When to prevent cardiovascular disease? As early as possible: lessons from prospective cohorts beginning in childhood. Curr Opin Cardiol. 2013;28:561-568. [PMID: 23928921 DOI: 10.1097/hco.0b013e32836428f4]

Monitoring of child-specific activities in ambulatory children with and without developmental disabilities

BACKGROUND

Pediatric healthcare professionals facilitate children to enhance and maintain a physically active lifestyle. Activity monitors (AM) can help pediatric healthcare professionals assess physical activity in everyday life. However, validation research of activity monitors has often been conducted in laboratories and insight into physical activity of children in their own everyday environment is lacking. Our goal was to study the criterion validity of a prototype AM (AM-p) model in a natural setting.

METHODS

Cross-sectional community-based study with ambulatory children (2-19 years) with and without developmental disability. Children wore the AM-p on the ankle and were filmed (gold standard) while performing an activity protocol in a natural setting. We labelled all videos per 5-second epoch with individual activity labels. Raw AM-p data were synchronized with activity labels. Using machine learning techniques, activity labels were subdivided in three pre-defined categories. Accuracy, recall, precision, and F1 score were calculated per category.

RESULTS

We analyzed data of 93 children, of which 28 had a developmental disability. Mean age was 11 years (SD 4.5) with 55% girls. The AM-p model differentiated between 'stationary', 'cycling' and 'locomotion' activities with an accuracy of 82%, recall of 78%, precision of 75%, and F1 score of 75%, respectively. Children older than 13 years with typical development can be assessed more accurately than younger children (2-12 years) with and without developmental disabilities.

CONCLUSION

The single ankle-worn AM-p model can differentiate between three activity categories in children with and without developmental disabilities with good accuracy (82%). Because the AM-p can be used for a heterogenous group of ambulatory children with and without developmental disabilities, it may support the clinical assessment for pediatric healthcare professionals in the future.

The association of physical activity and carotid intima-media-thickness in adolescents-data of the prospective early vascular ageing-tyrol cohort study

Background

Physical activity (PA) protects against cardiovascular disease. However, previous research has shown that high PA is associated with an increased carotid intima-media-thickness (cIMT), an independent predictor for future cardiovascular disease. Our aim was to further investigate this unexpected association with two different measurement methods of PA and two established markers for Early Vascular Ageing: cIMT and carotid-femoral pulse-wave velocity (cfPWV).

Methods

The community-based Early Vascular Ageing-Tyrol cohort study included adolescents in western Austria and northern Italy. Medical examinations included anthropometric measurements, fasting blood analysis, a physician guided interview to assess lifestyle factors, measurement of cIMT and cfPWV. PA was rated by an in-person interview on the basis of average minutes of moderate- or vigorous sports per day and by the Baecke questionnaire expressed as Baecke score (BS).

Results

Complete data set was available for 1,001 adolescents with a mean age of 17.8 years (standard deviation ±0.9 years). 558 (55.7%) of participants were female. cIMT was positively associated with both measures of PA in univariate (minutes sports per day: p < 0.001; BS: p < 0.001) as well as multivariable analysis adjusting for established cardiovascular risk factors (minutes sports per day: p = 0.001; BS: p = 0.002). Using cfPWV in a multivariate model an inverse correlation with the BS (p = 0.023) was observed, but not for minutes sports per day (p = 0.554).

Conclusion

In our large community-based cohort of adolescents, PA was associated with an increased cIMT but shows a trend towards lower aortic stiffness measured by cfPWV. We hypothesize that the association of PA with increased cIMT is not caused by early atherosclerotic vessel wall changes but is rather a physiologic adaptive process of the vessel wall.

Trial Registration Number

The EVA-Tyrol Study has been registered at clinicaltrials.gov under NCT03929692 since April 29, 2019.

BMI trajectories from birth to young adulthood associate with distinct cardiometabolic profiles

BACKGROUND

Numerous studies have investigated links between body mass index (BMI) trajectories and cardiovascular risk, yet discrepancies in BMI measurement duration and timing of the cardiovascular-related outcome evaluation have led to inconsistent findings.

METHODS

We included participants from the Swedish birth cohort (BAMSE) and applied latent class mixture modeling to identify BMI trajectories using data of multiple BMI measures (≥ 4 times) from birth until 24-year follow-up (n = 3204). Subsequently, we analyzed the associations of BMI trajectories with lipids (n = 1974), blood pressure (n = 2022), HbA1c (n = 941), and blood leukocytes (n = 1973) using linear regression. We also investigated the circulating levels of 92 inflammation-related proteins (n = 1866) across BMI trajectories.

RESULTS

Six distinct BMI groups were identified, denoted as increasing-persistent high (n = 74; 2.3%), high-accelerated increasing (n = 209; 6.5%), increasing-accelerated resolving (n = 142; 4.4%), normal-above normal (n = 721; 22.5%), stable normal (n = 1608; 50.2%), and decreasing-persistent low (n = 450; 14.1%) BMI groups. The increasing-persistent high and high-accelerated increasing BMI groups had higher levels of total cholesterol [mean difference (95% confidence intervals): 0.30 (0.04-0.56) and 0.16 (0.02-0.31) mmol/L], triglyceride, low-density lipoprotein, hemoglobin A1C [3.61 (2.17-5.54) and 1.18 (0.40-1.98) mmol/mol], and low-density lipoprotein/high-density lipoprotein ratios, but a lower level of high-density lipoprotein than the stable normal BMI group. These two groups also had higher leukocyte cell counts and higher circulating levels of 28 inflammation-related proteins. No increased cardiometabolic markers were observed in the increasing-accelerated resolving BMI group.

CONCLUSIONS

Participants with persistently high or accelerated increasing BMI trajectories from birth to young adulthood have elevated levels of cardiometabolic risk markers at young adulthood than those with stable normal BMI. However, a raised BMI in childhood may not be inherently harmful to cardiometabolic health, provided it does not persist into adulthood.

Optimal domain-specific physical activity and sedentary behaviors for blood lipids among Japanese children: a compositional data analysis

BACKGROUND

Optimizing childhood domain-specific physical activity (PA) and sedentary behavior (SB) for blood lipid profile is not well understood. We aimed to (1) determine the associations between accelerometer-measured PA and SB for each domain (school time and out-of-school time) with blood lipid profile and (2) estimate predicted changes in blood lipid profile with hypothetical time-reallocation between domain-specific SB and PA among Japanese children using compositional data analysis (CoDA).

METHODS

This cross-sectional study included 284 children (147 boys and 137 girls) aged 9-12 years (mean age [years]: 10.1 ± 1.2 for boys, 10.0 ± 1.1 for girls; mean body mass index: 18.2 ± 3.2 for boys, 17.5 ± 2.5 for girls). Time spent in domain-specific SB, light-intensity PA (LPA), moderate-intensity PA (MPA), and vigorous-intensity PA (VPA) was assessed using accelerometry. The non-fasting lipid profile considered measures of triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and non-HDL-C levels. CoDA and isotemporal substitution model were performed to examine the associations of domain-specific PA and SB with blood lipids.

RESULTS

Time spent in out-of-school VPA relative to the other behaviors was negatively associated with non-HDL-C (boys: βilr1 = - 0.10, 95% confidence interval [CI] =  - 0.19 to - 0.01), TG (boys: βilr1 = - 0.45, 95% CI = - 0.68 to - 0.22), and positively associated with HDL-C (girls: βilr1 = 0.09, 95% CI = 0.02 to 0.16) after adjusting for age, body mass index, and time spent in SB, LPA, and MPA. During the out-of-school period, a replacement of 1 min of any other behavior with VPA was associated with decreases in LDL-C in boys (predicted changes [95% CI] - 0.03 mmol/L [- 0.05 to - 0.00] for LPA), non-HDL-C in boys (predicted changes [95% CI] - 0.03 mmol/L [- 0.06 to - 0.01] for SB and LPA) and TG in boys (predicted changes [95% CI] - 0.04 mmol/L [- 0.06 to - 0.02] for SB and LPA, - 0.05 mmol/L [- 0.07 to - 0.02] for MPA) and in girls (predicted changes [95% CI] - 0.02 mmol/L [- 0.04 to - 0.00] for LPA), and increases in HDL-C in girls (predicted changes [95% CI] 0.02 mmol/L [0.00 to 0.04] for SB and LPA, 0.03 mmol/L [0.00 to 0.05] for MPA).

CONCLUSIONS

Increasing out-of-school VPA might be an effective approach to improve blood lipid profiles among Japanese children.

Study protocol: Identification and validation of integrative biomarkers of physical activity level and health in children and adolescents (INTEGRActiv)

Background

Physical activity (PA) provides health benefits across the lifespan and improves many established cardiovascular risk factors that have a significant impact on overall mortality. However, discrepancies between self-reported and device-based measures of PA make it difficult to obtain consistent results regarding PA and its health effects. Moreover, PA may produce different health effects depending on the type, intensity, duration, and frequency of activities and individual factors such as age, sex, body weight, early life conditions/exposures, etc. Appropriate biomarkers relating the degree of PA level with its effects on health, especially in children and adolescents, are required and missing. The main objective of the INTEGRActiv study is to identify novel useful integrative biomarkers of PA and its effects on the body health in children and adolescents, who represent an important target population to address personalized interventions to improve future metabolic health.

