndersenLBWedderkoppNRiddochCFrobergKHansenHS.Biological cardiovascular risk factors cluster in Danish children and adolescents. Danish part of the European Heart Study. Prev Med2003; 37:363–367.
33.
SinaikoARDonahueRPJacobsDRJrPrineasRJ.Relation of weight and rate of increase in weight during childhood and adolescence to body size, blood pressure, fasting insulin, and lipids in young adults. The Minneapolis Children's Blood Pressure Study. Circulation1999; 99:1471–1476.
34.
StrongJPMalcomGTMcMahanCATracyRENewmanWPIIIHerderickEE. Prevalence and extent of atherosclerosis in adolescents and young adults: implications for prevention from the Pathobiological Determinants of Atherosclerosis in Youth Study. JAMA1999; 281:727–735.
35.
McGillHCMcMahanAZieskeAWTracyREMalcolmGTHerderickEE. Association of coronary heart disease risk factors with microscopic qualities of coronary atherosclerosis in youth. Circulation2000; 102: 374–379.
36.
BerensonGSSrinivasanSRBaoWHNewmanWPTracyREWattigneyWA.Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. N Engl J Med1998; 338:1650–1656.
37.
ErikssenGLiestolKBjørnholtJThaulowESandvikL.Changes in physical fitness and changes in mortality. Lancet1998; 352:759–762.
38.
WannametheeGShaperAGWalkerM.Changes in physical activity, mortality, and incidence of coronary heart disease in older men. Lancet1998; 351:1603–1608.
39.
BorehamCTwiskJNevilleCSavageMMurrayLGallagherA.Associations between physical fitness and activity patterns during adolescence and cardiovascular risk factors in young adulthood: the Northern Ireland Young Hearts Project. Int J Sports Med2002; 23 (Suppl 1):S22–S26.
40.
BrageSWedderkoppNEkelundUFranksPWWarehamNJAndersenLB. Features of the metabolic syndrome are associated with objectively measured physical activity and fitness in Danish children: the European Youth Heart Study (EYHS). Diabetes Care2004; 27:2141–2148.
41.
GutinBIslamSManosTCucuzzoNSmithCStachuraME.Relation of percentage of body fat and maximal aerobic capacity to risk factors for atherosclerosis and diabetes in black and white seven-to eleven-year-old children. J Pediatrics1994; 125:847–852.
42.
TörökKSzelenyiZPórszászJMolnárD.Low physical performance in obese adolescent boys with metabolic syndrome. Int J Obesity2001; 25:966–970.
43.
ShaibiGQCruzMLBallGDWeigensbergMJKobaissiHASalemGJ. Cardiovascular fitness and the metabolic syndrome in overweight latino youths. MSSE2005; 37:922–928.
44.
MoranAJacobsDRJrSteinbergerJHongCPPrineasRLuepkerR. Insulin resistance during puberty: results from clamp studies in 357 children. Diabetes1999; 48:2039–2044.
45.
AndersenLBHenckelPSaltinB.Maximal oxygen uptake in Danish adolescents 16-19 years of age. Eur J Appl Physiol1987; 56:74–82.
46.
RiddochCEdwardsDPageAFrobergKAnderssenSAWedderkoppN. The European Youth Heart Study –cardiovascular disease risk factors in children: rationale, aims, design and validation of methods. J Physical Activity Health2005; 2:115–129.
47.
TannerJM.Growth at adolescence. Oxford: Blackwell; 1962.
48.
RadziukJ.Insulin sensitivity and its measurement: structural commonalities among methods. J Clin Endocrinol Metab2000; 85:4426–4433.
49.
BorehamCTwiskJWRMurrayLSavageMStrainJJCranG.Fitness, fatness, and coronary heart disease risk in adolescents: the Northern Ireland Young Hearts Project. MSSE2001; 33:270–274.
50.
RaitakariOTPorkkaKVKTaimelaSTelemaRRasanenLViikariSA.Effects of persistent physical activity and inactivity on coronary risk factors in children and young adults. Am J Epidemiol1994; 140:195–205.
51.
HardinDSHebertJDBaydenTDehartMMazurL.Treatment of childhood syndrome X. Pediatrics1997; 100:E5.
52.
FergusonMAGutinBLeN-AKarpWLitakerMHumphriesM. Effects of exercise training and its cessation on components of the insulin resistance syndrome in obese children. Int J Obesity1999; 22:889–895.
53.
KangH-SGutinBBarbeauPOwensSLemmonCRAllisonJ. Physical training improves insulin resistance syndrome markers in obese adolescents. MSSE2002; 34:1920–1927.
54.
GoodmanEDolanLMMorrisonJADanielsSR.Factor analysis of clustered cardiovascular risks in adolescence: obesity is the predominant correlate of risk among youth. Circulation2005; 111:1970–1977.
55.
SjølAGrunnetKSchrollM.Secular trends in serum cholesterol, high density lipoproteins and triglycerides 1964-1987. Int J Epidemiol1991; 20:105–113.
56.
WisloffUNajjarSMEllingsenOHaramPMSwoapSAl ShareQ. Cardiovascular risk factors emerge after artificial selection for low aerobic capacity. Science2005; 307:418–420.
