Body Composition Indices and Single and Clustered Cardiovascular Disease Risk Factors in Adolescents: Providing Clinical-Based Cut-Points

doi:10.1016/j.pcad.2015.11.002

Progress in Cardiovascular Diseases

Volume 58, Issue 5, March–April 2016, Pages 555-564

https://doi.org/10.1016/j.pcad.2015.11.002 Get rights and content

Abstract

The aims of the present study in adolescents were 1) to examine how various body composition-screening tests relate to single and clustered cardiovascular disease (CVD) risk factors, 2) to examine how lean mass and body fatness (independently of each other) relate to clustered CVD risk factors, and 3) to calculate specific thresholds for body composition indices associated with an unhealthier clustered CVD risk. We measured 1089 European adolescents (46.7% boys, 12.5–17.49 years) in 2006–2007. CVD risk factors included: systolic blood pressure, maximum oxygen uptake, homeostasis model assessment, C-reactive protein (n = 748), total cholesterol/high density lipoprotein cholesterol and triglycerides. Body composition indices included: height, body mass index (BMI), lean mass, the sum of four skinfolds, central/peripheral skinfolds, waist circumference (WC), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR). Most body composition indices are associated with single CVD risk factors. The sum of four skinfolds, WHtR, BMI, WC and lean mass are strong and positively associated with clustered CVD risk. Interestingly, lean mass is positively associated with clustered CVD risk independently of body fatness in girls. Moderate and highly accurate thresholds for the sum of four skinfolds, WHtR, BMI, WC and lean mass are associated with an unhealthier clustered CVD risk (all AUC > 0.773). In conclusion, our results support an association between most of the assessed body composition indices and single and clustered CVD risk factors. In addition, lean mass (independent of body fatness) is positively associated with clustered CVD risk in girls, which is a novel finding that helps to understand why an index such as BMI is a good index of CVD risk but a bad index of adiposity. Moderate to highly accurate thresholds for body composition indices associated with a healthier clustered CVD risk were found. Further studies with a longitudinal design are needed to confirm these findings.

Section snippets

Study design and study sample

The current report is based on data derived from the Healthy Lifestyle in Europe by Nutrition in Adolescence cross-sectional study (HELENA-CSS). Participants were recruited at schools in 10 European cities: Stockholm (Sweden), Athens and Heraklion (Greece), Rome (Italy), Zaragoza (Spain), Pecs (Hungary), Ghent (Belgium), Lille (France), Dortmund (Germany) and Vienna (Austria). To ensure that the heterogeneity of social background of the population would be represented, schools were randomly

Results

Table 1 shows descriptive characteristics (mean ± SD) of the study sample. The ANOVA showed that there were no sex differences in age, BMI, WHtR ratio, HOMA-IR index score, TC/HDLc and CVD risk score; however, most variables differed by sex.

Discussion

The main findings of the present study indicate that: i) the majority of the assessed body composition indices are associated with single and clustered CVD risk in adolescents; ii) the sum of four skinfolds, BMI, WHtR, WC and lean mass are the strongest indices associated with clustered CVD risk; iii) lean mass, independently of the sum of four skinfolds (index of BF), is a significant contributing factor of clustered CVD risk in girls; and iv) moderate to highly accurate specific thresholds

Conclusions

Our results support an association between most of the assessed body composition indices and single and clustered CVD risk factors in European adolescents. In addition, lean mass is positively associated with clustered CVD risk independently of BF in girls, which is a novel finding. Finally, moderate to highly accurate specific thresholds associated with an unhealthier clustered CVD risk are provided for the sum of four skinfolds, WHtR, BMI, WC and lean mass in boys and girls.

Statement of conflicts of interest

All authors declare that there are no conflicts of interest.

Acknowledgments

The authors gratefully acknowledge all participating children and adolescents, and their parents and teachers, for their collaboration.

The HELENA project was supported by the European Community Sixth RTD Framework Programme (Contract FOOD-CT-2005-007034). The data for this study were gathered under the aegis of the HELENA project and their further analysis was additionally supported by grants from the Spanish Ministry of Economy and Competitiveness (RYC-2010-05957; RYC-2011-09011), the Spanish

