Cardiovascular health behavior and cardiorespiratory fitness in adolescents: a longitudinal study.

Cardiorespiratory fitness has been substantially associated with health status. However, longitudinal studies on cardiorespiratory fitness and ideal cardiovascular health behavior (ICHB) in adolescents are scarce. The aim of this study was to evaluate the longitudinal association between ICHB (at baseline) and cardiorespiratory fitness (at follow-up). This is a 2-year prospective analysis of 445 adolescents (232 girls) aged 12-18 years. The ICHB was developed by the American Heart Association as meeting the ideal health behaviors for a healthy diet, physical activity, smoking status, and body mass index. ANCOVAS adjusted by age, sex, pubertal stage, socioeconomic status, and cardiorespiratory fitness showed that the higher the number of ICHB metrics accumulated at baseline (from 1 to 4), the higher the cardiorespiratory fitness levels over a 2-year period (p = 0.038). In logistic regressions, after adjusting for potential confounders, the odds ratios for having high cardiorespiratory fitness at follow-up was 4.9 (95% CI, 1.2-20.1, p = 0.02) for those who accumulated all four metrics of ICHB, when compared to those with 1 or less metrics of ICHB. In addition, the higher the number of ICHB metrics accumulated, the higher the likelihood of having a high cardiorespiratory fitness level over a 2-year period (p for trend = 0.01). CONCLUSION:  We identified a significant association between ICBH and cardiorespiratory fitness in adolescents. Therefore, improving ICBH in adolescence is likely to benefit the cardiorespiratory fitness. WHAT IS KNOWN: • Smoking status, body mass index, physical activity, and diet are associated to cardiorespiratory fitness in adulthood. • Lifestyle behaviors such as physical activity, smoking, body weight, and healthy diet are individually linked with cardiorespiratory fitness and, however, have not been examined jointly, as combined health behaviors. WHAT IS NEW: • Accumulation of cardiovascular health behavior metrics was positively associated with cardiorespiratory fitness at a 2-year follow-up, in adolescents. • Meeting all the four metrics of ideal cardiovascular health behavior seems important for healthy cardiorespiratory fitness during adolescence.

Is the Leptin/Adiponectin Ratio a Better Diagnostic Biomarker for Insulin Resistance than Leptin or Adiponectin Alone in Adolescents?

Background: Recently, the leptin/adiponectin (L/A) ratio has been suggested as a novel predictor of cardio-metabolic and other chronic diseases. Aim: To evaluate the ability of leptin (L), adiponectin (A), and the L/A ratio in identifying high risk of insulin resistance IR in adolescents, adjusted by cardiorespiratory fitness, adherence to the Mediterranean diet, and body fat percentage. Subjects and methods: This is a cross-sectional analysis with 529 adolescents aged 12−18 years-old. Blood samples were taken to analyze glucose, insulin, leptin, and adiponectin levels. IR (homeostasis model assessment of insulin resistance (HOMA-IR) was estimated from fasting serum insulin and glucose). Results: Adiponectin, leptin, and L/A ratio were accurate to predict IR among adolescents. The optimal L/A cut-off value to indicate risk of IR development was >0.35 in boys and >0.97 in girls. Logistic analyses showed that the suggested cut-off points for adiponectin (girls: OR: 2.87 (1.26−6.53); p = 0.012); leptin (boys: OR: 5.23 (1.16−7.14) p = 0.006; girls: OR: 2.99 (1.10−8.09) p = 0.031), and the L/A ratio (boys: OR: 8.38 (2.6−26.8) p < 0.001; girls: OR: 6.1 (2.1−17.0) p < 0.001), were significant predictors of IR, after adjustments for age, pubertal stage, adherence to the Mediterranean diet, cardiorespiratory fitness, and body fat percentage. Conclusion: Leptin and L/A ratio were associated with IR risk, after adjustments for confounders in both sexes and adiponectin in girls. The L/A ratio seems to have a higher diagnostic accuracy to identify IR risk than adiponectin or leptin, in both sexes.

