Cardiopulmonary Capacity in Overweight and Obese Children and Adolescents: A Cross-Sectional Study

The use of submaximal parameters in the assessment of exercise capacity in children with obesity

BACKGROUND

Peak oxygen uptake (VO2) is considered the most important indicator of aerobic exercise capacity during cardiopulmonary exercise testing (CPET). However, its accuracy is compromised when maximal effort is not achieved. In such cases, submaximal parameters can serve as surrogates for assessing exercise performance.

OBJECTIVES

To compare the differences in maximal and submaximal exercise parameters between children with obesity and normal weight.

METHODS

A prospective study evaluating CPET using a treadmill completed by children with and without obesity.

RESULTS

A total of 153 children (50.9% females) were divided into two groups: obese (n = 87) and non-obese (n = 66). Children with obesity achieved lower exercise capacity (peakVO2 of 68% ± 16% vs. 89% ± 15%; p < 0.0001) with fewer achieving maximal effort (26.4% vs. 78.7%, respectively). VO2-derived submaximal parameters showed a significantly lower oxygen uptake efficiency slope per body weight (OUES/kg) (30.5 ± 6.1 vs. 39.0 ± 9.5; p < 0.0001) and lower VO2 at ventilatory threshold (VO2@AT) (21.2 ± 4.6 vs. 26.4 ± 5.3, p = 0.0001) in the obese group, with no significant differences in the CO2-derived parameters.

CONCLUSIONS

Maximal exercise data in children with obesity is frequently unavailable due to failure to achieve maximal effort. Submaximal parameters, such as OUES and VO2@AT, may be useful substitute options for assessing the health and functional level of this population.

Impact of Idiopathic Scoliosis on the Cardiopulmonary Capacity of Adolescents

Chest deformities in children with scoliosis may result in cardiopulmonary disorders, lowering cardiopulmonary capacity levels. However, results regarding the dependence of cardiopulmonary capacity on the severity level of scoliosis remain controversial. We aimed to use dynamic cardiopulmonary exercise testing (CPET) to investigate exercise capacity in reference to spinal deformity in patients with mild or moderate idiopathic scoliosis by means of multivariate analyses. Methods: We included 92 children and adolescents aged 10-17 years with mild and moderate idiopathic scoliosis and 94 healthy peers. The study consisted of three parts: (1) medical record analyses; (2) anthropometric measurements; and (3) CPET. Results: Our results revealed that the mean VO2peak and VO2peak/kg values of the participants with scoliosis were 0.27 L/min and 0.37 mL/min/kg lower than their healthy peers, respectively, regardless of age and gender. Furthermore, the occurrence of scoliosis correlates with a mean decrease in minute ventilation volume by 10.10 L/min, tidal volume by 0.11 L, breathing frequency by 3.78 bpm, and breathing reserve by 14.34%, regardless of the age and gender of the participants. Children and adolescents with mild-to-moderate scoliosis during CPET exhibit a lower ventilation capacity and lower VO2 max than healthy adolescents matched in age but their cardiorespiratory fitness parameters do not depend on the Cobb angle value and the angle rotation of the primary spinal curvature. Conclusions: Physical therapy and activity should be recommended to prevent cardiorespiratory failure in later life in patients with scoliosis. This study may also provide CPET reference values for healthy children and adolescents with scoliosis.

Reduced exercise capacity for muscle mass in adolescents living with obesity

BACKGROUND

Adolescents living with obesity (AlwO) can have limited exercise capacity. Exercise capacity can be predicted by a 2-factor model comprising lung function and leg muscle function, but no study has looked at cycling leg muscle function and its contribution to cycling exercise capacity in AlwO.

METHODS

Twenty-two nonobese adolescents and 22 AlwO (BMI > 95 percentile) were studied. Anthropometry, body composition (dual-energy X-ray absorptiometry), spirometry, 30-s isokinetic work capacity, and maximal exercise (cycle ergometry) were measured.

