Cardiorespiratory Fitness Associates with Blood Pressure and Metabolic Health of Children—The Arkansas Active Kids Study

ABSTRACT Introduction High blood pressure (HBP) in children causes preclinical damage to the heart and accelerates atherosclerosis. Current pharmacological treatments have limited ability to prevent end-organ damage, particularly that of the kidneys. A contrasting element between adult versus pediatric HPB treatment is the emphasis in adults on exercise regimens that target increments in cardiorespiratory fitness (CRF; peak oxygen consumption [V˙O2peak]). The aim of this study was to evaluate the association of CRF with blood pressure percentiles and blood pressure status in children with normal and excessive adiposity (NA vs EA). An exploratory aim was to measure associations of CRF with (a) other cardiovascular disease risk factors commonly found in children with HBP and (b) kidney function. Methods Children (n = 211) attended one study visit. CRF was measured using an incremental bike test and body composition by dual-energy x-ray absorptiometry. Fat-free mass (FFM) index was calculated as kilograms of FFM per square meter. Multiple logistic and linear regression analyses were used to model the probability of HBP and other variables of interest (plasma lipids, HOMA2-IR, alanine aminotransferase, and estimated glomerular filtration rate) against V˙O2peak. Results CRF interacted with adiposity status in predicting the probability of HBP. Each additional milliliter per minute per FFM index in V˙O2peak decreased the odds of HBP by 8% in the EA group only (odds ratio = 0.92, 95% confidence interval = 0.87–0.99). Systolic and diastolic blood pressure percentiles decreased, and estimated glomerular filtration rate increased with increasing CRF in both adiposity-level groups. HOMA2-IR and alanine aminotransferase decreased with increasing CRF in children with EA only. Conclusions Higher CRF associated with decreased probability of clinical HBP, lower insulin resistance, and improved liver function in children with EA. Yet blood pressure percentiles and kidney function improved with increasing CRF irrespective of adiposity status.

[1]  A. Bhat,et al.  Novel therapeutics for the treatment of hypertension and its associated complications: peptide- and nonpeptide-based strategies , 2021, Hypertension Research.

[2]  J. Weber,et al.  The Arkansas Active Kids Study: Identifying contributing factors to metabolic health and obesity status in prepubertal school-age children , 2020, Nutrition and health.

[3]  M. Hargraves,et al.  The Children , 2020, Bring Now the Angels.

[4]  J. J. Lang,et al.  Establishing modified Canadian Aerobic Fitness Test (mCAFT) cut-points to detect clustered cardiometabolic risk among Canadian children and youth aged 9 to 17 years. , 2020, Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme.

[5]  Z. Kułaga,et al.  Hemodynamic Patterns and Target Organ Damage in Adolescents With Ambulatory Prehypertension , 2019, Hypertension.

[6]  K. Cusi,et al.  Modulation of Insulin Resistance in Nonalcoholic Fatty Liver Disease , 2019, Hepatology.

[7]  J. J. Lang,et al.  The association between physical fitness and health in a nationally representative sample of Canadian children and youth aged 6 to 17 years. , 2019, Health promotion and chronic disease prevention in Canada : research, policy and practice.

[8]  Sander Babby,et al.  Calculator , 1932, Speculum.

[9]  J. Samuels,et al.  Prevalence of Hypertension in Children , 2018, Hypertension.

[10]  W. van Biesen,et al.  The effects of aerobic exercise on eGFR, blood pressure and VO2peak in patients with chronic kidney disease stages 3-4: A systematic review and meta-analysis , 2018, PloS one.

[11]  Wilbert S Aronow,et al.  2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. , 2018, Hypertension.

[12]  D. Metzger,et al.  Prevalence and Severity of High Blood Pressure Among Children Based on the 2017 American Academy of Pediatrics Guidelines , 2018, JAMA pediatrics.

[13]  S. Daniels,et al.  Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents , 2017, Pediatrics.

[14]  J. Viikari,et al.  Cardiometabolic Determinants of Carotid and Aortic Distensibility From Childhood to Early Adulthood , 2017, Hypertension.

[15]  Leonard A Kaminsky,et al.  Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign A Scientific Statement From the American Heart Association , 2016, Circulation.