Bullying and Health Related Quality of Life among Adolescents-A Systematic Review.

Health-related quality of life is among global health goals not only in adulthood but also in childhood and adolescence. Being a multi-component construct, health-related quality of life covers various domains, such as physical and psychological wellbeing and social and environmental areas. Bullying might significantly influence those domains especially in adolescence, a period of life when numerous personal and interpersonal transformations are experienced. Therefore, the aim of the current systematic review was to provide a comprehensive overview of the relationship of bullying with the health-related quality of adolescents' lives. An electronic literature search was performed using PubMed, Embase, and Cochrane Library, and 3621 full-text articles were identified. After a selection process, 12 studies covering diagnosis, prevention and treatment for each of the three sections "adolescents", "health related quality of life" and "bullying" were reviewed. An overall reduction in health-related quality of life in regard to bullying appeared from the studies analyzed, as well as a decline in adolescent mental health. Different bullying types were identified as causing harm to various adolescents' health-related quality of life domains. These findings may contribute to effective bullying management in schools and/or societal settings, and inform intervention strategies for maintaining the quality of life of adolescents being bullied.

Cardiovascular health behavior and blood pressure in adolescents: A longitudinal analysis.

BACKGROUND: The ideal cardiovascular health behaviors (ICHB) have been associated with a subsequent positive health status in adults. However, evidence regarding blood pressure (BP) and ICHB in adolescents is scarce. The aim of this prospective cohort was to evaluate the impact of accumulation of ICHB on BP values in adolescents over two years. METHODS: This is a longitudinal analysis with 445 adolescents (232 girls) aged 12-18 years old. Resting blood pressure was measured at baseline and 2 years later, and ICHBs at baseline according to standard procedures. Based on the American Heart Association definition, the ICHB index was defined as a sum of meeting the ICHBs (from 0 to 4, where 4 would be the healthiest profile of all ICHBs) for a healthy diet, physical activity, smoking status and body mass index. RESULTS: Adjusted means values (ANCOVA) of BP parameters through achievement of a greater number of (between 1-4) the ICHBs (adjusting for potential confounders, age, sex, pubertal stage and socioeconomic status) showed that, as increase the number of ICHB accumulated as a lower the BP levels [ICHB and SBP (F3.435) = 4.501, p = 0.004), DBP (F(3.435) = 2.725, p = 0.044), pulse pressure (F(3.435) = 4.004, p = 0.008), and rate pressure product (F(3.435) = 2.866, p = 0.036)] over two years. CONCLUSION: A lower number of ICHB (smoking status, body mass index, physical activity, and diet) during adolescence play a key role on blood pressure over two years. A higher number of ICHB is seen to be associated with a lower risk of short-term, hypertension.

IDEAL CARDIOVASCULAR HEALTH STATUS AND HEALTH-RELATED QUALITY OF LIFE IN ADOLESCENTS: THE LABMED PHYSICAL ACTIVITY STUDY.

OBJECTIVE: Adolescent's ideal cardiovascular health index (ICVH) seems to be an important indicator of youth's lifestyles and cardiometabolic health with potential positive consequences for their Health-Related Quality of Life (HRQoL). The purpose of this study was to examine the associations between the ICVH index and HRQoL in adolescents. METHODS: This was a cross-sectional study based on secondary analyses from the LabMed Physical Activity Study (n=407 adolescents, 53% girls). ICVH, as defined by the American Heart Association, was determined as meeting ideal behaviors (physical activity, body mass index, smoking status, and diet intake) and health factors (blood pressure, total glucose, and cholesterol). HRQoL was measured with the Kidscreen-10 self-report questionnaire. RESULTS: Analysis of covariance (ANCOVA) showed a significant association between the accumulation of ideal cardiovascular health metrics and HRQoL (F(4,403)=4.160; p=0.003). In addition, the higher the number of ideal health behaviors accumulated, the higher the mean values of HRQoL (p-value for trend=0.001), after adjustments for age, sex, socioeconomic status and pubertal stage. CONCLUSIONS: ICVH index was positively associated with HRQoL in adolescents. Ideal health behaviors metrics seem to have a stronger association with HRQoL than the ideal health factors metrics in adolescents.

