Body fatness and clustering of cardiovascular disease risk factors in Portuguese children and adolescents.

Modifiable cardiovascular risk factors that increase the risk for cardiovascular diseases (CVD) in adult populations have also been observed in pediatric populations. Childhood and adolescence obesity has been strongly implicated in the clustering of risk factors. The aims of the present study were 1) to examine whether clustering of CVD risk factors, either biological risk factors (high blood pressure (HBP), percentage of high fat mass (%HBF), and high total cholesterol (HTC)) and one behavioral/lifestyle risk factor (low physical activity index (LPAI)) exist, and 2) to analyze the relationship between body fatness and the clustering of other risk factors. The cluster of CVD risk factors was determined in 1,533 (8-15 years of age) children, 731 males (age 10.8 +/- 2.3 years; weight, 40.6 +/- 12.7 kg; height, 143.1 +/- 14.1 cm; BMI, 19.4 +/- 3.4 kg(-2)) and 802 females (age, 11.0 +/- 2.4; weight, 41.0 +/- 12.4; height, 142.8 +/- 13.2; BMI, 19.7 +/- 3.5). Sex- and age-specific "high risk" quartiles were formed for each of the biological risk factors and the lifestyle factor. Thus, for blood pressure (high blood pressure, HBP), cholesterol (high cholesterol, HTC), and obesity (high percent of body fat, HBF), the sex- and age-adjusted 4th quartile (4Q) was defined as the "high risk" quartile, while for physical activity the 1st quartile (1Q) was defined as the "high risk" quartile. The majority of children (62% of boys and 62% of girls) at risk of obesity are at risk of another risk factor. In our sample, estimated ORs indicated that, compared with 1Q, the "risk of obesity" children and adolescents were two times as likely (P < 0.001) to have two or three risk factors. Our results suggest that children 8-15 years old in the highest quartile of body fatness are an increased risk of having a cluster of other risk factors, namely HBP, HTC, and LPAI. These data provide further evidence that juvenile obesity warrants early intervention because the patterns of unhealthy behavior are formed in adolescence and young adulthood. Copyright 2004 Wiley-Liss, Inc.