Methods/design

The study is structured in two phases. First, biomarkers of PA and health will be identified at baseline in a core cohort of 180 volunteers, distributed into two age groups: prepubertal (n = 90), and postpubertal adolescents (n = 90). Each group will include three subgroups (n = 30) with subjects of normal weight, overweight, and obesity, respectively. Identification of new biomarkers will be achieved by combining physical measures (PA and cardiorespiratory and muscular fitness, anthropometry) and molecular measures (cardiovascular risk factors, endocrine markers, cytokines and circulating miRNA in plasma, gene expression profile in blood cells, and metabolomics profiling in plasma). In the second phase, an educational intervention and its follow-up will be carried out in a subgroup of these subjects (60 volunteers), as a first validation step of the identified biomarkers.

Discussion

The INTEGRActiv study is expected to provide the definition of PA and health-related biomarkers (PA-health biomarkers) in childhood and adolescence. It will allow us to relate biomarkers to factors such as age, sex, body weight, sleep behavior, dietary factors, and pubertal status and to identify how these factors quantitatively affect the biomarkers' responses. Taken together, the INTEGRActiv study approach is expected to help monitor the efficacy of interventions aimed to improve the quality of life of children/adolescents through physical activity.

Clinical Trial Registration

ClinicalTrials.gov, Identifier NCT05907785.

Air Pollution, Built Environment, and Early Cardiovascular Disease

As the world's population becomes increasingly urbanized, there is growing concern about the impact of urban environments on cardiovascular health. Urban residents are exposed to a variety of adverse environmental exposures throughout their lives, including air pollution, built environment, and lack of green space, which may contribute to the development of early cardiovascular disease and related risk factors. While epidemiological studies have examined the role of a few environmental factors with early cardiovascular disease, the relationship with the broader environment remains poorly defined. In this article, we provide a brief overview of studies that have examined the impact of the environment including the built physical environment, discuss current challenges in the field, and suggest potential directions for future research. Additionally, we highlight the clinical implications of these findings and propose multilevel interventions to promote cardiovascular health among children and young adults.

Association between prenatal metals exposure and blood pressure in 5-6 years children: A birth cohort study

BACKGROUND

The trajectory of blood pressure (BP) from childhood to early middle age suggested that individuals with elevated BP in early childhood were more likely to be affected by cardiovascular disease in adulthood. Exposure to metals may affect BP in children, and pregnancy is a sensitive time for metal exposure. This study assessed the relationship between different stages of prenatal exposure to metals or metal mixtures and BP in children aged 5-6 years.

METHODS

The study included 2535, 2680, 2534 mother-child pairs in three trimesters, from the Ma'anshan birth cohort study (MABC). We collected maternal blood samples during pregnancy and measured the serum levels of four metals (arsenic, selenium, cadmium, and mercury). BP was measured in children aged 5-6 years. A linear regression model and Bayesian kernel machine regression (BKMR) were used to explore associations between prenatal exposure to metals at different stages and multiple metal exposure with BP in children aged 5-6 years.

RESULTS

Associations were observed between the arsenic in the third trimester and children's diastolic blood pressure (DBP) (β = 0.88, 95% CI: 0.44, 1.33), systolic blood pressure (SBP) (β = 0.72, 95% CI: 0.19, 1.24) and mean arterial pressure (MAP) (β = 0.83, 95% CI: 0.42, 1.23), as well as between the mercury and children's DBP (β = 0.65, 95% CI: 0.13, 1.16) and MAP (β = 0.60, 95% CI: 0.14, 1.07). The BKMR analysis showed that multiple metals had a significant positive joint effect on children's DBP, SBP and MAP. A potential interaction between arsenic and mercury was observed (β = -0.85, 95% CI: -1.62, -0.08).

CONCLUSIONS

Exposure to arsenic and mercury during pregnancy was associated with altered BP in children. The third trimester may represent an important window of opportunity to reduce the effects of metal exposure on children's blood pressure and long-term health.

Effects of prolonged sitting and physical activity breaks on measures of arterial stiffness and cortisol in adolescents

AIM

In adults, prolonged periods of sitting have been linked to acute negative effects on vascular structure and function. The aim of this study was to evaluate the acute effects of physical activity (PA) breaks during prolonged sitting on arterial stiffness, cortisol and psychological factors in adolescents.

METHODS

Adolescents underwent different short (3-min) breaks starting every 20 min, during 80 min of sitting on three separate days. Breaks were (A) social seated breaks (SOC), (B) low-intensity simple resistance activity PA breaks (SRA) and (C) moderate-intensity step-up PA breaks (STEP). The arterial stiffness measures were augmentation index (AIx), AIx@75 and pulse wave velocity (PWV). Cortisol was measured from saliva. Psychological factors were self-reported.

RESULTS

Eleven girls and six boys (average age 13.6 ± 0.7 years) participated, with average baseline heart rates of 72 ± 11 bpm, systolic/diastolic blood pressure 111 ± 7/64 ± 6 mmHg and cortisol 10.9 ± 5.8 nmoL/L. PWV, cortisol and psychological factors did not change after any of the conditions. AIx@75 increased significantly (4.9 ± 8.7-9.2 ± 13.2) after the STEP intervention compared with SOC and SRA (time × condition p < 0.05).

CONCLUSION

Arterial stiffness increased after prolonged sitting with frequent, short step-up activity breaks. The results indicate potential important intensity-dependent effects of physical activity on vascular regulation in youth.

Association of Ambient Air Pollution with Blood Pressure in Adolescence: A Systematic-review and Meta-analysis

We systematically reviewed the association of ambient air pollution with blood pressure (BP) as a primary outcome in adolescents (10-19 years). Five databases (Ovid Medline, Ovid Embase, Web of Science, The Cochrane Library, and LILACS) were searched for relevant articles published up to August 2022. Meta-analyses were conducted using STATA v17 (Protocol - OSF Registries https://doi.org/10.17605/OSF.IO/96G5Q). Eight studies (5 cohort, 3 cross-sectional) with approximately 15,000 adolescents were included. Data from 6 studies were suitable for inclusion in the meta-analyses. In sub-group analyses, non-significant positive associations were observed for cohort studies assessing long-term exposure to PM10, PM2.5, and NO2 on systolic and diastolic BP. At age 12 years old (3702 adolescents), we found significant positive associations for long-term exposure to PM2.5(β=5.33 (1.56, 9.09) mmHg) and PM10 (β=2.47 (0.10, 4.85) mmHg) on diastolic BP. Significant positive associations were observed (3,592 adolescents) for long-term exposure to PM10(β=0.34 (0.19, 0.50) mmHg) and NO2 on diastolic BP (β=0.40 (0.09, 0.71) mmHg), and PM10 on systolic BP (β=0.48 (0.19, 0.77) mmHg). The overall quality of evidence analysed was graded as "low/very low." Insufficient data for short-term exposures to PM2.5, PM10, NO2, CO on BP led to their exclusion from the meta-analysis. Inconsistent associations were reported for gender-stratified results. The evidence, though of low-quality and limited, indicated that ambient air pollution was positively associated with adolescent BP. Future studies need improved measures of air pollutant exposures, consideration of gender and socio-economic circumstances on the observed pollution effects, as well as adjustment for other potential confounding factors.

Exposure to barium and blood pressure in children and adolescents: results from the 2003-2018 National Health and Nutrition Examination Survey

Barium (Ba) is ubiquitous in the environment, and humans are primarily exposed to it through ingestion of drinking water. Previous studies focused on the exposure to lead, cadmium, and arsenic, but have not focused on exposure to Ba. Recent studies found a significant association between Ba exposure and elevated blood pressure in pregnant women and adults. However, there are no studies regarding the effect of Ba exposure on blood pressure in children and adolescents, and the potential biological mechanisms remain unclear. We evaluated the associations between urinary Ba and systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) among 8- to 17-year-old participants (n = 3707) of the 2003-2018 National Health and Nutrition Examination Survey. Furthermore, the potential roles of inflammation in these associations were explored. Weighted linear regression was used to analyze the association between urinary Ba and blood pressure, and mediation analyses were used to estimate the potential role of white blood cell count (WBC) in these associations. Quantile g-computation models were used to explore the effect of co-exposure to Ba and other metals on blood pressure. After adjusting for covariates, a two-fold increase in urinary Ba concentration was associated with a 0.41 (95% CI 0.12, 0.70) mmHg increase in SBP, a 1.04 (95% CI 0.55, 1.53) mmHg increase in PP, but a -0.63 (95% CI -1.04, -0.22) mmHg decrease in DBP. WBC significantly mediated 6% of the association between urinary Ba and SBP. Quantile g-computation models suggested that urinary Ba was the main contributor to the elevation of SBP and PP in the urinary metal mixture. Our findings revealed that exposure to Ba was associated with elevated SBP and PP among children and adolescents. Inflammation may play an important role in the associations of Ba exposure with SBP.

