Ideal Cardiovascular Health and Adiposity: Implications in Youth

Amber L Fyfe-Johnson, Justin R Ryder, Alvaro Alonso, Richard F MacLehose, Kyle D Rudser, Claudia K Fox, Amy C Gross, Aaron S Kelly, Amber L Fyfe-Johnson, Justin R Ryder, Alvaro Alonso, Richard F MacLehose, Kyle D Rudser, Claudia K Fox, Amy C Gross, Aaron S Kelly

Abstract

Background: The American Heart Association set 2020 Strategic Impact Goals that defined cardiovascular risk factors to be included in the concept of ideal cardiovascular health (ICH). The prevalence of ICH among differing levels of adiposity in youth, especially severe obesity, is uncertain.

Methods and results: The cross-sectional study measured ICH metrics in 300 children and adolescents stratified by adiposity: normal weight, overweight/obese, and severely obese. ICH incorporates 7 behavioral and health metrics, and was characterized as poor, intermediate, or ideal. Individual ICH metrics were transformed into standardized sample z-scores; a summary ICH sample z-score was also calculated. Multivariable linear regression models were used to estimate differences in ICH sample z-scores by adiposity status. Of the 300 participants, 113 were classified as having normal weight, 87 as having overweight/obesity, and 100 as having severe obesity (mean age 12.8 years, SD 2.7; 48% female). No participants met the criteria for ICH; 80% of those classified as having normal weight, 81% of those with overweight/obesity, and all of those with severe obesity were in poor cardiovascular health. After multivariable adjustment, those with overweight/obesity (sample z-score: -1.35; 95% confidence interval, -2.3, -1.1) and severe obesity (sample z-score: -1.45; 95% confidence interval, -2.9, -0.92) had lower overall ICH sample z-scores compared with participants with normal weight. Results were similar for individual ICH metrics.

Conclusions: Poor cardiovascular health was highly prevalent in youth; ICH sample z-scores increased across levels of adiposity. Youth with obesity, particularly those with severe obesity, remain a rich target for primary prevention efforts.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01508598.

Keywords: adolescence; ideal cardiovascular health; obesity; pediatrics; risk factor.

© 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Figures

Figure 1
Figure 1
Prevalence of number of ideal cardiovascular health (ICH) subcomponents* by adiposity status (n=300). *Those in the OW/OB and SO categories unable to attain 7 ICH components based on adiposity status. Error bars indicate the 95% confidence interval that would be anticipated in the population given the data. OB indicates obese; OW, overweight; SO, severely obese.

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