Ideal Cardiovascular Health and Abdominal Obesity in a Biracial Sample... D.M. Harrington & P.T. Katzmarzyk BACKGROUND:

Ideal Cardiovascular Health and Abdominal Obesity in a Biracial Sample of Children
D.M. Harrington & P.T. Katzmarzyk
Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA
BACKGROUND:
Ideal Cardiovascular (CV) Health is the American Heart Association (AHA)
definition of CV health and is made up of 7 metrics. One of the AHA 2020
Impact Goals is to improve the CV health of all Americans by 20% (LloydJones et al., 2010). The individual metrics are well supported in the
literature but the degree to which Ideal CV Health is related to adiposity in
specific body depots in children is unknown.
Aim:
Table 1. AHA Ideal Cardiovascular Health and it’s measurement and prevalence in the present
study
AHA Criteria
Current
Smoking
Sample: The sample consisted of 363 children from age 5 to 18 years (94
White males, 78 African American males, 80 White females, and 111
African American females) who did not report any past cardiovascular
related diagnoses. Mean BMI percentile for the same was 73rd (SD: 28).
MRI: Abdominal VAT and SAT masses were measured by MRI (GE Signa
Excite 3.0Tesla, GE Medical Systems, Milwaukee, WI). A series of scans
from the highest point of the liver to the bottom pole of the right kidney
were acquired. Images were analyzed using the Analyze® software
package (CNSoftware, Rochester, MN).
DXA: A whole body dual energy X-ray absorptiometry (DXA) scanner
(Hologic QDR 4500, Bedford, MA) was used to quantify participant’s TBF
mass. Scans were analyzed with QDR for Windows V.11.2.
Ideal CV Health: The 7 Ideal Cardiovascular Health metrics, and how they
was assessed herein are reported in Table 1.
Statistical Analysis: VAT, SAT and TBF were regressed against age for
each sex by race group. These sex- and race-specific residuals were
divided into quartiles to represent age-adjusted adiposity levels. The
highest quartile represented the “at-risk” group.
Logistic regression, controlling for age and race, was used to calculate
odds ratios (OR). ≥ 5 Ideal CV Health criteria was used as the reference.
Each OR was converted to a relative risk as per Zhang & Yu (1998).
Never tried; never smoked a whole
cigarette
Physical Activity ≥ 60 mins MVPA every day
Healthy Diet
Score
The aim was to investigate how Ideal CV Health relates to abdominal
visceral (VAT) and subcutaneous (SAT) adipose tissue and total body fat
(TBF), with and without including BMI as a criterion.
METHODS:
AHA Definition
Body Mass
Index
Defined in the
Source
Analysis
Answered no to ‘Do you Self-report
smoke or use tobacco’ questionnaire‡
4 - 5 Components
1. Fruits and Vegetables,
2. Fish,
3. Fiber rich whole grains,
4. Sweets and sugar sweetened
beverages,
5. Sodium
7 days active ≥
60mins/day
4 - 5 Components
1. Fruit and Vegetables,
2. Fish,
3. Brown bread,
4. Soft drinks, sweets,
cakes
5. N/A
Self-report
questionnaire‡
Self-report Food
Frequency
questionnaire‡
< 85th percentile
<85th percentile
Height and
weight in
duplicate
Measured
Fasting
Measured
sitting quietly, in
duplicate
Measured
Fasting
Total
< 170 mg/dL (untreated)
Cholesterol
Blood pressure < 90th percentile (untreated)
Fasting Plasma < 100 mg/dL (untreated)
Glucose
‡ With parental assistance if necessary
< 170 mg/dL
Both SBP and DBP <
90th percentile
< 100 mg/dL
Prevalence
of Ideal
99%
VAT
SAT
TBF
RR
15.3 (8.6-21.4)
RR
(BMI Excluded)
1.6 (0.8-2.7)
4
10.1 (4.9-16.8)
1.1 (0.4-2.0)
≥5
1.0
1.0
≤3
18.7 (9.7-27.0)
2.0 (0.8-3.4)
1.4 (0.6-2.8)
4
13.1 (5.9-22.2)
≥5
1.0
1.0
≤3
18.4 (9.5-26.8)
2.0 (0.8-3.4)
4
12.9 (5.8-22.0)
1.4 (0.5-2.7)
≥5
1.0
1.0
[email protected]
A total of 24.2% (88/363) of the sample had ≤ 3, 36.4%
(132/363) had 4, and 39.4% (143/363) had ≥ 5 Ideal Health
criteria. Prevalence of the Ideal level of each metric can
be found in Table 1.
9%
2%
53%
63%
93%
96%
Table 2 Relative risks (RR) for the prediction of the upper quartile of adiposity
measures from the number of Ideal Health criteria
Number of Ideal
Health Criteria
≤3
RESULTS :
White participants possessed more metrics (χ2=17.7;
p=0.001) than African Americans but there were no sex
differences evident (χ2 =1.0; p= 0.91).
Those with fewer Ideal Health metrics had a significantly
greater risk of having high abdominal VAT, SAT and TBF
(Table 2). Once BMI was removed as a metric, due to its
high correlation with adiposity, the RR estimates were
substantially reduced.
CONCLUSIONS:
A lower number of Ideal criteria was related to higher
abdominal and total adiposity. While it appears that a
large part of the association can be explained by BMI, a
substantial increase in risk exists for those with ≤ 3 Ideal
criteria. These data lend support to the American Heart
Association’s Ideal CV Health. Individuals should be
supported in increasing the number of Ideal criteria they
possess.
ACKNOWLEDGEMENT:
The authors wish to thank Dr. Alok Gupta, Dr. Stephanie
Broyles and Dr. Amanda Staiano. This work was
supported by grant # NIH-NIDDK-1RC1DK086881-01 and
by a Nutrition Obesity Research Center (NIH2P30DK072476) grant from the National Institutes of
Health. clinicaltrials.gov registration# NCT01595100
REFERENCES:
• Lloyd-Jones, et al. Circulation. 2010: 121(4); 586-613
• Zhang & Yu. JAMA.1998:280(19); 1690-91