Ideal cardiovascular health status and health-related quality of life in adolescents: the labmed physical activity study / Estado de saúde cardiovascular ideal e qualidade de vida relacionada à saúde em adolescentes: estudo labmed

ABSTRACT Objective: Adolescent's ideal cardiovascular health index (ICVH) seems to be an important indicator of youth's lifestyles and cardiometabolic health with potential positive consequences for their Health-Related Quality of Life (HRQoL). The purpose of this study was to examine the associations between the ICVH index and HRQoL in adolescents. Methods: This was a cross-sectional study based on secondary analyses from the LabMed Physical Activity Study (n=407 adolescents, 53% girls). ICVH, as defined by the American Heart Association, was determined as meeting ideal behaviors (physical activity, body mass index, smoking status, and diet intake) and health factors (blood pressure, total glucose, and cholesterol). HRQoL was measured with the Kidscreen-10 self-report questionnaire. Results: Analysis of covariance (ANCOVA) showed a significant association between the accumulation of ideal cardiovascular health metrics and HRQoL (F(4,403)=4.160; p=0.003). In addition, the higher the number of ideal health behaviors accumulated, the higher the mean values of HRQoL (p-value for trend=0.001), after adjustments for age, sex, socioeconomic status and pubertal stage. Conclusions: ICVH index was positively associated with HRQoL in adolescents. Ideal health behaviors metrics seem to have a stronger association with HRQoL than the ideal health factors metrics in adolescents.

RESUMO Objetivo: O Índice de Saúde Cardiovascular Ideal (ISCI) do adolescente parece ser um importante indicador do estilo de vida e da saúde cardiometabólica dos jovens, com possíveis consequências positivas para a Qualidade de Vida Relacionada à Saúde (QVRS). O objetivo deste estudo foi examinar as associações do ISCI e da QVRS em adolescentes. Métodos: Este foi um estudo transversal baseado em análises secundárias do estudo LabMed Physical Activity (n=407 adolescentes, 53% meninas). O ISCI, conforme definido pela American Heart Association, foi determinado como atendendo a comportamentos ideais (atividade física, índice de massa corporal, tabagismo e padrão alimentar) e fatores de saúde (pressão arterial, glicose total e colesterol). A QVRS foi mensurada com o questionário de autorrelato Kidscreen-10. Resultados: A análise de covariância mostrou associação entre o acúmulo de métricas ideais de saúde cardiovascular e a QVRS (F(4,403)=4,160; p=0,003). Quanto maior o número de comportamentos ideais de saúde acumulados, maiores os valores médios da QVRS (p-valor de tendência=0,001), após ajustes para idade, sexo, status socioeconômico e estágio pubertal. Conclusões: O índice de saúde cardiovascular ideal associou-se positivamente à QVRS em adolescentes. As métricas ideais de comportamentos de saúde parecem ter uma associação mais forte com a QVRS do que as métricas ideais de fatores de saúde em adolescentes.

Association of Adipocytokines and Inflammatory Biomarkers with Blood Pressure in Adolescents: A Longitudinal Analysis.

BACKGROUND AND AIMS: Several cross-sectional, but few prospective, studies suggest that inflammation may be involved in the development of high blood pressure. We examined markers of inflammation for their associations with blood pressure levels over a two-year period in healthy adolescents. METHODS AND RESULTS: The sample comprised 406 adolescents (209 girls) aged 12-18 years in the LabMed Physical Activity Study were followed-up for 2 years. Anthropometric (weigh, height, BMI), markers of inflammation (high sensitivity C-reactive protein, complement factors C3 and C4, fibrinogen, leptin and adiponectin) and ambulatory blood pressure (BP) were collected. Socioeconomic status, pubertal development, adherence to Mediterranean diet and cardiorespiratory fitness were measured for adjustment for potential confounders. Adjusted linear regression models revealed a significant association of Leptin/Adiponectin (L/A) Ratio (baseline) with systolic BP (ß = 0.120; p < 0.034) and with diastolic BP (ß = 0.125; p < 0.036) at follow-up (full adjusted model). Leptin was associated with systolic BP at follow-up (ß = 0.102; p < 0.038) after adjustment for systolic BP at baseline, height, pubertal stage, socioeconomic status, adherence to Mediterranean diet, cardiorespiratory fitness, however, not independently of BMI. CONCLUSION: L/A ratio was positively associated with systolic BP and diastolic BP even after adjusting confounding variables. Therefore, a higher misbalance between leptin and adiponectin (higher L/A ratio) early adolescence may exert a negative effect BP levels in late adolescence regardless of several confounders factors.

