Nutr Res Pract.  2015 Aug;9(4):404-410. 10.4162/nrp.2015.9.4.404.

Is the association of continuous metabolic syndrome risk score with body mass index independent of physical activity? The CASPIAN-III study

• Heshmat R
• Shafiee G
• Kelishadi
• Babaki AE
• Motlagh ME
• Arefirad T
• Ardalan G
• Ataie-Jafari A
• Asayesh H
• Mohammadi
• Qorbani M

• KMID: 2313858
• DOI: http://doi.org/10.4162/nrp.2015.9.4.404

Abstract

BACKGROUND/OBJECTIVES
Although the association of body mass index (BMI) with metabolic syndrome (MetS) is well documented, there is little knowledge on the independent and joint associations of BMI and physical activity with MetS risk based on a continuous scoring system. This study was designed to explore the effect of physical activity on interactions between excess body weight and continuous metabolic syndrome (cMetS) in a nationwide survey of Iranian children and adolescents.
SUBJECTS/METHODS
Data on 5,625 school students between 10 and 18 years of age were analyzed. BMI percentiles, screen time activity (STA), leisure time physical activity (LTPA) levels, and components of cMetS risk score were extracted. Standardized residuals (z-scores) were calculated for MetS components. Linear regression models were used to study the interactions between different combinations of cMetS, LTPA, and BMI percentiles.
RESULTS
Overall, 984 (17.5%) subjects were underweight, whereas 501 (8.9%) and 451 (8%) participants were overweight and obese, respectively. All standardized values for cMetS components, except fasting blood glucose level, were directly correlated with BMI percentiles in all models (P-trend < 0.001); these associations were independent of STA and LTPA levels. Linear associations were also observed among LTPA and standardized residuals for blood pressure, high-density lipoprotein, and waist circumference (P-trend < 0.01).
CONCLUSIONS
Our findings suggest that BMI percentiles are associated with cMetS risk score independent of LTPA and STA levels.

Keyword

BMI; metabolic syndrome; physical activity

MeSH Terms

Adolescent
Blood Glucose
Blood Pressure
Body Mass Index*
Body Weight
Child
Fasting
Humans
Joints
Leisure Activities
Linear Models
Lipoproteins
Motor Activity*
Overweight
Thinness
Waist Circumference
Blood Glucose
Lipoproteins

Reference

1. Reppert A, Steiner BF, Chapman-Novakofski K. Prevalence of metabolic syndrome and associated risk factors in Illinois. Am J Health Promot. 2008; 23:130–138.

2. Day C. Metabolic syndrome, or What you will: definitions and epidemiology. Diab Vasc Dis Res. 2007; 4:32–38.

3. Nguyen NT, Magno CP, Lane KT, Hinojosa MW, Lane JS. Association of hypertension, diabetes, dyslipidemia, and metabolic syndrome with obesity: findings from the National Health and Nutrition Examination Survey, 1999 to 2004. J Am Coll Surg. 2008; 207:928–934.

4. Mehrkash M, Kelishadi R, Mohammadian S, Mousavinasab F, Qorbani M, Hashemi ME, Asayesh H, Poursafa P, Shafa N. Obesity and metabolic syndrome among a representative sample of Iranian adolescents. Southeast Asian J Trop Med Public Health. 2012; 43:756–763.

5. Khashayar P, Heshmat R, Qorbani M, Motlagh ME, Aminaee T, Ardalan G, Farrokhi-Khajeh-Pasha Y, Taslimi M, Larijani B, Kelishadi R. Metabolic syndrome and cardiovascular risk factors in a national sample of adolescent population in the Middle East and North Africa: the CASPIAN III Study. Int J Endocrinol. 2013; 2013:702095.

6. Kahn R, Buse J, Ferrannini E, Stern M. American Diabetes Association. European Association for the Study of Diabetes. The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2005; 28:2289–2304.

7. Tentolouris N, Papazafiropoulou A, Moyssakis I, Liatis S, Perrea D, Kostakis M, Katsilambros N. Metabolic syndrome is not associated with reduction in aortic distensibility in subjects with type 2 diabetes mellitus. Cardiovasc Diabetol. 2008; 7:1.

8. Eisenmann JC. Aerobic fitness, fatness and the metabolic syndrome in children and adolescents. Acta Paediatr. 2007; 96:1723–1729.

9. Wijndaele K, Beunen G, Duvigneaud N, Matton L, Duquet W, Thomis M, Lefevre J, Philippaerts RM. A continuous metabolic syndrome risk score: utility for epidemiological analyses. Diabetes Care. 2006; 29:2329.

10. Ragland DR. Dichotomizing continuous outcome variables: dependence of the magnitude of association and statistical power on the cutpoint. Epidemiology. 1992; 3:434–440.

