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Metabolic syndrome and cardiorespiratory fitness in children and adolescents: the role of obesity as a mediator

  • Noelia González-Gálvez ORCID logo EMAIL logo , Jose Ribeiro ORCID logo and Jorge Mota
Published/Copyright: June 23, 2021
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 34 Issue 8

Abstract

Objectives

To analyse the prevalence and association between metabolic syndrome (MetS), clustered cardiometabolic risk (CCMR), obesity (body mass index [BMI], fat mass [FM] and waist circumference [WC]), and cardiorespiratory fitness (CRF); and to assess whether obesity (BMI, FM, and WC) acts as a mediator between CRF and MetS or CCMR.

Methods

This cross-sectional study included a subsample of the AFINA-te Study (n = 209; 11.51 ± 0.72 years old). BMI, FM, and WC were assessed. The Course-Navette test was used to assess CRF. MetS was calculated following the International Diabetes Federation (IDF) definitions, and assessed using WC, triglycerides (TGs), high density lipoprotein (HD), fasting glucose (FG), and systolic and diastolic blood pressures (SBP/DBP). CCMR was calculated based on the sex and age-specific z score.

Results

The prevalence of overweightness, obesity, MetS, and CCMR were 17.22, 1.44, 5.74, and 18.36%, respectively. After including BMI, FM, or WC into the model, the association between CRF and MetS was no longer significant, and the association between CRF and CCMR was only significant when it was mediated by BMI (β = −0.006; p = 0.026). The rest of the analysis of the mediation did not show a direct effect, although a significant indirect effect with a significant value for the Sobel test was observed (all p < 0.001).

Conclusions

BMI, FM, and WC act as full mediators in the association between CRF and MetS; FM and WC act as full mediators in the association between CRF and CCMR; and BMI acts as a partial mediator. The use of FM or WC as obesity variables is recommended.

Keywords: cardiometabolic; disease; health behaviours; mediation analysis; prevalence; school

Correction note

Correction added after online publication August 04, 2021: Second author’s name and ORCID have been updated.

Corresponding author: Noelia González-Gálvez, PhD, Sports Injury Prevention Research Group, Faculty of Sports, Universidad Católica de Murcia, Campus de los Jerónimos, 30107Guadalupe, Murcia, Spain, Phone: +34 968 278 824, E-mail:

Funding source: FCT- Portuguese Foundation for Science and Technology DOI: 10.13039/501100001871

Award Identifier / Grant number: FCOMP-01-0124-FEDER-028619

  1. Research funding: This work was supported by ID grant number: PTDC/DTP-DES/1328/2012. Name of the organization that funded the research: Portuguese Fundação para Ciência e a Tecnologia (FCT). Funder DOI: 10.13039/501100001871.

  2. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  3. Competing interests: The authors have no conflicts of interest to disclose.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The local Institutional Review Board deemed the study exempt from review. AFINA-te Project Study (Physical Activity and Nutritional Information for Adolescents). Grant from the Foundation for Science and Technology [FCOMP-01-0124-FEDER-028619 (PTDC/DTP-DES/1328/2012)]. Ethical Committee of the Faculty of Sport of the University of Porto (Process CEFADE 13/2013), the National Data Protection Commission (process n.6766/2015), and Regional Section of the Ministry of Education (process 0053200004).

References

1. Eberly, L, Prineas, R, Cohen, J, Vazquez, G, Zhi, Z, Neaton, JD, et al.. Risk factor distribution and 18-year mortality in the multiple risk factor intervention trial. Cardiovasc Metab Risk 2006;29:123–30.10.2337/diacare.29.01.06.dc05-1320Search in Google Scholar

2. Friend, A, Craig, L, Turner, S. The prevalence of metabolic syndrome in children: a systematic review of the literature. Metab Syndr Relat Disord 2013;11:71–80. https://doi.org/10.1089/met.2012.0122.Search in Google Scholar PubMed

3. Andersen, LB, Lauersen, JB, Brønd, JC, Anderssen, SA, Sardinha, LB, Steene-johannessen, J, et al.. A new approach to define and diagnose cardiometabolic disorder in children. J Diabetes Res 2015:1–10. Article ID.10.1155/2015/539835Search in Google Scholar PubMed PubMed Central

4. Weihe, P, Weihrauch-Blüher, S. Metabolic syndrome in children and adolescents: diagnostic criteria, therapeutic options and perspectives. Curr Obes Rep 2019;5:1–8. https://doi.org/10.1007/s13679-019-00357-x.Search in Google Scholar PubMed