Exercise training in paediatric congenital heart disease: fit for purpose?

Exercise and physical activity (PA) have been shown to be effective, safe and feasible in both healthy children and children with congenital heart disease (CHD). However, implementing exercise training as an intervention is still not routine in children with CHD despite considerable evidence of health benefits and well-being. Understanding how children with CHD can safely participate in exercise can boost participation in PA and subsequently reduce inactivity-related diseases. Home-based exercise intervention, with the use of personal wearable activity trackers, and high-intensity interval training have been beneficial in adults' cardiac rehabilitation programmes. However, these remain underutilised in paediatric care. Therefore, the aims of this narrative review were to synthesise prescribed exercise interventions in children with CHD, identify possible limitation to exercise training prescription and provide an overview on how to best integrate exercise intervention effectively for this population into daily practice.

Cardiorespiratory Fitness and Health-Related Quality of Life in Secondary School Children Aged 14 to 18 Years: A Cross-Sectional Study

The main aim of this study is to examine age and gender differences in cardiorespiratory fitness (CRF) among Serbian secondary school children. The secondary aim is to explore the association between CRF and quality of life in Serbian adolescents. The sample consisted of 579 adolescents (285 males), aged from 14 to 18 years old. To evaluate their anthropometric measurements, body height and body weight were examined, the 20 m shuttle run test was used to access CRF, and the standardized global measure of wellbeing KIDSCREEN was used to access the wellbeing of adolescents. The results show that the boys possessed higher CRF compared to the girls, as well as higher scores on variable distance, but there were no significant differences according to age. CRF was positively associated with physical wellbeing, psychological wellbeing, total score HRQL, body height and body weight, and negatively correlated with BMI. Conversely, physical wellbeing showed positive correlation with the other subscales of KIDSCREEN (psychological wellbeing, autonomy and parents, peers and social support, and school environment), and total score of (Health–Related Quality of Life) HRQL. The results showed that better CRF would be beneficial for quality of life among Serbian adolescents, especially among girls. Moreover, the relationship between CRF and BMI shows that adolescents with regular values of BMI have better physical fitness and wellbeing.

Prospective physical fitness status and development of cardiometabolic risk in children according to body fat and lifestyle behaviours: The IDEFICS study

BACKGROUND

Elevated cardiometabolic risk (CMR) is an important factor for cardiovascular diseases later in life while physical fitness seems to decrease CMR.

OBJECTIVE

Thus, the aim of the present study is to assess the association between muscular fitness (MF) and cardiorespiratory fitness (CRF) on CMR in European children, both cross-sectional and longitudinally.

METHODS

A total of 289 children (49.5% males) from eight European countries, aged 6 to 9, with longitudinal information on blood pressure, triglycerides, total cholesterol, HDL-cholesterol, homoeostasis model assessment, body mass index, data on fitness level, objectively measured physical activity (PA), diet quality, and total screen time were included. A CMR score was calculated and dichotomized. MF and CRF were also dichotomized. Cross-sectional and longitudinal multilevel logistic regressions adjusting for lifestyle behaviours were performed.

RESULTS

Reaching a high level of MF during childhood as well as remaining in that level over-time were associated with an 82% and 62% lower probability of high CMR at follow-up, respectively. Also, children who became top CRF over time, showed a 77% lower probability (P < 0.05) of being in the highest CMR quartile at follow-up, independently of sociodemographic and lifestyle indicators.

CONCLUSIONS

A high MF at early childhood and during childhood reduces the odds of having CMR. Same occurs with the improvement of CRF during childhood. These findings highlight the importance of enhancing fitness to avoid CMR already in children.

Your Physical Activity Is in Your Hand-Objective Activity Tracking Among University Students in Hungary, One of the Most Obese Countries in Europe

Inadequate physical activity is currently one of the leading risk factors for mortality worldwide. University students are a high-risk group in terms of rates of obesity and lack of physical activity. In recent years, activity trackers have become increasingly popular for measuring physical activity. The aim of the present study is to examine whether university students in Hungary meet the health recommendations (10,000 steps/day) for physical activity and investigate the impact of different variables (semester-exam period, days-weekdays, days, months, sex) on the level of physical activity in free-living conditions for 3 months period. In free-living conditions, 57 healthy university students (male: 25 female: 32 mean age: 19.50 SD = 1.58) wore MiBand 1S activity tracker for 3 months. Independent sample t-tests were used to explore differences between sexes. A One-way analysis of variance (ANOVA) was used to explore differences in measures among different grouping variables and step count. A Two-way ANOVA was conducted to test for differences in the number of steps by days of the week, months, seasons and for sex differences. Tukey HSD post-hoc tests were used to examine significant differences. Students in the study achieved 10,000 steps per day on 17% of days (minimum: 0%; maximum: 76.5%; median: 11.1%). Unfortunately, 70% of the participants did not comply the 10,000 steps at least 80% of the days studied. No statistical difference were found between sexes. However, significant differences were found between BMI categories (underweight <18.50 kg/m2; normal range 18.50-24.99 kg/m2; overweight: 25.00-29.99 kg/m2 obese > 30 kg/m2, the number of steps in the overweight category was significantly lower (F = 72.073, p < 0.001). The average daily steps were significantly higher in autumn (t = 11.457, p < 0.001) than in winter. During exam period average steps/day were significantly lower than during fall semester (t = 13.696, p < 0.001). On weekdays, steps were significantly higher than on weekends (F = 14.017, p < 0.001), and even within this, the greatest physical activity can be done by the middle of the week. Our data suggest that university students may be priority groups for future physical activity interventions. Commercial activity trackers provide huge amount of data for relatively low cost therefore it has the potential to objectively analyze physical activity and plan interventions.

Associations between ambient air pollutants and blood pressure among children and adolescents: A systemic review and meta-analysis

OBJECTIVE

Numerous epidemiological studies have investigated the effects of short-term and long-term exposure to ambient air pollution on hypertension and blood pressure among children and adolescents. However, the results were controversial. To provide researchers reliable evidence, this meta-analysis was performed.

METHODS

We searched all published studies in four databases examining the effects of particulate matter (PM₁₀, PM_2.5 and PM_1.0), nitrogen oxide (NO₂), sulfur dioxide (SO₂), ozone (O₃) and carbon monoxide (CO) on hypertension and blood pressure in children and adolescents. Overall risk estimates associated with per 10 μg/m³ increase of air pollution were analyzed by a random-effect model for articles with significant heterogeneity, otherwise, a fixed-effect model was applied. Subgroup analysis was conducted for studies with significant heterogeneity.

RESULTS

Of 3918 identified literatures, 154 were evaluated in-depth with 15 satisfying inclusion criteria. Increased risk of hypertension was associated with long-term PM₁₀ exposure (OR = 1.17, 95% confidence interval [CI]:1.13, 1.21). For systolic blood pressure (SBP), significant results were found for short-term PM₁₀ (β = 0.26, 95% CI: -0.00, 0.53) exposure, long-term PM_2.5 (β = 1.80, 95% CI: 0.94, 2.65) and PM₁₀ (β = 0.50, 95% CI: 0.19, 0.81) exposure. The corresponding estimates of diastolic blood pressure (DBP) were 0.32 mmHg (95% CI: 0.19, 0.45) for short-term PM₁₀ exposure, 1.06 mmHg (95% CI: 0.32, 1.80), 0.34 mmHg (95% CI: 0.11, 0.57) and 0.44 mmHg (95% CI: 0.25, 0.63) for long-term PM_2.5, PM₁₀ and NO₂ exposure, respectively. Stratified analyses showed stronger effects of PM₁₀ on blood pressure among studies with ≥50% boys' percentage (0.57 mmHg [95% CI: 0.44, 0.70] for SBP, 0.44 mmHg, [95% CI: 0.34, 0.54] for DBP, respectively) and articles using models to estimate exposure (0.90 mmHg [95% CI: 0.20 1.59] for SBP).

CONCLUSION

Ambient air pollution was associated with higher hypertension prevalence and elevated blood pressure in children and adolescents.

Psychometric properties of instruments to measure parenting practices and children's movement behaviors in low-income families from Brazil

Background

Childhood obesity has increased remarkably in low and middle-income (LMIC) countries. Movement behaviors (physical activity, screen time, and sleep) are crucial in the development of overweight and obesity in young children. Yet, few studies have investigated the relationship between children’s movement behaviors and parenting practices because validated measures for use among families from LMIC are lacking. This study evaluated the psychometric properties of previously validated measures of young children’s physical activity, screen time, and sleep and parenting practices, translated and culturally adapted to Brazilian families.

Methods

A total of 78 parent-child dyads completed an interviewer-administered survey twice within 7 days. Child physical activity, sedentary time and sleep were concurrently measured using a wrist-worn accelerometer. Internal consistency and test-retest reliability was assessed using McDonald’s Omega and Intraclass Correlation Coefficients (ICC’s). Concurrent validity was evaluated by calculating Spearman correlations between parent reported child behaviors and accelerometer measured behaviors.

