Cardiometabolic risk through an integrative classification combining physical activity and sedentary behavior in European adolescents: HELENA study

Abstract

Purpose: This study aims to compare adolescents' cardiometabolic risk score through an integrative classification of physical activity (PA), which involves the combination of moderate-to-vigorous physical activity (MVPA) and sedentary behavior (SB).

Methods: A cross-sectional study derived from the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study database (2006-2008) was conducted in adolescents (n = 548; boys, 47.3%; 14.7 ± 1.2 years) from 10 European cities. MVPA and SB were objectively measured using accelerometry. Adolescents were divided into 4 categories according to MVPA (meeting or not meeting the international recommendations) and the median of SB time (above or below sex- and age-specific median) as follows: High-SB & Inactive, Low-SB & Inactive, High-SB & Active, and Low-SB & Active. A clustered cardiometabolic risk score was computed using the homeostatic model assessment, systolic blood pressure, triglycerides, total cholesterol/high-density lipoprotein cholesterol, sum 4 skinfolds, and cardiorespiratory fitness (CRF). Analyses of covariance were performed to discern differences on cardiometabolic risk scores among PA categories and each health component.

Results: The cardiometabolic risk score was lower in adolescents meeting the MVPA recommendation and with less time spent in SB in comparison to the high-SB & Inactive group (p < 0.05). However, no difference in cardiometabolic risk score was established between High-SB or Low-SB groups in inactive adolescents. It is important to note that CRF was the only variable that showed a significant modification (higher) when children were compared from the category of physically inactive with "active" but not from high- to low-SB.

Conclusion: Being physically active is the most significant and protective outcome in adolescents to reduce cardiometabolic risk. Lower SB does not exhibit a significant and extra beneficial difference.

Keywords: Accelerometry; Cardiovascular disease; Exercise; Metabolic disease; Sedentary lifestyles.

Fig. 1

Comparison across 4 categories (High-SB & Inactive (n = 177), Low-SB & Inactive (n = 135), High-SB & Active (n = 95), and Low-SB & Active (n = 141)) for the 6 health parameters composing the cardiometabolic risk score. All values are mean ± SD. Nontransformed data are presented, but statistical analyses were performed on log-transformed data. Analysis of covariance adjusted for age, sex, body mass index, accelerometer wear time, and study center (random factor). Bonferroni post hoc analysis was used. *p < 0.05, **p < 0.001 compared with High-SB & Active group. CRF = cardiorespiratory fitness; HOMA = homeostasis model assessment; SB = sedentary behavior; SBP = systolic blood pressure; TC/HDL = ratio between total cholesterol and high-density lipoprotein. TG = triglycerides.

Fig. 2

Differences in cardiometabolic risk score across 4 categories (High-SB & Inactive (n = 177), Low-SB & Inactive (n = 135), High-SB & Active (n = 95), and Low-SB & Active (n = 141)). All values are mean ± SD. Nontransformed data are presented, but statistical analyses were performed on log-transformed data. Analysis of covariance adjusted for age, sex, body mass index, accelerometer wear time, and study (random factor). *p < 0.01, **p < 0.001 compared with High-SB & Inactive group. Bonferroni post hoc analysis was used. SB = sedentary behavior.