Higher Cardiorespiratory Fitness Levels May Attenuate the Detrimental Association between Weight Status, Metabolic Phenotype and C-Reactive Protein in Adolescents-A Multi-Cohort Study.

Results from several studies show that only obese, unfit subjects, but not obese, fit subjects, are at higher mortality risk than are normal-weight fit subjects. The aim of the study was two-fold: (1) to examine the differences in C-reactive protein levels across different metabolic phenotypes (healthy and unhealthy) of weight status and (2) ascertain whether high levels of cardiorespiratory fitness (CRF) attenuate the association of C-reactive protein and metabolic phenotypes of weight status. This was a pooled study, which included data from three cross-sectional projects (1706 youth (921 girls) aged 12-18 years). We used a Shuttle run test to assess CRF. Adolescents were classified into six metabolic phenotypes (healthy and unhealthy) of weight status (non-overweight, overweight and obese), based on age- and sex-specific cutoff points for triglycerides, systolic blood pressure, HDL-cholesterol, glucose and body mass index. High-sensitivity assays were used to obtain the C-reactive protein as inflammatory biomarker. After adjustment for potential confounders (age, sex, pubertal stage and country), the analysis of covariance (ANCOVA) shows that C-reactive protein is directly associated with metabolic phenotypes of weight status. Subjects with obesity, regardless of their metabolic profile, had higher levels of C-reactive protein Z-score. In addition, (after adjustments for potential confounders) a two-way ANCOVA showed that high levels of CRF attenuated the associations of C-reactive protein levels in metabolic healthy non-overweight and in adolescents with obesity. In conclusion, higher CRF levels may attenuate the detrimental association between obesity and C-reactive protein independently of metabolic phenotype. Findings from this study are important for prevention, clinical practice on issues associated with adiposity and metabolic disorders.

High levels of adiponectin attenuate the detrimental association of adiposity with insulin resistance in adolescents.

BACKGROUND AND AIM: This study aimed to: i) examine the differences in insulin resistance (IR) across adiposity levels; and ii) ascertain whether high levels of adiponectin attenuate the detrimental association of adiposity with IR in adolescents. METHODS AND RESULTS: A total of 529 adolescents aged 12-18 years participated in this cross-sectional study (267 girls). Anthropometry and body adiposity parameters [body mass index (BMI), sum of skinfolds, body fat percentage (BF %) by bio-impedance analysis and waist circumference (WC)], were measured according to standardized procedures and categorized into age- and sex-specific quartiles. Socioeconomic status, pubertal stage and lifestyle determinants (Mediterranean diet adherence and cardiorespiratory fitness) were gathered and used as confounders. Serum adiponectin and IR (homeostasis model assessment of insulin resistance [HOMA-IR] estimated from fasting serum insulin and glucose were assessed. Analysis of covariance (ANCOVA) showed that HOMA-IR increased in a linear fashion throughout the quartiles of all adiposity measures (p < 0.001 for all), independently of age, sex, pubertal stage, socioeconomic status, adherence to the Mediterranean diet and cardiorespiratory fitness. Two-way ANCOVA showed that adolescents in the higher quartile of adiposity for BF%, BMI, WC and skinfolds sum (Q4) presented the highest adiponectin levels, and had 0.77 Standard Deviation (SD), 0.8 SD, 0.85 SD and 0.8 SD lower HOMA-IR, respectively (p < 0.01) than their low adiponectin group counterparts, after adjustments for potential confounders. CONCLUSION: Higher adiponectin levels may attenuate the detrimental association between adiposity and IR, particularly in subjects with higher adiposity.