Results

Seventeen of the 19 parenting practices scales exhibited acceptable internal consistency reliability (Ω ≥ 0.70). Test-retest reliability ICC’s were acceptable and ranged from 0.82 - 0.99. Parent reported child physical activity was positively correlated with objectively measured total movement (rho= 0.29 - 0.46, p < .05) and energetic play (rho= 0.29 – 0.40, p < .05). Parent reported child screen time was positively correlated with objectively measured sedentary time; (rho = 0.26, p < .05), and inversely correlated with total movement (rho = - 0.39 – - 0.41, p < .05) and energetic play (rho = - 0.37 – - 0.41, p < .05). Parent reported night-time sleep duration was significantly correlated with accelerometer measured sleep duration on weekdays (rho = 0.29, p < .05), but not weekends.

Conclusions

Measurement tools to assess children’s movement behaviors and parenting practices, translated and culturally adapted for use in Brazilian families, exhibited acceptable evidence of concurrent validity, internal consistency, and test-retest reliability.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-021-01320-y.

Childhood traffic-related air pollution and adverse changes in subclinical atherosclerosis measures from childhood to adulthood

BACKGROUND

Chronic exposure to air pollutants is associated with increased risk of cardiovascular disease (CVD) among adults. However, little is known about how air pollution may affect the development of subclinical atherosclerosis in younger populations. Carotid artery intima-media thickness (CIMT) is a measure of subclinical atherosclerosis that provides insight into early CVD pathogenesis.

METHODS

In a pilot study of 70 participants from the Southern California Children's Health Study, we investigated CIMT progression from childhood to adulthood. Using carotid artery ultrasound images obtained at age 10 and follow-up images at age 21-22, we examined associations between childhood ambient and traffic-related air pollutants with changes in CIMT over time and attained adult CIMT using linear mixed-effects models adjusted for potential confounders. Average residential childhood exposures (i.e., birth to time of measurement at 10-11 years) were assigned for regional, ambient pollutants (ozone, nitrogen dioxide, particulate matter, interpolated from regulatory air monitoring data) and traffic-related nitrogen oxides (NO_x) by road class (modeled using the CALINE4 line source dispersion model). Traffic density was calculated within a 300-m residential buffer.

RESULTS

For each 1 standard deviation (SD) increase in childhood traffic-related total NO_x exposure, we observed greater yearly rate of change in CIMT from childhood to adulthood (β: 2.17 μm/yr, 95% CI: 0.78-3.56). Increases in annual rate of CIMT change from childhood to adulthood also were observed with freeway NO_x exposure (β: 2.24 μm/yr, 95% CI: 0.84-3.63) and traffic density (β: 2.11 μm/yr, 95% CI: 0.79-3.43). Traffic exposures were also related to increases in attained CIMT in early adulthood. No associations of CIMT change or attained level were observed with ambient pollutants.

CONCLUSIONS

Overall, we observed adverse changes in CIMT over time in relation to childhood traffic-related NO_x exposure and traffic density in our study population. While these results must be cautiously interpreted given the limited sample size, the observed associations of traffic measures with CIMT suggest a need for future studies to more fully explore this relationship.

Prenatal and postnatal mercury exposure and blood pressure in childhood

Elevated blood pressure in childhood is an important risk factor for hypertension in adulthood. Environmental exposures have been associated with elevated blood pressure over the life course and exposure to mercury (Hg) has been linked to cardiovascular effects in adults. As subclinical vascular changes begin early in life, Hg may play a role in altered blood pressure in children. However, the evidence linking early life Hg exposure to altered blood pressure in childhood has been largely inconsistent. In the ongoing New Hampshire Birth Cohort Study, we investigated prenatal and childhood Hg exposure at multiple time points and associations with blood pressure measurements in 395 young children (mean age 5.5 years, SD 0.4). Hg exposure was measured in children's toenail clippings at age 3 and in urine at age 5-6 years, as well as in maternal toenail samples collected at ∼28 weeks gestation and 6 weeks postpartum, the latter two samples reflecting early prenatal and mid-gestation exposures, respectively. Five measurements of systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were averaged for each child using a standardized technique. In covariate-adjusted linear regression analyses, we observed that a 0.1 μg/g increase in child toenail Hg at age 3 or a 0.1 μg/L urine Hg at age 5-6 were individually associated with greater DBP (toenail β: 0.53 mmHg; 95% CI: -0.02, 1.07; urine β: 0.48 mmHg; 95% CI: 0.10, 0.86) and MAP (toenail β: 0.67 mmHg; 95% CI: 0.002, 1.33; urine β: 0.55 mmHg; 95% CI: 0.10, 1.01). Neither early prenatal nor mid-gestation Hg exposure, as measured by maternal toenails, were related to any changes to child BP. Simultaneous inclusion of both child urine Hg and child toenail Hg in models suggested a potentially stronger relationship of urine Hg at age 5-6 with DBP and MAP, as compared to toenail Hg at age 3. Our findings suggest that Hg exposure during childhood is associated with alterations in BP. Childhood may be an important window of opportunity to reduce the impacts of Hg exposure on children's blood pressure, and in turn, long-term health.

Cross-Cultural Adaptation of Instruments Measuring Children's Movement Behaviors and Parenting Practices in Brazilian Families

Childhood obesity is a global problem, disproportionately affecting children in low-to-middle income countries (LMIC). Despite this evidence, no previous study has adapted instruments measuring children’s movement behaviors and associated parenting practices for use in LMIC families. This study reports the results of a cross-cultural adaptation of previously validated measures of children’s movement behaviors and parenting practices in economically disadvantaged Brazilian families. Study 1 involved translation of the instruments from English to Portuguese. A team of translators (fluent in both English and Portuguese) and researchers followed established procedures for translating measurement scales, identifying problematic items, and reaching consensus on discrepancies. Study 2 involved cognitive interviews with 24 parents from urban and rural North-eastern Brazil addressing the format, content, and clarity of the items. Half the parents provided feedback on the first 33 items of the questionnaire, with the remaining parents providing feedback on the final 29 items. Notes were recorded during the interview and parents’ feedback summarized in a report. In the translation and back-translation, 15 discrepancies were identified. These were mostly due to multiple Portuguese words having the same meaning in English. The research team discussed these discrepancies and consensus was reached to ensure that the concepts depicted in the Portuguese version were consistent with the English version. In the cognitive interviews, parents identified minor problems with item comprehension resulting in minor adaptations to response options, recall period, and format of the questionnaire. The process of translation and cognitive interviews conducted in Brazilian families resulted in an appropriate cultural adaptation of scales measuring children’s movement behaviors and parenting practices. Future studies should evaluate the validity and reliability of the measures in LMIC families.

Childhood Obesity as a Predictor of Coronary Artery Disease in Adults: A Literature Review

Obesity in children is becoming a worldwide epidemic that requires immediate attention. Despite all the efforts directed towards controlling this issue, its prevalence is increasing overtime both in developed and developing countries. With an increasing prevalence in the younger age groups, it is emerging as a public health crisis. A rise in body mass index (BMI) results in an increased risk of developing a variety of metabolic and cardiovascular diseases, particularly coronary artery disease (CAD). The early onset of the disease affects the peak productivity years in young individuals leading to disability at a later age. It makes it essential that we understand the contributory factors towards the development of obesity as a risk factor for CAD and develop strategies that hinder the progression towards adverse outcomes. There is an urgent need to screen these children at a younger age and educate them to change their lifestyle to decrease the BMI within the normal range to promote cardiovascular health. It requires a multidisciplinary approach involving dietary, physical, and behavioral-centered strategies. Failure to control this epidemic timely may cause widespread consequences for the quality of life and longevity. 

Associations between physical activity, body composition, and physical fitness in the transition from preschool to school

The purpose of the study was to assess the longitudinal associations of physical activity (PA) with body composition and physical fitness (PF) at the 12-month follow-up during the transition from kindergarten to school in Estonian children aged 6 to 8 years (n = 147). PA and sedentary behavior (SB) were assessed using the accelerometer. Body composition was measured from triceps and subscapular skinfold thicknesses and PF using PREFIT test battery. SB at the mean age of 6.6 year had negative relation with upper and lower body strength and motor fitness at the mean age of 7.6 year in adjusted models. Light PA (LPA) and moderate PA(MPA) at 6.6 year were positively and SB was negatively associated with fat-free mass index (FFMI) at 7.6 year after adjustments for confounders [vigorous PA (VPA), total awake wear time, child's sex, age at measurement]. Substituting 5 min/d of SB at 6.6 year with 5 min of VPA was related to higher FFMI at 7.6 year. In adjusted models, VPA at 6.6 year was positively associated with cardiorespiratory fitness at 7.6 year, greater baseline VPA or moderate-to-vigorous PA (MVPA) predicted greater upper body strength a year later and LPA, MPA, VPA, MVPA at 6.6 year were positively related to lower body strength at follow-up. In adjusted analysis greater VPA at 6.6 year was related to better motor fitness at follow-up. Promoting higher-intensity PA and reducing SB at preschool may have long-term effects on body composition and PF in children at the first grade.