5. Golden, SH, Folsom, AR, Coresh, J, Sharrett, AR, Szklo, M, Brancati, F. Risk factor groupings related to insulin resistance and their synergistic effects on subclinical atherosclerosis. Diabetes 2002;51:3069–76.10.2337/diabetes.51.10.3069Search in Google Scholar PubMed

6. Agudelo, GM, Bedoya, G, Estrada, A, Patin, FA, Mun, AM. Variations in the prevalence of metabolic syndrome in adolescents according to different criteria used for diagnosis: which definition should be chosen for this age group ?. Metab Syndr Relat Disord 2014;12:202–9. https://doi.org/10.1089/met.2013.0127.Search in Google Scholar PubMed

7. Zimmet, P, Alberti, K, Kaufman, F, Tajima, N, Silink, M, Arslanian, S, et al.. The metabolic syndrome in children and adolescents – an IDF consensus report. Pediatr Diabetes 2007;8:299–306.10.1111/j.1399-5448.2007.00271.xSearch in Google Scholar PubMed

8. Ahrens, W, Moreno, LA, Mårild, S, Molnár, D, Siani, A, Henauw, SD, et al.. Metabolic syndrome in young children : de fi nitions and results of the IDEFICS study. Int J Obes 2014;38:4–14. https://doi.org/10.1038/ijo.2014.130.Search in Google Scholar PubMed

9. Martínez-Vizcaíno, V, Solera, M, Salcedo, F, Serrano, S, Franquelo, R, Sánchez, M, et al.. Validity of a single-factor model underlying the metabolic syndrome in children. Cardiovasc Metab Risk 2010;33:1370–2. https://doi.org/10.2337/dc09-2049.Search in Google Scholar PubMed PubMed Central

10. Suebsamran, P, Pimpak, T, Thani, P, Chamnan, P. The metabolic syndrome and health behaviors in school children aged 13–16 years in Ubon Ratchathani: UMeSIA project. Metab Syndr Relat Disord 2018;16:425–32. https://doi.org/10.1089/met.2017.0150.Search in Google Scholar PubMed

11. Nyström, C, Henriksson, P, Martínez-Vizcaíno, V, Medrano, M, Cadenas-Sanchez, C, Arias-Palencia, NM, et al.. Does cardiorespiratory fitness attenuate the adverse effects of severe/morbid obesity on cardiometabolic risk and insulin resistance in Children ? A pooled analysis. Diabetes Care 2017;40:1580–7. https://doi.org/10.2337/dc17-1334.Search in Google Scholar PubMed

12. Pérez-Bey, A, Segura-jiménez, V, Fernández-santos, JR, Esteban-cornejo, I, Gómez-martínez, S, Veiga, O, et al.. The role of adiposity in the association between muscular fitness and cardiovascular disease. J Pediatr 2018;199:178–85. https://doi.org/10.1016/j.jpeds.2018.03.071.Search in Google Scholar PubMed

13. Werneck, O, Silva, DR, Collings, PJ, Fernandes, A, Ronque, ERV. Biological maturation, central adiposity, and metabolic risk in adolescents: a mediation analysis. Child Obes 2016;12:3773–83. https://doi.org/10.1089/chi.2016.0042.Search in Google Scholar PubMed

14. Díez-Fernández, A, Sánchez-López, M, Mora-Rodriguez, R, Notario-Pacheco, B, Torrijos-Niño, C, Martínez-Vizcaíno, V. Obesity as a mediator of the influence of cardiorespiratory fitness on cardiometabolic risk: a mediation analysis. Diabetes Care 2014;37:855–62. https://doi.org/10.2337/dc13-0416.Search in Google Scholar PubMed

15. Buchan, D, Young, J, Boddy, L, Baker, J. Independent associations between cardiorespiratory fitness, waist circumference, BMI, and clustered cardiometabolic risk in adolescents. Am J Hum Biol 2014;26:29–35. https://doi.org/10.1002/ajhb.22466.Search in Google Scholar PubMed

16. Bailey, DP, Savory, LA, Denton, SJ, Kerr, CJ. The association between cardiorespiratory fitness and cardiometabolic risk in children is mediated by abdominal adiposity: the HAPPY study. J Phys Act Health 2015;12:1148–52.10.1123/jpah.2014-0311Search in Google Scholar PubMed

