Associações longitudinais entre aptidão cardiorrespiratória, adiposidade e risco cardiometabólico em crianças e adolescentes.

Abstract

Introduction: Chronic diseases are the leading cause of disability and mortality in the world and there is evidence supporting that its development starts during childhood and adolescence. The excess weight may be a great risk factor for developing cardiometabolic risk factors. Conversely, there are those who suggest that a better cardiorespiratory fitness (CRF) level can attenuate adverse outcomes associated with excess weight. Objective: To evaluate the separate mediating roles of CRF and adiposity in the possible association with clustered cardiometabolic risk score (cMetS) across a 3-year time span. Manuscript 1: Objectives: (01) To analyze the tracking of cardiometabolic risk factors and cMetS in children and adolescents across a 3-year time span; (02) To verify the odds of staying at higher risk (measured by the cMetS) across a 3-year time span. Method: Observational longitudinal study that included 354 (155 boys; 43.8%) children and adolescents, 7-12 years of age at baseline. A cMetS was calculated by summing the waist circumference, glucose, systolic blood pressure, triglycerides, and the total cholesterol and high-density lipoprotein cholesterol ratio Z-scores divided by five. A second cMetS was calculated including CRF (peak oxygen uptake [VO2peak]; inverted) Z-score, but divided by six. Tracking coefficients (r) for cardiometabolic risk factors and the cMetS were calculated using the Spearman correlation test. Additionally, odds ratios of being at higher risk at follow-up and 95% confidence intervals (CI) according to baseline levels of cMetS, CRF, and adiposity were calculated. Results: CRF and adiposity anthropometric parameters (waist circumference, body mass index [BMI], and sum of skinfolds) presented high tracking (r≥0.662), whereas the other cardiometabolic parameters exhibited low-to-moderate tracking (0.100≤r≤0.571). Tracking was moderate for the cMetS (r≥0.508 without VO2peak; r≥0.588 with VO2peak). Participants in the higher clustered risk group (less favorable) at baseline presented 3.81 (95% CI: 2.40 to 6.05) and 4.64 (95% CI: 2.85 to 7.56) times higher chance of remaining in the higher risk group three years later (without and with VO2peak in the score, respectively). Moreover, participants at risk and in the worst profile regarding anthropometrics or CRF at baseline presented at least 4.00 times higher chance of being in the higher clustered risk group three years later. Conclusion: CRF and adiposity anthropometric parameters presented high tracking. Further, participants with less favorable CRF and adiposity had an increased risk of presenting higher clustered cardiometabolic risk after three years of follow-up. Manuscript 2: Objectives: (01) To evaluate if CRF and adiposity at baseline are associated with the cardiometabolic risk at follow-up; (02) To evaluate the separate mediating roles of CRF and adiposity in the possible association with cMetS. Method: Observational longitudinal study that included 420 (184 boys; 43.8%) children and adolescents, 7-15 years of age at baseline. BMI and CRF were evaluated, the later using an indirect submaximal exercise test, assessed in meters, with subsequent conversion into VO2peak. A cMetS was calculated by summing the glucose, systolic blood pressure, triglycerides, and the total cholesterol and high-density lipoprotein cholesterol ratio Z-scores divided by four. Mediations analyses evaluated the role of BMI in the association between CRF and cMetS, and whether CRF mediated the association between BMI and cMetS. Results: CRF and BMI at baseline were longitudinally associated, either directly or indirectly, with the cMetS at follow-up. also, 59.3% of the association between CRF and cMetS was explained via the mediation role of BMI, whereas, 24.6% of the association between BMI and cMetS was explained via the mediation role of CRF. Conclusion: CRF and BMI present a reciprocal longitudinal relationship, also acting as mediators in the relationships with cardiometabolic risk profile. Final considerations: Both CRF and adiposity should be considered to improve the cardiometabolic health profile in childhood, adolescence, and later in life. Future intervention studies aiming at decreasing the cardiometabolic risk profile in children and adolescents need to account for this possible mutual causal chain between CRF and adiposity in relation to the cardiometabolic risk profile.