Obesity in Young Adulthood: The Role of Physical Activity Level, Musculoskeletal Pain, and Psychological Distress in Adolescence (The HUNT-Study)

The global obesity epidemic raises long-term health concerns which underline the importance of preventive efforts. We aimed to investigate individual and combined effects of common health problems in adolescence on the probability of obesity in young adulthood. This prospective population-based study included data from participants in the Nord-Trøndelag Health Study in Norway (Young-HUNT1 (1995–1997), age 13–19, baseline) who participated in HUNT3 as young adults 11 years later (age 23–31). Exposure variables at baseline included self-reported physical activity, musculoskeletal pain, and psychological distress. We examined associations between exposure variables and the main outcome of obesity in young adulthood (BMI ≥ 30 kg/m²) using univariate and multiple logistic regression, stratified by sex. Probabilities of obesity for given combinations of the exposure variables were visualized in risk matrixes. The study sample consisted of 1859 participants (43.6% boys). Higher probabilities of obesity in young adulthood were found across combinations of lower physical activity levels and presence of musculoskeletal pain in adolescence. Additional adverse effects of psychological distress were low. Proactive intervention strategies to promote physical activity and facilitate sports participation for all adolescents, whilst addressing musculoskeletal pain and its potential individual causes, could prove helpful to prevent development of obesity in young adulthood.

A cardiovascular disease risk factor in children with congenital heart disease: unmasking elevated waist circumference - a CHAMPS* study *CHAMPS: Children's Healthy-Heart Activity Monitoring Program in Saskatchewan

BACKGROUND

Children with congenital heart disease (CHD) have an elevated risk of future cardiovascular disease but the underlying mechanisms are unclear. Abdominal obesity (measured as waist circumference) is a risk factor for adult onset of cardiovascular diseases and is correlated with low physical activity levels, commonly found in children with congenital heart disease. Elevated waist circumference may be a mechanism by which cardiovascular disease risk is elevated in children with CHD. The purpose of this study was to compare waist circumference between children with and without CHD, while considering potential confounders. We hypothesized that children with CHD would have higher measures of waist circumference when controlling for differences in birthweight, lean mass, and physical activity.

METHODS

Thirty-two children with CHD (10.9 ± 2.6 years; 12 female) from the Children's Healthy-Heart Activity Monitoring Program in Saskatchewan, and 23 healthy controls (11.7 ± 2.5 years; 10 female) were studied. Waist circumference, physical activity (physical activity questionnaire), body composition (lean mass; dual x-ray absorptiometry), and birthweight were assessed. Analysis of covariance, Mann-Whitney U, and independent sample t-tests were used to assess group differences (p < 0.05).

RESULTS

Children with CHD had greater waist circumference than controls, controlling for lean mass, physical activity, birthweight, and sex (F (1, 49) = 4.488, p = 0.039). Physical activity, lean mass, and birthweight were not significantly different between groups (p > 0.05).

CONCLUSION

Our findings generate a novel hypothesis-higher waist circumferences in children with CHD compared to age-matched controls, may contribute to an elevated risk of cardiovascular disease.

Exercise-associated prevention of adult cardiovascular disease in children and adolescents: monocytes, molecular mechanisms, and a call for discovery

Atherosclerosis originates in childhood and adolescence. The goal of this review is to highlight how exercise and physical activity during childhood and adolescence, critical periods of growth and development, can prevent adult cardiovascular disease (CVD), particularly through molecular mechanisms of monocytes, a key cell of the innate immune system. Monocytes are heterogeneous and pluripotential cells that can, paradoxically, play a role in both the instigation and prevention of atherosclerosis. Recent discoveries in young adults reveal that brief exercise affects monocyte gene pathways promoting a cell phenotype that patrols the vascular system and repairs injuries. Concurrently, exercise inhibits pro-inflammatory monocytes, cells that contribute to vascular damage and plaque formation. Because CVD is typically asymptomatic in youth, minimally invasive techniques must be honed to study the subtle anatomic and physiologic evidence of vascular dysfunction. Exercise gas exchange and heart rate measures can be combined with ultrasound assessments of vascular anatomy and reactivity, and near-infrared spectroscopy to quantify impaired O2 transport that is often hidden at rest. Combined with functional, transcriptomic, and epigenetic monocyte expression and measures of monocyte-endothelium interaction, molecular mechanisms of early CVD can be formulated, and then translated into effective physical activity-based strategies in youth to prevent adult-onset CVD.

Impact of sedentary behavior on large artery structure and function in children and adolescents: a systematic review

Sedentary behavior contributes to increased atherosclerotic risk in adults. Whether or not this can be extended to pediatric populations is unclear. This systematic review assessed associations of sedentary behavior with large artery structure and function in pediatric populations. MEDLINE, EMBASE, CENTRAL, and Web of Science were searched from the earliest available date to 31st of December 2018. Analyses of associations of sedentary behavior with large artery structure or function in a pediatric (sub-)population were included, adhering to the PRISMA guidelines. The protocol was published in advance on PROSPERO (CRD42018112996). Study quality and quality of evidence were analyzed using NHLBI Study Quality assessment tools and GRADE. Six observational studies found no association of exposure and outcome variables, and one had contradicting results. One intervention found reduced flow-mediated dilation after 3 h of uninterrupted sitting. Exposure and outcome measures were highly heterogeneous. Study quality was low to moderate. Quality of evidence was very low or low in the observational studies and high in the intervention.Conclusion: In pediatric populations, current evidence is limited and of low quality about how acute effects of sedentary behavior translate into early vascular aging and the long-term development of vascular dysfunction and atherosclerotic risk. Future studies should emphasize a careful choice of the adequate type and measurement site of a biomarker for large artery structure and function as well as conduct a detailed assessment of sedentary behavior patterns.Trial registration: PROSPERO Registration Number: CRD42018112996What is known: • An independent association of sedentary behavior and biomarkers of large artery structure and function has been demonstrated in adults. • In children, sedentary behavior is directly associated with classical cardiovascular risk factors like elevated blood glucose levels, insulin resistance, high blood pressure, obesity, and elevated blood lipids.What is new: • Currently, only few studies of low quality in children and adolescents provide limited evidence about how acute effects of sedentary behavior translate into early vascular aging and the long-term development of atherosclerosis. • The type and measurement site of vascular biomarker need to be chosen carefully, and a detailed assessment of sedentary behavior patterns is important to minimize the methodological bias.

Cardiovascular Disease Prevention: The Earlier the Better? A Review of Plant Sterol Metabolism and Implications of Childhood Supplementation

Atherosclerosis is the underlying cause of major cardiovascular events. The development of atherosclerotic plaques begins early in life, indicating that dietary interventions in childhood might be more effective at preventing cardiovascular disease (CVD) than treating established CVD in adulthood. Although plant sterols are considered safe and consistently effective in lowering plasma cholesterol, the health effects of early-life supplementation are unclear. Studies suggest there is an age-dependent effect on plant sterol metabolism: at a younger age, plant sterol absorption might be increased, while esterification and elimination might be decreased. Worryingly, the introduction of low-cholesterol diets in childhood may unintentionally favor a higher intake of plant sterols. Although CVD prevention should start as early as possible, more studies are needed to better elucidate the long-term effects of plant sterol accumulation and its implication on child development.

Cardiometabolic risk factor levels in Norwegian children compared to international reference values: The ASK study

OBJECTIVE

To investigate cardiometabolic risk factor levels in a group of Norwegian 10-year-old children compared to international values and examine the association between cardiorespiratory fitness (CRF) and the reference-standardized clustered risk score.

METHODS

913 children (49% girls) were included from the Active Smarter Kids (ASK) study. Body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC) to HDL-C ratio, triglyceride (TG), glucose, insulin, homeostatic model assessment (HOMA) score and CRF, were standardized according to international age-and sex-specific reference values.

RESULTS

The Norwegian children had significantly more favorable WC, DBP, glucose, HDL-C and CRF levels compared to the international reference values, but similar or less favorable levels of other cardiometabolic risk factors. CRF was the variable that differed the most from the international values (mean (95% CI) 1.20 (1.16 to 1.24) SD). The clustered risk score (excluding CRF) was higher in the Norwegian children, but decreased to below international levels when including CRF (mean (95% CI) - 0.08 (- 0.12 to -0.05) SD). CRF had a significant inverse association with the clustered risk score (excluding CRF) (β - 0.37 SD, 95% CI -0.43 to -0.31).

CONCLUSIONS

Norwegian children have substantially higher CRF levels than international standards, and including CRF in clustered risk scores reduces overall risk in Norwegian children below that of international levels. CRF is associated with improved cardiometabolic health in children.

Exposure to ambient particulate matter air pollution, blood pressure and hypertension in children and adolescents: A national cross-sectional study in China

BACKGROUND

Air pollution has been associated with elevated blood pressure in adults. However, epidemiological evidence from children and adolescents is limited. We investigated the associations between long-term exposure to particulate matter (PM) air pollution and blood pressure in a large population of children and adolescents.