17. Christodoulos, AD, Douda, HT, Tokmakidis, SP. Cardiorespiratory fitness, metabolic risk, and inflammation in children. Int J Pediatr 2012:1–6. Article ID. https://doi.org/10.1155/2012/270515.Search in Google Scholar PubMed PubMed Central

18. Pozuelo-carrascosa, DP, Sánchez-lópez, M, Cavero-redondo, I, Torres-costoso, A, Bermejo-cantarero, A, Martínez-vizcaíno, V. Obesity as a mediator between cardiorespiratory fitness and blood pressure in preschoolers. J Pediatr 2016;182:114–9.10.1016/j.jpeds.2016.11.005Search in Google Scholar PubMed

19. Vanderwall, C, Clark, RR, Eickhoff, J, Carrel, AL. BMI is a poor predictor of adiposity in young overweight and obese children. BMI Pediatr 2017;17:1–6. https://doi.org/10.1186/s12887-017-0891-z.Search in Google Scholar PubMed PubMed Central

20. Cole, TJ, Flegal, KM, Jackson, AA. Body mass index cut offs to define thinness in children and adolescents: international survey. Br Med J 2007;335:166–7. https://doi.org/10.1136/bmj.39238.399444.55.Search in Google Scholar PubMed PubMed Central

21. Fennoy, I. Effect of obesity on linear growth. Endocrinology 2013;20:44–9. https://doi.org/10.1097/MED.0b013e32835b7f15.Search in Google Scholar PubMed

22. Klakk, H, Grøntved, A, Møller, NC, Heidemann, M, Andersen, LB, Wedderkopp, N. Prospective association of adiposity and cardiorespiratory fitness with cardiovascular risk factors in healthy children. Scand J Med Sport 2014;24:275–82. https://doi.org/10.1111/sms.12163.Search in Google Scholar

23. Baron, RM, Kenny, DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 1986;51:1173–82. https://doi.org/10.1037//0022-3514.51.6.1173.Search in Google Scholar

24. Cole, TJ, Bellizzi, MC, Flegal, KM, Dietz, WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. Br Med J (Clin Res Ed). 2000;320:1–6.10.1136/bmj.320.7244.1240Search in Google Scholar

25. Esparza-Ros, F, Vaquero-Cristóbal, R, Marfell-Jones, M. International Standards for Anthropometric Assessment. Murcia: Internatio.; 2019.Search in Google Scholar

26. Léger, LA, Mercier, D, Gadoury, C, Lambert, J. The multistage 20 metre shuttle run test for aerobic fitness. J Sport Sci ISSN 1988;6:93–101. https://doi.org/10.1080/02640418808729800.Search in Google Scholar

27. Preacher, K, Hayes, A. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 2008;40:879–91. https://doi.org/10.3758/BRM.40.3.879.Search in Google Scholar

28. Sobel, E. Asymptotic confidence intervals for indirect effects in structural equation models. Sociol Methodol 2014;13:290–312.10.2307/270723Search in Google Scholar

29. Wang, Y, Lim, H. The global childhood obesity epidemic and the association between socio-economic status and childhood obesity. Int Rev Psychiatry 2012;24:176–88. https://doi.org/10.3109/09540261.2012.688195.Search in Google Scholar

30. Kimm, S, Obarzanek, E. Childhood obesity: a new pandemic of the new millennium. Pediatrics 2002;110:1003–7.10.1542/peds.110.5.1003Search in Google Scholar

31. GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990 – 2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1659-724. https://doi.org/10.1016/S0140-6736(16)31679-8.Search in Google Scholar

32. Kim, J, Lee, I, LIm, S. Overweight or obesity in children aged 0 to 6 and the risk of adult metabolic-syndrome: a systematic review and meta-analysis. J Clin Nurs 2017;26:3869–80. https://doi.org/10.1111/ijlh.12426.Search in Google Scholar PubMed

33. Castro-Piñero, J, Laurson, K, Artero, E, Ortega, FB, Labayen, I, Ruperez, AI, et al.. Muscle strength field-based tests to identify European adolescents at risk of metabolic syndrome: the HELENA study. J Sci Med Sport 2019. https://doi.org/10.1016/j.jsams.2019.04.008.Search in Google Scholar PubMed

34. Goodman, E, Daniels, S, Morrison, J, Huang, B, Dolan, L. The world health organization and national cholesterol education program adult treatment panel III definitions of metabolic syndrome among adolescents. J Pediatr 2004;145:445–51.10.1016/j.jpeds.2004.04.059Search in Google Scholar PubMed