11. Klein BE, Klein R, Lee KE. Components of the metabolic syndrome and risk of cardiovascular disease and diabetes in Beaver Dam. Diabetes Care. 2002; 25:1790–1794.

12. Katzmarzyk PT, Pérusse L, Malina RM, Bergeron J, Després JP, Bouchard C. Stability of indicators of the metabolic syndrome from childhood and adolescence to young adulthood: the Québec Family Study. J Clin Epidemiol. 2001; 54:190–195.

13. Andersen LB, Harro M, Sardinha LB, Froberg K, Ekelund U, Brage S, Anderssen SA. Physical activity and clustered cardiovascular risk in children: a cross-sectional study (The European Youth Heart Study). Lancet. 2006; 368:299–304.

14. Brage S, Wedderkopp N, Ekelund U, Franks PW, Wareham NJ, Andersen LB, Froberg K. European Youth Heart Study (EYHS). Features of the metabolic syndrome are associated with objectively measured physical activity and fitness in Danish children: the European Youth Heart Study (EYHS). Diabetes Care. 2004; 27:2141–2148.

15. Eisenmann JC, Katzmarzyk PT, Perusse L, Tremblay A, Després JP, Bouchard C. Aerobic fitness, body mass index, and CVD risk factors among adolescents: the Québec Family Study. Int J Obes (Lond). 2005; 29:1077–1083.

16. Raitakari OT, Porkka KV, Räsänen L, Rönnemaa T, Viikari JS. Clustering and six year cluster-tracking of serum total cholesterol, HDL-cholesterol and diastolic blood pressure in children and young adults. The Cardiovascular Risk in Young Finns Study. J Clin Epidemiol. 1994; 47:1085–1093.

17. Okosun IS, Lyn R, Davis-Smith M, Eriksen M, Seale P. Validity of a continuous metabolic risk score as an index for modeling metabolic syndrome in adolescents. Ann Epidemiol. 2010; 20:843–851.

18. Eisenmann JC, Laurson KR, DuBose KD, Smith BK, Donnelly JE. Construct validity of a continuous metabolic syndrome score in children. Diabetol Metab Syndr. 2010; 2:8.

19. Liu W, Lin R, Liu A, Du L, Chen Q. Prevalence and association between obesity and metabolic syndrome among Chinese elementary school children: a school-based survey. BMC Public Health. 2010; 10:780.

20. Okosun IS, Boltri JM, Lyn R, Davis-Smith M. Continuous metabolic syndrome risk score, body mass index percentile, and leisure time physical activity in American children. J Clin Hypertens (Greenwich). 2010; 12:636–644.

21. Kelishadi R, Heshmat R, Motlagh ME, Majdzadeh R, Keramatian K, Qorbani M, Taslimi M, Aminaee T, Ardalan G, Poursafa P, Larijani B. Methodology and early findings of the third survey of CASPIAN Study: a national school-based surveillance of students' high risk behaviors. Int J Prev Med. 2012; 3:394–401.

22. McNamara JR, Schaefer EJ. Automated enzymatic standardized lipid analyses for plasma and lipoprotein fractions. Clin Chim Acta. 1987; 166:1–8.

23. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, Mei Z, Curtin LR, Roche AF, Johnson CL. CDC growth charts: United States. Adv Data. 2000; 1–27.

24. Kelishadi R, Ardalan G, Gheiratmand R, Majdzadeh R, Hosseini M, Gouya MM, Razaghi EM, Delavari A, Motaghian M, Barekati H, Mahmoud-Arabi MS, Lock K. Caspian Study Group. Thinness, overweight and obesity in a national sample of Iranian children and adolescents: CASPIAN Study. Child Care Health Dev. 2008; 34:44–54.

25. Ziaoddini H, Kelishadi R, Kamsari F, Mirmoghtadaee P, Poursafa P. First nationwide survey of prevalence of weight disorders in Iranian children at school entry. World J Pediatr. 2010; 6:223–227.

26. The Australian College of Paediatrics. Policy statement. Children's television. J Paediatr Child Health. 1994; 30:6–8.

27. Strong WB, Malina RM, Blimkie CJ, Daniels SR, Dishman RK, Gutin B, Hergenroeder AC, Must A, Nixon PA, Pivarnik JM, Rowland T, Trost S, Trudeau F. Evidence based physical activity for school-age youth. J Pediatr. 2005; 146:732–737.

28. Kelishadi R, Majdzadeh R, Motlagh ME, Heshmat R, Aminaee T, Ardalan G, Esmaillzadeh A, Azadbakht L, Poursafa P, Movahedian M, Baraz S. Development and evaluation of a questionnaire for assessment of determinants of weight disorders among children and adolescents: the Caspian-IV Study. Int J Prev Med. 2012; 3:699–705.