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Citation Excerpt :
However, a cross-sectional study assessing FFM by BIA in 1089 European individuals of similar age described opposite results [31]. This latter study found positive associations between age- and sex-specific measures of FFM and HOMA-IR in boys (r = 0.335) and in girls (r = 0.215), all p < 0.001 [31]; but limitations inherent to the body technique employed may have contributed to inaccurate measurements of FFM. Bioelectrical impedance analysis is highly sensitive to hydration status requiring individuals to be in a euhydrated state [44], a standardized clinical condition hardly obtained in large-scale observational studies.
Skeletal muscle is recognized as a tissue with high metabolic capacity given its key roles in glucose and lipid metabolism. Although low muscle mass has been associated with metabolic disorders in adults, it is not clear if this body composition phenotype is related to metabolic health status earlier in life. In this review, we aim to clarify whether having low muscle mass is associated with increased risk of metabolic dysregulation in the pediatric population. Fifteen original articles investigating the relationship between body composition measures of muscle mass and single or clustered metabolic risk factors in children and adolescents were critically evaluated. Despite a growing body of evidence supporting low muscle mass as a risk factor for metabolic health in children and adolescents, conflicting associations were reported. Differences in body composition techniques, muscle mass indices, and clinical methods used to assess metabolic biomarkers may have contributed to a lack of a consistent conclusion. Moreover, most studies did not control for potential biological and lifestyle confounders. Future studies using precise, reproducible techniques to evaluate body composition and metabolic biomarkers are required to determine the implications of low muscle mass on metabolic health during childhood and adolescence.
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Skeletal muscle plays major roles in metabolism and overall health across the lifecycle. Emerging evidence indicates that prenatal (maternal diet during pregnancy and genetic defects) and postnatal factors (physical activity, hormones, dietary protein, and obesity) influence muscle mass acquisition and strength early in life. As a consequence, low muscle mass and strength contributes to several adverse health outcomes during childhood. Specifically, studies demonstrated inverse associations of muscle mass and strength to single and clustered metabolic risk factors. The literature also consistently reports that low muscle mass and strength are associated with reduced bone parameters during growth, increasing the risk of osteoporosis in old age. Furthermore, muscle mass gains are associated with improved neurodevelopment in the first years of life. Given these negative implications of low muscle mass and strength on health, it is crucial to track muscle mass and strength development from childhood to adolescence. Several body composition techniques are currently available for estimation of muscle mass, all with unique advantages and disadvantages. The value of ultrasound as a technique to measure muscle mass is emerging in pediatric research with potential for translating the research findings to clinical settings. For the assessment of muscle strength, the handgrip strength test has been widely employed but without a standardized protocol. Although further research is needed to define normative data and cut points for the low muscle mass and strength phenotype, the use of such non-invasive medical monitoring is a promising strategy to identify early abnormalities and prevent low muscle mass in adulthood.
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: Statement of Conflict of Interest: see page 563.

¹: All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

View full text

Body Composition Indices and Single and Clustered Cardiovascular Disease Risk Factors in Adolescents: Providing Clinical-Based Cut-Points

Abstract

Section snippets

Study design and study sample

Results

Discussion

Conclusions

Statement of conflicts of interest

Acknowledgments

Lancet

Nutr Metab Cardiovasc Dis

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study

N Engl J Med

Origin of atherosclerosis in childhood and adolescence

Am J Clin Nutr

The relationship between physical fitness and clustered risk, and tracking of clustered risk from adolescence to young adulthood: eight years follow-up in the Danish Youth and Sport Study

Int J Behav Nutr Phys Act

Longitudinal preventive-screening cutoffs for metabolic syndrome in adolescents

Int J Obes (Lond)

Predictive associations between alternative measures of childhood adiposity and adult cardio-metabolic health

Int J Obes (Lond)

Association between body composition and blood pressure in a contemporary cohort of 9-year-old children

J Hum Hypertens

C-reactive protein as a risk factor for coronary heart disease: a systematic review and meta-analyses for the U.S. Preventive Services Task Force

Ann Intern Med

C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis

Lancet

Association of C-reactive protein with cardiovascular disease mortality according to diabetes status: pooled analyses of 25,979 participants from four U.K. prospective cohort studies

Diabetes Care

Design and implementation of the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study

Int J Obes (Lond)

Quality assurance of ethical issues and regulatory aspects relating to good clinical practices in the HELENA Cross-Sectional Study

Int J Obes (Lond)

Physical activity and clustered cardiovascular disease risk factors in young children: a cross-sectional study (the IDEFICS study)

BMC Med

Validation of two automatic devices for self-measurement of blood pressure according to the International Protocol of the European Society of Hypertension: the Omron M6 (HEM-7001-E) and the Omron R7 (HEM 637-IT)

Blood Press Monit

Independent and combined effects of physical activity and sedentary behavior on blood pressure in adolescents: gender differences in two cross-sectional studies

PLoS One