Adherence to Southern European Atlantic Diet and physical fitness on the atherogenic index of plasma in adolescents.

We sought (i) to evaluate the associations of cardiorespiratory fitness (CRF), muscular fitness (MF) and Southern European Atlantic Diet (SEADiet) with atherogenic index of plasma (AIP) and (ii) to investigate de combined association of MF, CRF and SEADiet on AIP in adolescents. A cross-sectional school-based study was conducted on 493 adolescents (285 girls and 208 boys) aged 15-18 years, from the Portuguese Azorean Archipelago. CRF was measured by shuttle run test and MF by curl up and push up tests. Adherence to SEADiet was assessed with a semi-quantitative food frequency questionnaire (FFQ). The AIP was estimated as log (TG/HDL-C). Measures of pubertal stage and socioeconomic status were assessed. Linear regression showed a significant inverse association between MF (standardized ß = -0.165; p < 0.001), CRF (standardized ß = -0.081; p < 0.030) and SEADiet (standardized ß = -0.081; p < 0.045) with AIP, after adjustments for age, sex, pubertal stage and parental education. Furthermore, participants classified with an optimal as well as those with low adherence to a SEADiet but with LowMF/LowCRF had on average the highest AIP (F(7.482) = 3.270; p = 0.002). Moreover, optimal SEADiet with HighMF/HighCRF group showed the lowest AIP when compared with those with low adherence to a SEADiet with HighMF/HighCRF group (p = 0.03). AIP is inversely associated with MF, CRF and SEADiet. The low MF combined with a low CRF levels seems to overcome the potential healthy effect of having an optimal adherence to the SEADiet on AIP. However, an optimal adherence to SEADiet seems to improve the AIP in those adolescents with high fitness levels.

Adherence to Southern European Atlantic Diet and physical fitness on the atherogenic index of plasma in adolescents / Adesão à Dieta Atlântica do Sul da Europa e aptidão física ao índice aterogênico do plasma em adolescentes / Adherencia a la Dieta Atlántica del Sur de Europa y condiciones físicas en el índice aterogénico de plasma en adolescentes

Abstract: We sought (i) to evaluate the associations of cardiorespiratory fitness (CRF), muscular fitness (MF) and Southern European Atlantic Diet (SEADiet) with atherogenic index of plasma (AIP) and (ii) to investigate de combined association of MF, CRF and SEADiet on AIP in adolescents. A cross-sectional school-based study was conducted on 493 adolescents (285 girls and 208 boys) aged 15-18 years, from the Portuguese Azorean Archipelago. CRF was measured by shuttle run test and MF by curl up and push up tests. Adherence to SEADiet was assessed with a semi-quantitative food frequency questionnaire (FFQ). The AIP was estimated as log (TG/HDL-C). Measures of pubertal stage and socioeconomic status were assessed. Linear regression showed a significant inverse association between MF (standardized β = -0.165; p < 0.001), CRF (standardized β = -0.081; p < 0.030) and SEADiet (standardized β = -0.081; p < 0.045) with AIP, after adjustments for age, sex, pubertal stage and parental education. Furthermore, participants classified with an optimal as well as those with low adherence to a SEADiet but with LowMF/LowCRF had on average the highest AIP (F(7.482) = 3.270; p = 0.002). Moreover, optimal SEADiet with HighMF/HighCRF group showed the lowest AIP when compared with those with low adherence to a SEADiet with HighMF/HighCRF group (p = 0.03). AIP is inversely associated with MF, CRF and SEADiet. The low MF combined with a low CRF levels seems to overcome the potential healthy effect of having an optimal adherence to the SEADiet on AIP. However, an optimal adherence to SEADiet seems to improve the AIP in those adolescents with high fitness levels.