METHODS

A cross-sectional analysis was performed in a nationally representative sample consisting of 43,745 children and adolescents aged 7 to 18 years in seven provinces in China. Exposure to ambient fine particles (PM_2.5) and thoracic particles (PM₁₀) was estimated using spatiotemporal models based on satellite remote sensing, meteorological data and land use information. Mixed-effects (two-level) linear and logistic regression models were used to investigate the associations between PM exposure and systolic blood pressure (SBP), diastolic blood pressure (DBP) and hypertension.

RESULTS

After adjustment for a wide range of covariates, every 10 μg/m³ increment in PM_2.5 and PM₁₀ concentration was associated with 1.46 [95% confidence interval (CI): 0.05, 2.88] and 1.36 (95% CI: 0.34, 2.39) mmHg increases in SBP, respectively. PM₁₀ was also associated with higher prevalence of hypertension [odds ratio per 10 μg/m³ increment: 1.45 (95% CI: 1.07, 1.95)].

CONCLUSIONS

Long-term exposure to ambient PM air pollution was associated with increased blood pressure and higher prevalence of hypertension in children and adolescents. Our findings support air pollution reduction strategies as a prevention measure of childhood hypertension, a well-recognized risk factor of future cardiovascular health.

Predictors of objectively measured physical activity in 12-month-old infants: A study of linked birth cohort data with electronic health records

BACKGROUND

Physical activity (PA) levels are associated with long-term health, and levels of PA when young are predictive of adult activity levels.

OBJECTIVES

This study examines factors associated with PA levels in 12-month infants.

METHOD

One hundred forty-one mother-infant pairs were recruited via a longitudinal birth cohort study (April 2010 to March 2013). The PA level was collected using accelerometers and linked to postnatal notes and electronic medical records via the Secure Anonymised Information Linkage databank. Univariable and multivariable linear regressions were used to examine the factors associated with PA levels.

RESULTS

Using univariable analysis, higher PA was associated with the following (P value less than 0.05): being male, larger infant size, healthy maternal blood pressure levels, full-term gestation period, higher consumption of vegetables (infant), lower consumption of juice (infant), low consumption of adult crisps (infant), longer breastfeeding duration, and more movement during sleep (infant) but fewer night wakings. Combined into a multivariable regression model (R2  = 0.654), all factors remained significant, showing lower PA levels were associated with female gender, smaller infant, preterm birth, higher maternal blood pressure, low vegetable consumption, high crisp consumption, and less night movement.

CONCLUSION

The PA levels of infants were strongly associated with both gestational and postnatal environmental factors. Healthy behaviours appear to cluster, and a healthy diet was associated with a more active infant. Boys were substantially more active than girls, even at age 12 months. These findings can help inform interventions to promote healthier lives for infants and to understand the determinants of their PA levels.

Exercise Science and Child Health: A Tale of Many Journeys

Children are the most naturally physically active human beings; reduced physical activity is a cardinal sign of childhood disease, and exercise testing provides mechanistic insights into health and disease that are often hidden when the child is at rest. The physical inactivity epidemic is leading to increased disease risk in children and, eventually, in adults in unprecedented ways. Cardiopulmonary exercise testing (CPET) biomarkers are used to assess disease severity, progress, and response to therapy across an expanding range of childhood diseases and conditions. There is mounting data that fitness in children tracks across the life span and may prove to be an early, modifiable indicator of cardiovascular disease risk later in life. Despite these factors, CPET has failed to fulfill its promise in child health research and clinical practice. A major barrier to more accurate and effective clinical use of CPET in children is that data analytics and testing protocols have failed to keep pace with enabling technologies and computing capacity. As a consequence, biomarkers of fitness and physical activity have yet to be widely incorporated into translational research and clinical practice in child health. In this review, the author re-examines some of the long-held assumptions that mold CPET in children. In particular, the author suggests that current testing strategies that rely predominantly on maximal exercise may, inadvertently, obfuscate novel and clinically useful insights that can be gleaned from more comprehensive data analytics. New pathways to discovery may emanate from the simple recognition that the physiological journey that human beings undertake in response to the challenge of exercise may be far more important than the elusive destination of maximal or peak effort.

Parental smoking and blood pressure in children and adolescents: a national cross-sectional study in China

Background

Current evidence on the health effects of passive smoking on childhood blood pressure is limited and inconsistent. We investigated the associations between exposure to parental smoking and blood pressure in children and adolescents.

Methods

A cross-sectional analysis was performed in a national sample of 42,745 children and adolescents (50.2% boys) aged 7–18 years from seven provinces in China. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured. Information on parental smoking was collected through questionnaire. Multivariable linear regression and logistic regression was used to investigate the associations of parental smoking with blood pressure and prevalent hypertension, respectively.

Results

The reported parental smoking rates were 49.7 and 50.2% in boys and girls, respectively. After adjustment for a range of potential confounders, exposure to parental smoking was associated with 0.44 [95% confidence interval (CI): 0.16, 0.72] mmHg and 0.26 (95% CI: 0.04, 0.47) mmHg higher SBP and DBP in girls. Girls exposed to parental smoking were also more likely to have hypertension compared with those without exposure (odds ratio = 1.11, 95% CI: 1.02, 1.20). No significant associations were found in boys.

Conclusions

Exposure to parental smoking was associated with increased blood pressure and higher prevalence of hypertension in girls, but not in boys. Urgent strategies are needed for the promotion of smoking-free environment, especially for children and adolescents.

Electronic supplementary material

The online version of this article (10.1186/s12887-019-1505-8) contains supplementary material, which is available to authorized users.

Cardiorespiratory Fitness in Childhood and Adolescence Affects Future Cardiovascular Risk Factors: A Systematic Review of Longitudinal Studies

BACKGROUND

Although cardiorespiratory fitness (CRF) in childhood and adolescence may be linked to future cardiovascular health, there is currently limited evidence for a longitudinal association.

OBJECTIVES

To provide a systematic review on the prospective association between CRF in childhood and adolescence and cardiovascular disease (CVD) risk factors at least 2 years later.

METHODS

Using a systematic search of Medline, Embase, and SPORTDiscus, relevant articles were identified by the following criteria: generally healthy children and adolescents between 3 and 18 years of age with CRF assessed at baseline, and a follow-up period of ≥ 2 years. The outcome measures were CVD risk factors. We appraised quality of the included articles with STROBE and QUIPS checklists.

RESULTS

After screening 7524 titles and abstracts, we included 38 articles, assessing 44,169 children and adolescents followed up for a median of 6 years. Eleven articles were of high quality. There was considerable heterogeneity in methodology, measurement of CRF, and outcomes, which hampered meta-analysis. In approximately half of the included articles higher CRF in childhood and adolescence was associated with lower body mass index (BMI), waist circumference, body fatness and lower prevalence of metabolic syndrome in later life. No associations between CRF in childhood and adolescence and future waist-to-hip ratio, blood pressure, lipid profile, and glucose homeostasis were observed.

CONCLUSION

Although about half of the included articles reported inverse associations between CRF in childhood and adolescence and future BMI, body fatness, and metabolic syndrome, evidence for other CVD risk factors was unconvincing. Many articles did not account for important confounding factors such as adiposity. Recommendations for future research include standardizing the measurement of CRF, i.e. by reporting VO_2max, using standardized outcome assessments, and performing individual patient data meta-analyses.

Brief tools to measure obesity-related behaviours in children under 5 years of age: A systematic review

INTRODUCTION

Valid and reliable tools for measuring obesity-related behaviours in young children that are brief and can be administered quickly and cost-effectively in large-scale population studies are needed. The objectives of this systematic review were to describe brief tools that measure dietary intake, physical activity, sedentary behaviour, and sleep in young children.

METHODS

A systematic review of studies published in English in six databases (CINAHL, Medline, Embase, PsycINFO, HaPI, and Cochrane) prior to April 2018 was undertaken using the PROSPERO protocol and PRISMA guidelines. Included studies were those reporting the psychometric properties of brief (≤15 items) tools that measure dietary, activity, or sleep-related behaviours, alone or in combination, in children birth to 4.9 years of age.

RESULTS

The search identified 11 379 papers, 200 full-text articles were screened for eligibility, and 12 met the inclusion criteria. Three studies measured two behavioural domains, while most assessed a single behaviour (three diet, five physical activity, one sleep, and none sedentary behaviour). Only two (one diet, one sleep) focused on the under 2 age group. Few studies assessed reliability, and validity and findings were mixed.

CONCLUSIONS

There is a need to develop brief tools to measure early life obesity-related behaviours, particularly those assessing sedentary behaviour and sleep and tools that cover multiple domains.

At what age do normal weight Canadian children become overweight adults? Differences according to sex and metric

BACKGROUND

The prevalence of overweight and obesity doubles between adolescence and young adulthood; however, the exact age, and appropriate metric to use to identify when overweight develops is still debated.

AIM

To examine the age of onset of overweight by sex and four metrics: body mass index (BMI), fat mass (%FM), waist circumference (WC) and waist-to-height ratio (WHtR).