RESULTS

AlwO had greater total body mass, lean body mass, and lean leg mass (LLM). Lung function trended higher in AlwO. Leg 30-s work did not differ in absolute terms or per allometrically scaled LLM. Peak oxygen consumption did not differ between the groups in absolute terms or as percent predicted values (79.59 ± 14.6 vs. 82.3 ± 11.2% predicted control versus ALwO) but was lower in AlwO when expressed per kg body mass, kg lean body mass, scaled lean body mass, and LLM. Peak oxygen consumption related to both lung function and 30-s work, with no observed group effect. 30-s leg work related to the scaled LLM, with a small group effect. There was some correlation between leg work and time spent in moderate to vigorous physical activity in AlwO (rs = 0.39, p = .07).

CONCLUSION

AlwO have larger LLM and preserved exercise capacity, when expressed as percentage of predicted, but not per allometrically scaled LLM. Increasing time spent in moderate to vigorous activity may benefit AlwO.

Interaction between Serum Cotinine and Magnesium Intake with Childhood Asthma: A Cross-Sectional Study

INTRODUCTION

Serum cotinine and magnesium intake are often associated with childhood asthma. This study evaluated the interaction between serum cotinine and magnesium intake and childhood asthma.

METHODS

This cross-sectional study included 14,159 subjects from the National Health and Nutrition Examination Survey 2005-2018. Serum cotinine levels were classified according to the lower quartile: ≤0.2089 ng/mL as low level and >0.2089 ng/mL as high level. Magnesium intake was categorized as high (>98 mg/1,000 kcal) or low level (≤98 mg/1,000 kcal) based on the upper quartile. Weighted logistic regression analyses were adopted to analyze the association between cotinine, magnesium intake, and childhood asthma. Additionally, the combined effect of cotinine and magnesium intake on childhood asthma risk was examined. The stratified analyses were based on gender, body mass index, and family history of asthma to further examine the relationship between cotinine, magnesium intake, and childhood asthma.

RESULTS

The prevalence of asthma was approximately 17.56%. Compared to low-level cotinine, high-level cotinine was associated with asthma (odds ratio [OR] = 1.25, 95% confidence interval (CI): 1.04-1.50). Low-level magnesium intake was related to asthma compared with high-level magnesium intake (OR = 1.21, 95% CI: 1.04-1.40). Using interaction analysis, we also found that the combined effect of cotinine and magnesium intake was associated with childhood asthma risk, and the interaction between high-level cotinine and low-level magnesium intake was associated with the highest risk of childhood asthma (OR = 1.35, 95% CI: 1.04-1.74). Additionally, this interaction was also found in males, overweight/non-overweight, and those with family history of asthma.

CONCLUSION

There was an interaction between serum cotinine and magnesium intake on childhood asthma. The results suggested that implementing smoking bans in certain settings (e.g., communities, schools) and promoting the consumption of magnesium-rich foods may be effective strategies for preventing childhood asthma.

Eating Behavior and Factors of Metabolic Health in Primary Schoolchildren: A Cross-Sectional Study in Greek Children

Childhood obesity has been associated with altered blood lipids and bad eating habits. In this cross-sectional study, we assessed cardiorespiratory fitness and metabolic health markers in regard to weight status and dietary habits in schoolchildren. In 134 children (6-11 years), we conducted: (1) Anthropometry, namely z-score BMI (z-BMI), waist-to-height ratio (WHtR), and body composition analysis. (2) Measurements of handgrip strength (HGS), resting metabolic rate (RMR) and VO2max. (3) Quantification of blood lipids and antioxidant vitamins A, E, C. (4) Eating breakfast assessment. About 35% of children were overweight/obese. The z-BMI positively correlated with WHtR (r = 0.637, p < 0.001), and adversely correlated with fat-free mass (r = -0.728, p < 0.001) and vitamin E (r = -0.286, p < 0.001). RMR and VO2max were greater in normal weight children compared to those with overweight/obesity (p < 0.001). HGS did not differ between these groups, but was negatively correlated with dyslipidemia as shown by TG/HDL-C ratio (r = -0.224, p = 0.037). According to regression analysis, eating breakfast routinely at home was positively associated with RMR and adversely associated with z-BMI. Hence, regular breakfast consumption at home may improve RMR in kids. Cardiorespiratory fitness and physical strength are key modulators of metabolic health in Greek children added to a social determinant of health i.e., eating breakfast at home.