Resumo: O estudo teve como objetivos: (i) avaliar as associações entre a aptidão cardiorrespiratória (ACR), aptidão muscular (AM) e Dieta Atlântica do Sul da Europa (SEADiet) e o índice aterogênico do plasma (IAP) e (ii) investigar a associação combinada entre AM, ACR e SEADiet e IAP em adolescentes. Foi realizado um estudo transversal de base escolar em uma amostra de 493 adolescentes (285 do sexo feminino), entre 15 e 18 anos de idade, nos Arquipélago dos Açores, Portugal. A ACR foi medida pelo teste aeróbico de corrida de vai-e-vem e a AM pelos testes de abdominal modificado e de flexão. A adesão ao SEADiet foi avaliada através de um questionário semi-quantitativo de frequência alimentar. O IAP foi calculado como log(TG/HDL-C). Foram avaliadas as medidas de estágio de puberdade e de nível socioeconômico. A regressão linear revelou uma associação inversa significativa entre AM (β padronizado = -0,165; p < 0,001), ACR (β padronizado = -0,081; p < 0,030) e SEADiet (β padronizado = -0,081; p < 0,045) e IAP, depois de ajustar para idade, sexo, estágio de puberdade e escolaridade dos pais. Além disso, os participantes classificados como adesão excelente ou baixa ao padrão alimentar SEADiet mas com BaixaAM/BaixaACR, tiveram, em média, os maiores níveis de IAP (F(7,482) = 3,270; p = 0,002). O grupo com adesão excelente ao SEADiet e AltaAM/AltaACR mostrou IAP mais baixo, comparado com o grupo com baixa adesão ao padrão alimentar SEADiet e AltaAM/AltaACR (p = 0,03). O IAP está associado inversamente com AM, ACR e SEADiet. Os níveis baixos de AM e ACR parecem contrabalançar o efeito saudável potencial da adesão excelente ao padrão alimentar SEADiet sobre o IAP. Entretanto, a adesão excelente ao SEADiet parece melhorar o IAP nos adolescentes com níveis altos de aptidão física.

Resumen: Nuestro objetivo (i) fue evaluar las asociaciones de las condiciones cardiorrespiratorias (CRF), musculares (MF) y de la Dieta Atlántica del Sur de Europa (SEADiet), con el índice aterogénico de plasma (AIP), así como (ii) investigar la asociación combinada de MF, CRF y SEADiet en el AIP en adolescentes. Se trata de un estudio transversal, basado escolares, que se dirigió a 493 adolescentes (285 niñas), con edades comprendidas entre los 15 a 18 años, procedentes del archipiélago portugués de las Azores. Las CRF se midieron mediante una prueba de sprint y las MF mediante pruebas con flexiones y abdominales. La adherencia a la SEADiet se evaluó con un cuestionario semicuantitativo sobre la frecuencia de las comidas. El AIP se calculó como log (TG/HDL-C). Se evaluaron las medidas de la fase puberal y el estatus socioeconómico. La regresión lineal mostró una asociación significativa inversa entre MF (β estandarizado = -0,165; p < 0,001), CRF (β estandarizado = -0,081; p < 0,030) y SEADiet (β estandarizado = -0,081; p < 0,045) con el AIP, tras los ajustes por edad, sexo, fase puberal y educación parental. Asimismo, los participantes clasificados con una adherencia muy buena, así como los que tuvieron una baja adherencia a la SEADiet, pero con BajasMF/BajasCRF contaron con el promedio más alto en el AIP (F(7.482) = 3.270; p = 0,002). Además, el grupo con una muy buena SEADiet con AltasMF/AltasCRF mostró el más bajo AIP, cuando se compara con el grupo que tenía una baja adherencia a la SEADiet con AltasMF/AltasCRF (p = 0.03). El AIP está inversamente asociado con MF, CRF y SEADiet. La baja MF, combinada con los niveles bajos de CRF, parece superar el efecto potencial saludable de contar con una muy buena adherencia a la SEADiet en el AIP. No obstante, una muy buena adherencia a la SEADiet parece mejorar el AIP en aquellos adolescentes con altos niveles de condición física.