[16]  Katherine M Flegal,et al.  Trends in Obesity Prevalence Among Children and Adolescents in the United States, 1988-1994 Through 2013-2014. , 2016, JAMA.

[17]  A. Caspi,et al.  Childhood to Early-Midlife Systolic Blood Pressure Trajectories: Early-Life Predictors, Effect Modifiers, and Adult Cardiovascular Outcomes. , 2015, Hypertension.

[18]  N. Cook,et al.  Childhood Blood Pressure Trends and Risk Factors for High Blood Pressure: The NHANES Experience 1988–2008 , 2013, Hypertension.

[19]  Reneé H Moore,et al.  Fat and lean BMI reference curves in children and adolescents and their utility in identifying excess adiposity compared with BMI and percentage body fat. , 2013, The American journal of clinical nutrition.

[20]  Sanjay Rajagopalan,et al.  Beyond Medications and Diet: Alternative Approaches to Lowering Blood Pressure A Scientific Statement From the American Heart Association , 2013, Hypertension.

[21]  C. Boesch,et al.  Effects of Aerobic Versus Resistance Exercise Without Caloric Restriction on Abdominal Fat, Intrahepatic Lipid, and Insulin Sensitivity in Obese Adolescent Boys , 2012, Diabetes.

[22]  Jianxin Li,et al.  Physical activity reduces salt sensitivity of blood pressure: the Genetic Epidemiology Network of Salt Sensitivity Study. , 2012, American journal of epidemiology.

[23]  H. Morrison,et al.  Increasing blood pressure and its associated factors in Canadian children and adolescents from the Canadian Health Measures Survey , 2012, BMC Public Health.

[24]  Craig S. Wong,et al.  Validation of the revised Schwartz estimating equation in a predominantly non-CKD population , 2010, Pediatric Nephrology.

[25]  Susan L Furth,et al.  New equations to estimate GFR in children with CKD. , 2009, Journal of the American Society of Nephrology : JASN.

[26]  Youfa Wang,et al.  Tracking of Blood Pressure From Childhood to Adulthood: A Systematic Review and Meta–Regression Analysis , 2008, Circulation.

[27]  U. Ekelund,et al.  Independent associations of physical activity and cardiorespiratory fitness with metabolic risk factors in children: the European youth heart study , 2007, Diabetologia.

[28]  Véronique A. Cornelissen,et al.  Effects of Endurance Training on Blood Pressure, Blood Pressure–Regulating Mechanisms, and Cardiovascular Risk Factors , 2005, Hypertension.

[29]  Daniel W. Jones,et al.  Recommendations for blood pressure measurement in humans and experimental animals: Part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. , 2005, Hypertension.

[30]  Gerald S. Berenson,et al.  The Relation of Childhood BMI to Adult Adiposity: The Bogalusa Heart Study , 2005, Pediatrics.

[31]  B. Franklin,et al.  Exercise and Hypertension , 2004 .

[32]  T. Laitinen,et al.  Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. , 2003, JAMA.

[33]  G. de Simone,et al.  [Systolic, diastolic and pulse pressure: pathophysiology]. , 2001, Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology.

[34]  M. Goran,et al.  Examination of data normalization procedures for expressing peak VO2 data. , 1993, Journal of applied physiology.

[35]  J. Erikssen,et al.  Coronary risk factors and incidence of coronary death in relation to physical fitness. Seven-year follow-up study of middle-aged and elderly men. , 1985, European Heart Journal.

[36]  F. Klimt,et al.  INVESTIGATIONS ON THE STANDARDIZATION OF ERGOMETRY IN CHILDREN 1 , 1971, Acta paediatrica Scandinavica. Supplement.

[37]  M. Neophytou,et al.  Glomerular Filtration Rate , 1967 .

[38]  JOYCE E. MORROW,et al.  Official , 1947, Definitions.

[39]  J. Mandal,et al.  Prevalence of , 2021 .

[40]  S. Daniels,et al.  NASPGHAN Clinical Practice Guideline for the Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease in Children. , 2016, Journal of pediatric gastroenterology and nutrition.

[41]  Tim S Olds,et al.  Secular Trends in the Performance of Children and Adolescents (1980–2000) , 2003, Sports medicine.

[42]  G. Forbes Relation of Lean Body Mass to Height in Children and Adolescents , 1972, Pediatric Research.