29. Shafiee G, Kelishadi R, Heshmat R, Qorbani M, Motlagh ME, Aminaee T, Ardalan G, Taslimi M, Poursafa P, Larijani B. First report on the validity of a continuous Metabolic syndrome score as an indicator for Metabolic syndrome in a national sample of paediatric population - the CASPIAN-III study. Endokrynol Pol. 2013; 64:278–284.

30. Alberti KG, Zimmet P, Shaw J. IDF Epidemiology Task Force Consensus Group. The metabolic syndrome--a new worldwide definition. Lancet. 2005; 366:1059–1062.

31. Pahkala K, Heinonen OJ, Lagström H, Hakala P, Hakanen M, Hernelahti M, Ruottinen S, Sillanmäki L, Rönnemaa T, Viikari J, Raitakari OT, Simell O. Clustered metabolic risk and leisure-time physical activity in adolescents: effect of dose? Br J Sports Med. 2012; 46:131–137.

32. Pahkala K, Hernelahti M, Heinonen OJ, Raittinen P, Hakanen M, Lagström H, Viikari JS, Rönnemaa T, Raitakari OT, Simell O. Body mass index, fitness and physical activity from childhood through adolescence. Br J Sports Med. 2013; 47:71–77.

33. Guillaume M, Lapidus L, Björntorp P, Lambert A. Physical activity, obesity, and cardiovascular risk factors in children. The Belgian Luxembourg Child Study II. Obes Res. 1997; 5:549–556.

34. Hajian-Tilaki K, Heidari B. Prevalences of overweight and obesity and their association with physical activity pattern among Iranian adolescents aged 12-17 years. Public Health Nutr. 2012; 15:2246–2252.

35. Liu J, Bennett KJ, Harun N, Probst JC. Urban-rural differences in overweight status and physical inactivity among US children aged 10-17 years. J Rural Health. 2008; 24:407–415.

36. Kelishadi R, Razaghi EM, Gouya MM, Ardalan G, Gheiratmand R, Delavari A, Motaghian M, Ziaee V, Siadat ZD, Majdzadeh R, Heshmat R, Barekati H, Arabi MS, Heidarzadeh A, Shariatinejad K. CASPIAN Study Group. Association of physical activity and the metabolic syndrome in children and adolescents: CASPIAN Study. Horm Res. 2007; 67:46–52.

37. Holloszy JO, Hansen PA. Regulation of glucose transport into skeletal muscle. Rev Physiol Biochem Pharmacol. 1996; 128:99–193.

38. Goodyear LJ, Kahn BB. Exercise, glucose transport, and insulin sensitivity. Annu Rev Med. 1998; 49:235–261.

39. Rana JS, Li TY, Manson JE, Hu FB. Adiposity compared with physical inactivity and risk of type 2 diabetes in women. Diabetes Care. 2007; 30:53–58.

40. Hu G, Lindström J, Valle TT, Eriksson JG, Jousilahti P, Silventoinen K, Qiao Q, Tuomilehto J. Physical activity, body mass index, and risk of type 2 diabetes in patients with normal or impaired glucose regulation. Arch Intern Med. 2004; 164:892–896.

41. Sullivan PW, Morrato EH, Ghushchyan V, Wyatt HR, Hill JO. Obesity, inactivity, and the prevalence of diabetes and diabetes-related cardiovascular comorbidities in the U.S., 2000-2002. Diabetes Care. 2005; 28:1599–1603.

42. Visser M, Bouter LM, McQuillan GM, Wener MH, Harris TB. Elevated C-reactive protein levels in overweight and obese adults. JAMA. 1999; 282:2131–2135.

43. Grundy SM. Obesity, metabolic syndrome, and coronary atherosclerosis. Circulation. 2002; 105:2696–2698.

44. Kasapis C, Thompson PD. The effects of physical activity on serum C-reactive protein and inflammatory markers: a systematic review. J Am Coll Cardiol. 2005; 45:1563–1569.

45. Mora S, Lee IM, Buring JE, Ridker PM. Association of physical activity and body mass index with novel and traditional cardiovascular biomarkers in women. JAMA. 2006; 295:1412–1419.

46. McGuire KA, Ross R. Sedentary behavior is not associated with cardiometabolic risk in adults with abdominal obesity. PLoS One. 2011; 6:e20503.

47. Ekelund U, Brage S, Griffin SJ, Wareham NJ. ProActive UK Research Group. Objectively measured moderate- and vigorous-intensity physical activity but not sedentary time predicts insulin resistance in high-risk individuals. Diabetes Care. 2009; 32:1081–1086.