Children who appeared or remained overweight or obese predict a higher follow-up blood pressure and higher risk of hypertension: a 6-year longitudinal study in Yantai, China

Few longitudinal studies have examined the effect of weight status change on blood pressure change over time and incidence of hypertension among Chinese children. The longitudinal study enrolled 17,702 Chinese children aged 7 years in Yantai in 2014 as baseline, with a continuous 5 years of follow-up to 2019. Generalized estimating equation model was fitted to examine the main and interaction effects of weight status change and time with blood pressure and the incidence of hypertension. Compared with the participants who remained normal weight, the participants who remained overweight or obese had higher systolic blood pressure (SBP) (β = 2.89, p < 0.001) and diastolic blood pressure (DBP) (β = 1.79, p < 0.001). Significant interactions were identified between weight status change and time with SBP (χ2interaction = 697.77, p < 0.001) and DBP (χ2interaction = 270.49, p < 0.001). The odds ratio (OR) and 95% confidence interval (CI) of hypertension were 1.70 (1.59-1.82) for participants who appeared overweight or obese, 2.26 (2.14-2.40) for participants who remained overweight or obese, compared with the participants who remained normal weight. Those who switched from overweight or obesity to normal weight had almost the same risk of developing hypertension (OR = 1.13, 95% CI: 1.02 to 1.26) as children who remained normal weight. Children who appeared or remained overweight or obese predict a higher follow-up blood pressure and higher risk of hypertension, whereas losing weight could reduce blood pressure and the risk of hypertension. Children who appeared or remained overweight or obese predict a higher follow-up blood pressure and higher risk of hypertension, whereas losing weight could reduce blood pressure and the risk of hypertension.

Case report: A proposed role for cardiopulmonary exercise testing in detecting cardiac dysfunction in asymptomatic at-risk adolescents

Noninvasive cardiopulmonary exercise testing (CPET) provides the valuable capacity to analyze pulmonary gas exchange and cardiovascular responses that can be used to differentiate normal cardiopulmonary responses from abnormal. This case report highlights a proposed role for CPET in identifying potential cardiac pathologies in at-risk adolescents. An abnormal CPET response in an asymptomatic adolescent revealed a family history of early-age CAD. The significance of the abnormal CPET response was further supported by the presence of an elevated concentration of circulating high sensitivity C-reactive protein (hs-CRP). These findings emphasize the importance of a thorough clinical evaluation in at-risk adolescents, as CPET can aid in the early detection and management of cardiac pathologies, especially when combined with other relevant biomarkers such as plasma hs-CRP concentration, which can further suggest underlying pathology. Management considerations using serial CPET evaluations are recommended. Thus, CPET abnormalities combined with elevated hs-CRP should be taken seriously and provide justification for further evaluation and monitoring in adolescents at risk for cardiovascular disease.

Association between Cardiopulmonary Capacity and Body Mass Composition in Children and Adolescents with High Body Weight: A Cross-Sectional Study

(1) Background: Excessive body weight is a global problem in the 21st century. Children and adolescents, in particular, are at risk. Recently, there has been an increasing interest in the relationship between aerobic capacity and body composition. Therefore, this study aimed to determine the association between the individual parameters of cardiopulmonary capacity obtained in cardiopulmonary exercise testing (CPET) and selected parameters of body mass composition in high-BMI children and children over the 85th percentile according to the WHO growth reference. (2) Materials and Method: The research included 100 children of school-age (7-15 years) with an excessive BMI, i.e., over the 85th percentile as per the WHO Growth Reference (BMI percentile 95.21 ± 4.65; Z-score BMI: 2.07 ± 0.94). The study consisted of three parts: anthropometric measurements, measurement of body mass composition using a body composition analyzer (TANITA MC-780 S MA) using the bioimpedance method, and a cardiopulmonary exercise test on a pediatric cycle ergometer (Corival Pediatric, Lode BV) using the Godfrey protocol; (3) Results: The correlation between BMI and fat mass (FM) was very high (rho = 0.83; p = 0.00) with moderate body fat percentage (BF%) (rho = 0.48; p = 0.00). There was a relevant correlation between the amount of fat-free mass in total body mass and cardiopulmonary capacity expressed as the absolute aerobic capacity (VO2peak) (rho = 0.55; p = 0.00). (4) Conclusions: In the case of children and youth with higher BMI, there was a correlation between the amount of fat-free mass in total body mass and cardiopulmonary capacity in terms of absolute aerobic capacity.