SUBJECTS AND METHODS

Between 1991 and 2017, serial measures of body composition were taken on 237 (108 males) individuals (aged 8-40 years of age). Hierarchical random effects models were used to develop growth curves. Curves were compared to BMI, %FM and WC overweight age- and sex-specific cut-points.

RESULTS

In males, the BMI growth curve crossed the cut-point at 22.0 years, compared to 23.5 and 26.5 years for WHtR and %FM, respectively; WC cut-off was not reached until 36 years. In females, the BMI growth curve crossed the overweight cut-point at 21.5 years, compared to 14.2 years for %FM and 21.9 and 27.5 years for WC and WHtR, respectively.

CONCLUSION

In summary, overweight onset occurs during young adulthood with the exception of WC in males. BMI in males and %FM in females were the metrics identifying overweight the earliest.

Impact of gaining or maintaining excessive weight in infancy on markers of metabolic homeostasis in young children: A longitudinal study in Chilean children

Childhood obesity in Chile is one of the highest in the world. The objective of this study was to assess the impact of excessive weight gained or maintained over a 3-year period, on markers of metabolic homeostasis in young children. This is a longitudinal study which includes 243 children followed from 4 to 7 years. We assessed BMI, body fat percentage, waist circumference (WC), waist-hip ratio (WHR), waist-height (WH) and trunk fat as well as the following metabolic parameters: glucose, insulin, triglycerides, total cholesterol, LDL, HDL and metabolic risk score. Kruskal- Wallis was used to assess differences in metabolic markers by nutritional status and logistic regression to determine the effect of maintaining or gaining excess weight over the 3-year period, compared with children who maintained a normal weight. Children who were obese at both ages compared with those who were normal weight, had a significantly higher WC, serum concentrations of total fat, total cholesterol, triglycerides, LDL cholesterol and metabolic risk score (P < 0.05). Children who were overweight or obese at 4 and 7 years, had a greater risk of having a high WC (OR: 3.37; P = 0.03), total cholesterol (OR: 4.17; P < 0.003), triglycerides (OR: 1.96; P = 0.04); thus a higher metabolic risk score (OR: 3.21; P = 0.003). Excess weight maintained over time in early childhood, significantly increases the risk of having higher serum biomarkers of cardiovascular risk, which in turn determines the magnitude of cardiovascular and metabolic risks later in life.

•

A Chilean cohort study followed from 4 to 7 years showed that the prevalence of overweight/obese increased from 32 to 35%.

•

23% of children remained overweight/obese at both ages.

•

13% of children changed from normal to overweight.

•

Excess weight maintained over time increases disruption of metabolic homeostasis.

•

Cardiovascular parameters may determine the magnitude of cardiovascular risks.

Chronic Family Stress and Adolescent Health: The Moderating Role of Emotion Regulation

OBJECTIVE

The aim of the study was to assess whether the association between chronic family stress and physiological measures is moderated by emotion regulation strategies in an adolescent sample.

METHODS

Chronic family stress was assessed via a semistructured interview and emotion regulation strategies (cognitive reappraisal and suppression) via questionnaire among 261 adolescents (14.57 (1.07) years). Several metabolic (waist-hip ratio, systolic and diastolic blood pressure) and inflammatory markers (basal and stimulated proinflammatory cytokine production in response to bacterial challenge) as well as glucocorticoid sensitivity were assessed.

RESULTS

There were no main effects of chronic family stress, cognitive reappraisal, or suppression on physiological measures (all p's > .10). Emotion regulation moderated the association between chronic family stress and physiological measures. As chronic family stress increased, adolescents higher in cognitive reappraisal had smaller waist-hip ratios (B = -.003, SE = .001, p = .015) and lower systolic blood pressure (B = -.303, SE = .143, p = .035), although no moderation was found with respect to inflammatory markers and glucocorticoid sensitivity (all p's > .30). In addition, as chronic family stress increased, adolescents higher in suppression showed evidence of higher stimulated proinflammatory cytokine production (B = .046, SE = .020, p = .021) and lower glucocorticoid sensitivity (B = .051, SE = .021, p = .015), although basal inflammation and metabolic measures were not moderated by suppression (all p's > .50).

CONCLUSIONS

This study suggests that the types of emotion regulation strategies used by adolescents may affect the extent to which chronic family stress affects important metabolic and immune processes.

What is the effect of ADHD stimulant medication on heart rate and blood pressure in a community sample of children?

OBJECTIVE

This study examines the effect of ADHD (attention deficit hyperactivity disorder) diagnosis and stimulant medication for ADHD treatment on child heart rate (HR) and blood pressure (BP) in a community sample compared to children without ADHD.

METHODS

Data came from the HBEAT Study. From 49 schools, 2013 participants from southern Ontario in grades 5-8 were included. Linear regression analyses examined the effects of ADHD medications on systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate adjusting for age, sex and body mass index (BMI).

RESULTS

Compared to non-ADHD children and adjusting for age, sex and BMI, children with ADHD on stimulant medication had a 12.3-bpm higher HR, and 3.0-mmHg higher SBP and DBP (all statistically significant). Children with ADHD on no stimulant medication had no differences in HR and BP compared to those children without a diagnosis of ADHD.

CONCLUSION

Stimulant medications used to treat ADHD are associated with elevated HR and higher BP. While it is unknown whether children on ADHD medications may be at risk for longer-term cardiovascular issues, this study supports the need to examine the long-term consequences of ADHD medication.

Food intake patterns and cardiovascular risk factors in Japanese adults: analyses from the 2012 National Health and nutrition survey, Japan

BACKGROUND

There is an increasing global interest in the role of Japanese diet as a possible explanation for the nation's healthy diet, which contributes to the world's highest life-expectancy enjoyed in Japan. However, nationwide studies on current food intake status among general Japanese population have not been established yet. This study examined the association between food intake patterns and cardiovascular risk factors (CVRF) such as waist circumference (WC), body mass index (BMI), blood pressure (SBP, DBP), HbA1c and blood lipid profiles among general Japanese adults.

METHODS

De-identified data on the Japan National Health and Nutrition Survey (NHNS) 2012 with a total of 11,365 subjects aged 20-84 years were applied. Food intake patterns were derived by principal component analysis (PCA) based on 98 food groups. Generalized linear regression analysis was used to assess the relation between the food intake patterns and CVRF.

RESULTS

We identified three food intake patterns: traditional Japanese, Westernized, and meat and fat patterns. Traditional Japanese pattern was significantly related to high WC and BMI in men, and high DBP in women. Westernized pattern was associated with lower SBP, but high total cholesterol and LDL cholesterol in both men and women. Meat and fat pattern was associated with high WC, high BMI, high blood pressure and blood lipid profiles in both men and women (trend P < 0.001).

CONCLUSION

The significant association between cardiovascular disease risks and three food intake patterns derived from the NHNS, showed a similar tendency to other dietary survey methods.

Metabolic syndrome's risk factors and its association with nutritional status in schoolchildren

The metabolic risk factors (RF) to the diagnosis of metabolic syndrome (MetS) have been evidenced at early ages, including children. The aim of the present study was to identify the prevalence of RF to the diagnosis of MetS and its association with nutritional status of schoolchildren from 6 to 10 years old. A cross-sectional study was carried out in 505 students of municipal schools in Macae, Brazil, conducted from 2013 to 2014. The RF evaluated were: blood pressure (mm Hg), triglycerides (mmol/L), HDL-cholesterol (mmol/L) fasting glucose (mmol/L) and waist circumference (cm). At least one RF was present in 61% (n = 308) of the sample. By nutritional status, there was higher prevalence of RF in overweight/obese schoolchildren compared to those with normal weight, except in the concentration of HDL-c. The prevalence of one, two and three RF (MetS) were 34.7% (n = 175), 21.0% (n = 106) and 5.3% (n = 27), respectively. Two RF were more present in overweight (28.2% 95%CI 19.0; 39.0) and obese (41.5% 95%CI 31.4; 52.1) compared to normal weight children (13.5% 95%CI 9.9; 17.8). Three or more RF were more frequent among obese (25.5% 95%CI 17.0; 35.5) in relation to overweight (2.4% 95%CI 0.2; 8.2) and normal weight children (0.3% 95%CI 0; 1.7). The data indicate high prevalence of RF and its relationship with the magnitude of body weight excess. Therefore, the identification and early treatment of these RF might minimize the risk of MetS and related diseases.

Hypertension in the Pediatric Kidney Transplant Recipient

Hypertension after kidney transplant is a frequent occurrence in pediatric patients. It is a risk factor for graft loss and contributes to the significant burden of cardiovascular disease (CVD) in this population. The etiology of posttransplant hypertension is multifactorial including donor factors, recipient factors, medications, and lifestyle factors similar to those prevalent in the general population. Ambulatory blood pressure monitoring has emerged as the most reliable method for measuring hypertension in pediatric transplant recipients, and many consider it to be essential in the care of these patients. Recent technological advances including measurement of carotid intima-media thickness, pulse wave velocity, and myocardial strain using specked echocardiography and cardiac magnetic resonance imaging have improved our ability to assess CVD burden. Since hypertension remains underrecognized and inadequately treated, an early diagnosis and an appropriate control should be the focus of therapy to help improve patient and graft survival.