35. Bornhorst, C, Russo, P, Veidebaum, T, Tornaritis, M, Molnar, D, Lissner, L, et al.. Metabolic status in children and its transitions during childhood and adolescence — the IDEFICS/I. Family study. Int J Epidemiol 2019;48:1673–83. https://doi.org/10.1093/ije/dyz097.Search in Google Scholar PubMed

36. Mancini, M. Diabetology & Metabolic Syndrome Metabolic syndrome in children and adolescents - criteria for diagnosis. Diabetol Metab Syndr 2009;1:1–4. https://doi.org/10.1186/1758-5996-1-20.Search in Google Scholar PubMed PubMed Central

37. Kelishadi, R, Mirmoghtadaee, P, Najafi, H, Keikh, M. Systematic review on the association of abdominal obesity in children and adolescents with cardio-metabolic risk factors. J Res Med Sci 2105;20:294–307.Search in Google Scholar

38. Markovic-Jovanovic, S, Stolic, R, Jovanovic, A. The reliability of body mass index in the diagnosis of obesity and metabolic risk in children. J Pediatr Endocr Met 2015;28:515–23. https://doi.org/10.1515/jpem-2014-0389.Search in Google Scholar PubMed

39. Franco, O, Massaro, J, Civi, J, Cobain, M, Malley, B, Agostino, R. Epidemiology and prevention the Framingham Heart Study. Circulation 2009;120:1943–50. https://doi.org/10.1161/CIRCULATIONAHA.109.855817.Search in Google Scholar PubMed

40. Fairchild, TJ, Klakk, H, Heidemann, M, Andersen, LB, Wedderkopp, N. Exploring the relationship between adiposity and fitness in young children. Med Sci Sport Exerc 2016;48:1708–14. https://doi.org/10.1249/MSS.0000000000000958.Search in Google Scholar PubMed

41. Pojskic, H, Eslami, B, Clemente, FM. Relationship between obesity, physical activity, and cardiorespiratory fitness levels in children and adolescents in Bosnia and Herzegovina. An analysis of gender differences. 2018;9:1–11. https://doi.org/10.3389/fphys.2018.01734.Search in Google Scholar PubMed PubMed Central

Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/jpem-2020-0640).

Received: 2020-11-07
Accepted: 2021-04-12
Published Online: 2021-06-23
Published in Print: 2021-08-26

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/jpem-2020-0640
Keywords for this article
cardiometabolic; disease; health behaviours; mediation analysis; prevalence; school

Articles in the same Issue

  1. Frontmatter
  2. Original Articles
  3. Clinical characteristics and treatment patterns with histrelin acetate subcutaneous implants vs. leuprolide injections in children with precocious puberty: a real-world study using a US claims database
  4. High serum neurotensin level in obese adolescents is not associated with metabolic parameters, hyperphagia or food preference
  5. Increased lipocalin 2 levels in adolescents with type 2 diabetes mellitus
  6. Clinical, biochemical, and radiological follow-up results of children and adolescents with Hashimoto’s thyroiditis: a single-center experience
  7. Evaluation of children with type 1 diabetes mellitus in terms of overweight/obesity in tertiary care hospital
  8. Association between anthropometric measures and insulin resistance in Brazilian adolescents: data from the national study of cardiovascular risk factors in adolescents – ERICA
  9. Evaluation of metabolic parameters and aortic elasticity in normotensive children with premature adrenarche
  10. Molecular and clinical findings of Turkish patients with hereditary fructose intolerance
  11. Quantitation and evaluation of perinatal medium-chain and long-chain acylcarnitine blood concentrations in 12,000 full-term breastfed newborns
  12. Metabolic syndrome and cardiorespiratory fitness in children and adolescents: the role of obesity as a mediator
  13. Short Communication
  14. Transient neonatal hyperinsulinism: early predictors of duration
  15. Case Reports
  16. An extremely high blood glucose level in a child with hyperglycemic hyperosmolar state and type 1 diabetes
  17. Different clinical entities of the same mutation: a case report of three sisters with Wolfram syndrome and efficacy of dipeptidyl peptidase-4 inhibitor therapy
  18. Short report: craniosynostosis, a late complication of nutritional rickets
  19. Childhood obesity as a safeguarding issue: positive experiences with the “new home” environment as a treatment for weight management
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