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. 2024 May 15:15:1361447.
doi: 10.3389/fendo.2024.1361447. eCollection 2024.

Cardiorespiratory fitness attenuates the association between fatness and cardiometabolic risk in Chinese children

Ping-Ping Zhang #  1 , You-Xin Wang #  2 , Jia-Yin Gu  3 , Miao Xu  3 , Ye Zhou  3 , Hai-Jun Wang  2 , Patrick W C Lau  4   5 , Hui Wang  2 , Li Li  3
Affiliations

Cardiorespiratory fitness attenuates the association between fatness and cardiometabolic risk in Chinese children

Ping-Ping Zhang et al. Front Endocrinol (Lausanne). .

Abstract

Background: Childhood obesity tends to persist into adulthood, predisposing individuals to cardiometabolic risk (CMR). This study aims to investigate the mediating role of cardiorespiratory fitness (CRF) in the associations between multiple fatness indicators and individual CMR markers and clustered CMR-score, and explore sex differences.

Methods: We recruited 1,557 children (age: 8 to 10, male/female: 52.7%/47.3%) in September 2022 in Ningbo, China. Physical examinations, overnight fasting blood test, and CRF was evaluated. The CMR-score was calculated by summing age- and sex-specific z scores of four CMR markers, including mean arterial blood pressure, triglycerides, the total cholesterol to high-density lipoprotein cholesterol ratio, and homeostatic model assessment for insulin resistance. Generalized linear mixed models were used to identify the associations, mediation analyses were performed to dissect the function of CRF.

Results: Partial correlation analyses revealed positive associations between high fatness indicators (including body mass index [BMI], BMI z score, body fat mass index [BFMI] and waist-to-height ratio [WHtR]) and increased CMR markers, whereas high CRF was associated with decreased CMR markers (all P < 0.05). In the mediation analyses, CRF emerged as a partial mediator, attenuating the relationship between four fatness indicators and CMR-score. Specifically, CRF mediated 6.5%, 7.7%, 5.3%, and 12.5% of the association between BMI, BMI z score, BFMI, WHtR and CMR-score (all P < 0.001). And the mediating effects of CRF between WHtR and four individual CMR markers was particularly robust, ranging from 10.4% to 21.1% (all P < 0.05). What's more, CRF mediates the associations between WHtR and CMR-score more pronounced in girls than boys with a mediation effect size of 17.3% (P < 0.001).

Conclusion: In Chinese children, CRF partially mitigates the adverse effects of fatness on CMR, underscoring the significance of enhancing CRF in children.

Keywords: children; fitness; mediator; metabolism; obesity.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Flowchart for the selection of the study population.
Figure 2
Figure 2
The mediation model pattern. The meaning of the lowecase letters were: c means the total effect, c’ means the direct effect, ab means the indirect effect.
Figure 3
Figure 3
Mediation analysis. Contribution of CRF on the associations of fatness indicators and CMR-score. (A) The mediation between BMI and CMR-score; (B) The mediation between BMI z score and CMR-score; (C) The mediation between BFMI and CMR-score; (D) The mediation between WHtR and CMR-score. The meaning of the lowecase letters were: c means the total effect, c’ means the direct effect, ab means the indirect effect.
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