Reduced arterial stiffness in very fit boys and girls

Low cardiorespiratory fitness is associated with higher cardiovascular risk, whereas high levels of cardiorespiratory fitness protect the cardiovascular system. Carotid intima-media thickness and arterial distensibility are well-established parameters to identify subclinical cardiovascular disease. Therefore, this study investigated the influence of cardiorespiratory fitness and muscular strength on carotid intima-media thickness and arterial distensibility in 697 children and adolescents (376 girls), aged 7-17 years. Cardiorespiratory fitness and strength were measured with the test battery FITNESSGRAM; carotid intima-media thickness, arterial compliance, elastic modulus, stiffness index β, and pulse wave velocity β were assessed by B- and M-mode ultrasound at the common carotid artery. In bivariate correlation, cardiorespiratory fitness was significantly associated with all cardiovascular parameters and was an independent predictor in multivariate regression analysis. No significant associations were obtained for muscular strength. In a one-way variance analysis, very fit boys and girls (58 boys and 74 girls>80th percentile for cardiorespiratory fitness) had significantly decreased stiffness parameters (expressed in standard deviation scores) compared with low fit subjects (71 boys and 77 girls<20th percentile for cardiorespiratory fitness): elastic modulus -0.16±1.02 versus 0.19±1.17, p=0.009; stiffness index β -0.15±1.08 versus 0.16±1.1, p=0.03; and pulse wave velocity β -0.19±1.02 versus 0.19±1.14, p=0.005. Cardiorespiratory fitness was associated with healthier arteries in children and adolescents. Comparison of very fit with unfit subjects revealed better distensibility parameters in very fit boys and girls.

Metabolic syndrome in children and adolescents: Old concepts in a young population

Many years after first being described, there is still no clear consensus on diagnostic criteria for metabolic syndrome, particularly in children. However, identification of this cluster of cardiovascular risk factors especially in children with co-morbidities, is important in order to reduce their future risk of chronic disease and morbidity. Sustained multidisciplinary and family-based early intervention is required, aiming primarily at life-style change.

Health Behavior and Metabolic Risk Factors Associated with Normal Weight Obesity in Adolescents

OBJECTIVE

To explore health behaviors and metabolic risk factors in normal weight obese (NWO) adolescents compared with normal weight lean (NWL) peers.

DESIGN AND METHODS

A cross-sectional study of 18-year-old students (n = 182, 47% female) in the capital area of Iceland, with body mass index within normal range (BMI, 18.5-24.9 kg/m2). Body composition was estimated via dual energy X-ray absorptiometry, fitness was assessed with maximal oxygen uptake (VO2max) during treadmill test, dietary intake through 24-hour recall, questionnaires explained health behavior and fasting blood samples were taken. NWO was defined as normal BMI and body fat >17.6% in males and >31.6% in females.

RESULTS

Among normal weight adolescents, 42% (n = 76) were defined as NWO, thereof 61% (n = 46) male participants. Fewer participants with NWO were physically active, ate breakfast on a regular basis, and consumed vegetables frequently compared with NWL. No difference was detected between the two groups in energy- and nutrient intake. The mean difference in aerobic fitness was 5.1 ml/kg/min between the groups in favor of the NWL group (p<0.001). NWO was positively associated with having one or more risk factors for metabolic syndrome (Odds Ratio OR = 2.2; 95% confidence interval CI: 1.2, 3.9) when adjusted for sex. High waist circumference was more prevalent among NWO than NWL, but only among girls (13% vs 4%, p = 0.019).

CONCLUSIONS

High prevalence of NWO was observed in the study group. Promoting healthy lifestyle with regard to nutrition and physical activity in early life should be emphasized regardless of BMI.

The relationship between physical activity level and cardiovascular disease biomarkers in healthy, normal-weight 3- to 6-year-old children and their parents

To determine if physical activity is linked to cardiovascular biomarkers in preschool children at risk, we need information on these biomarkers in healthy normal-weight children. In this population, multi-level modelling analyses found no correlation between accelerometer recorded physical activity and fasting lipids, adiponectin, or insulin sensitivity. Exploratory analyses found positive correlations between adiponectin and time spent in light physical activity, and between triglyceride and time spent in sedentary behaviour; these findings need to be confirmed in longitudinal prospective studies.

Measurement of obesity prevention in childcare settings: A systematic review of current instruments

OBJECTIVE

The incidence of childhood obesity is highest among children entering kindergarten. Overweight and obesity in early childhood track through adulthood. Programs increasingly target children in early life for obesity prevention. However, the published literature lacks a review on tools available for measuring behaviour and environmental level change in child care. The objective is to describe measurement tools currently in use in evaluating obesity-prevention in preschool-aged children.

METHODS

Literature searches were conducted in PubMed using the keywords "early childhood obesity," "early childhood measurement," "early childhood nutrition" and "early childhood physical activity." Inclusion criteria included a discussion of: (1) obesity prevention, risk assessment or treatment in children ages 1-5 years; and (2) measurement of nutrition or physical activity.

RESULTS

One hundred thirty-four publications were selected for analysis. Data on measurement tools, population and outcomes were abstracted into tables. Tables are divided by individual and environmental level measures and further divided into physical activity, diet and physical health outcomes. Recommendations are made for weighing advantages and disadvantages of tools.

CONCLUSION

Despite rising numbers of interventions targeting obesity-prevention and treatment in preschool-aged children, there is no consensus for which tools represent a gold standard or threshold of accuracy.

Pediatric Blood Pressure and Adult Preclinical Markers of Cardiovascular Disease

A high blood pressure level in adults is considered the single most important modifiable risk factor for global disease burden, especially those of cardiovascular (CV) origin such as stroke and ischemic heart disease. Because blood pressure levels have been shown to persist from childhood to adulthood, elevations in pediatric levels have been hypothesized to lead to increased CV burden in adulthood and, as such, might provide a window in the life course where primordial and primary prevention could be focused. In the absence of substantive data directly linking childhood blood pressure levels to overt adult CV disease, this review outlines the available literature that examines the association between pediatric blood pressure and adult preclinical markers of CV disease.

Association of Mental Disorders With Subsequent Chronic Physical Conditions: World Mental Health Surveys From 17 Countries

IMPORTANCE

It is clear that mental disorders in treatment settings are associated with a higher incidence of chronic physical conditions, but whether this is true of mental disorders in the community, and how generalized (across a range of physical health outcomes) these associations are, is less clear. This information has important implications for mental health care and the primary prevention of chronic physical disease.

OBJECTIVE

To investigate associations of 16 temporally prior DSM-IV mental disorders with the subsequent onset or diagnosis of 10 chronic physical conditions.

DESIGN, SETTING, AND PARTICIPANTS

Eighteen face-to-face, cross-sectional household surveys of community-dwelling adults were conducted in 17 countries (47,609 individuals; 2,032,942 person-years) from January 1, 2001, to December 31, 2011. The Composite International Diagnostic Interview was used to retrospectively assess the lifetime prevalence and age at onset of DSM-IV-identified mental disorders. Data analysis was performed from January 3, 2012, to September 30, 2015.

MAIN OUTCOMES AND MEASURES

Lifetime history of physical conditions was ascertained via self-report of physician's diagnosis and year of onset or diagnosis. Survival analyses estimated the associations of temporally prior first onset of mental disorders with subsequent onset or diagnosis of physical conditions.

RESULTS

Most associations between 16 mental disorders and subsequent onset or diagnosis of 10 physical conditions were statistically significant, with odds ratios (ORs) (95% CIs) ranging from 1.2 (1.0-1.5) to 3.6 (2.0-6.6). The associations were attenuated after adjustment for mental disorder comorbidity, but mood, anxiety, substance use, and impulse control disorders remained significantly associated with onset of between 7 and all 10 of the physical conditions (ORs [95% CIs] from 1.2 [1.1-1.3] to 2.0 [1.4-2.8]). An increasing number of mental disorders experienced over the life course was significantly associated with increasing odds of onset or diagnosis of all 10 types of physical conditions, with ORs (95% CIs) for 1 mental disorder ranging from 1.3 (1.1-1.6) to 1.8 (1.4-2.2) and ORs (95% CIs) for 5 or more mental disorders ranging from 1.9 (1.4-2.7) to 4.0 (2.5-6.5). In population-attributable risk estimates, specific mental disorders were associated with 1.5% to 13.3% of physical condition onsets.

CONCLUSIONS AND RELEVANCE

These findings suggest that mental disorders of all kinds are associated with an increased risk of onset of a wide range of chronic physical conditions. Current efforts to improve the physical health of individuals with mental disorders may be too narrowly focused on the small group with the most severe mental disorders. Interventions aimed at the primary prevention of chronic physical diseases should optimally be integrated into treatment of all mental disorders in primary and secondary care from early in the disorder course.