Abstract
Aim
To assess the clustering of behavioral risk factors (BRFs) for chronic noncommunicable diseases and their association with biological factors and cardiorespiratory fitness levels among adolescents in Crete, Greece.
Subjects and methods
Among 589 adolescents aged 14.0–16.6 years, five BRFs (smoking, physical inactivity, sedentary behavior, alcohol consumption, high body weight) were estimated, and a clustering score of 0, 1, 2 or 3+ BRFs was calculated. Biological factors (blood pressure, blood glucose, serum lipids) and cardiorespiratory fitness were also assessed, and their associations with BRFs were examined.
Results
Physical inactivity was the most prevalent risk factor (48.2 %), whereas smoking was the least prevalent (8.7 %). Approximately 11.4 % of the adolescents displayed none of the five BRFs, while 19.5 % displayed 3 + factors (boys: 23.2 %, girls: 16.3 %, p > 0.05). High body weight was related to almost all biological factors (p < 0.05), while cardiorespiratory fitness was related to all BRFs (p < 0.05). Compared to adolescents with no BRFs, adolescents with 3+ BRFs had higher mean levels of systolic blood pressure (BP) (122.5 vs. 116.8 mmHg, p = 0.001) and triglycerides (73.5 vs. 58.9 mg/dl, p = 0.006), and lower levels of HDL-cholesterol (47.1 vs. 53.5 mg/dl, p < 0.001) and cardiorespiratory fitness (2.8 vs. 4.8 stages, p < 0.001). Only 10 % of the adolescents with no BRFs had low cardiorespiratory fitness, in contrast to 44.8 % of the adolescents with 3+ factors (p < 0.001).
Conclusion
Physical inactivity was the most prevalent individual risk factor, while one-fifth of the Cretan adolescents had an extended clustering of BRFs. Systolic BP, lipid levels and cardiorespiratory fitness were related to BRF clustering. Public health providers should adopt measures to improve these factors when designing health-care programs aimed at adolescents.
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References
Alamian A, Paradis G (2009) Clustering of chronic disease behavioral risk factors in Canadian children and adolescents. Prev Med 48(5):493–499
Alamian A, Paradis G (2012) Individual and social determinants of multiple chronic disease behavioral risk factors among youth. BMC Public Health 12:224
Andersen LB, Hasselstrom H, Gronfeldt V, Hansen SE, Karsten F (2004) The relationship between physical fitness and clustered risk, and tracking of clustered risk from adolescence to young adulthood: eight years follow-up in the Danish Youth and Sport Study. Int J Behav Nutr Phys Act 1(1):6
Arvanitidou M, Tirodimos I, Kyriakidis I, Tsinaslanidou Z, Seretopoulos D (2007) Decreasing prevalence of alcohol consumption among greek adolescents. Am J Drug Alcohol Abuse 33(3):411–417
Bitsori M, Linardakis M, Tabakaki M, Kafatos A (2009) Waist circumference as a screening tool for the identification of adolescents with the metabolic syndrome phenotype. Int J Pediatr Obes 4(4):325–331
Bouziotas C, Koutedakis Y (2003) A three year study of coronary heart disease risk factors in Greek adolescents. Pediatr Exerc Sc 15(1):9–18
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320(7244):1240–1243
Coups EJ, Gaba A, Orleans CT (2004) Physician screening for multiple behavioral health risk factors. Am J Prev Med 27(2 Suppl):34–41
Cugnetto ML, Saab PG, Llabre MM, Goldberg R, McCalla JR, Schneiderman N (2008) Lifestyle factors, body mass index, and lipid profile in adolescents. J Pediatr Psychol 33(7):761–771
Dumith SC, Muniz LC, Tassitano RM, Hallal PC, Menezes AM (2012) Clustering of risk factors for chronic diseases among adolescents from Southern Brazil. Prev Med 54(6):393–396
Eaton DK, Kann L, Kinchen S, Shanklin S, Ross J, Hawkins J, Harris WA, Lowry R, McManus T, Chyen D, Lim C, Whittle L, Brener ND, Wechsler H (2010) Youth risk behavior surveillance - United States, 2009. MMWR Surveill Summ 59(5):1–142
Ekelund U, Brage S, Froberg K, Harro M, Anderssen SA, Sardinha LB, Riddoch C, Andersen LB (2006) TV viewing and physical activity are independently associated with metabolic risk in children: the European Youth Heart Study. PLoS Med 3(12):e488
Faul F, Erdfelder E, Buchner A, Lang AG (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41(4):1149–1160
Fine LJ, Philogene GS, Gramling R, Coups EJ, Sinha S (2004) Prevalence of multiple chronic disease risk factors. 2001 national health interview survey. Am J Prev Med 27(2):18–24
Freedman DS, Dietz WH, Srinivasan SR, Berenson GS (1999) The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics 103(6 Pt 1):1175–1182
Hansen ML, Gunn PW, Kaelber DC (2007) Underdiagnosis of hypertension in children and adolescents. JAMA 298(8):874–879
Kafatos A, Codrington CA, Linardakis M (2005) Obesity in childhood: the Greek experience. World Rev Nutr Diet 94:27–35
Kafatos I, Manios Y, Moschandreas J, Kafatos A (2007) Health and nutrition education program in primary schools of Crete: changes in blood pressure over 10 years. Eur J Clin Nutr 61(7):837–845
Kantomaa MT, Tammelin TH, Ebeling HE, Taanila AM (2008) Emotional and behavioral problems in relation to physical activity in youth. Med Sci Sports Exerc 40(10):1749–1756
Klein-Geltink JE, Choi BC, Fry RN (2006) Multiple exposures to smoking, alcohol, physical inactivity and overweight: prevalences according to the Canadian community health survey cycle 1.1. Chronic Dis Can 27(1):25–33
Lawlor DA, O’Callaghan MJ, Mamun AA, Williams GM, Bor W, Najman JM (2005) Socioeconomic position, cognitive function, and clustering of cardiovascular risk factors in adolescence: findings from the Mater University study of pregnancy and its outcomes. Psychosom Med 67(6):862–868
Mammas IN, Bertsias GK, Linardakis M, Tzanakis NE, Labadarios DN, Kafatos AG (2003) Cigarette smoking, alcohol consumption, and serum lipid profile among medical students in Greece. Eur J Public Health 13(3):278–282
Manios Y, Kafatos A, Mamalakis G (1998) Physical activity of 6-year-old children: validation of two proxy reports. Pediatr Exerc Sc 10:176–188
Mistry R, McCarthy WJ, Yancey AK, Lu Y, Patel M (2009) Resilience and patterns of health risk behaviors in California adolescents. Prev Med 48(3):291–297
Muller-Riemenschneider F, Nocon M, Willich SN (2010) Prevalence of modifiable cardiovascular risk factors in German adolescents. Eur J Cardiovasc Prev Rehabil 17(2):204–210
Ortega FB, Artero EG, Ruiz JR, Espana-Romero V, Jimenez-Pavon D, Vicente-Rodriguez G, Moreno LA, Manios Y, Beghin L, Ottevaere C, Ciarapica D, Sarri K, Dietrich S, Blair SN, Kersting M, Molnar D, Gonzalez-Gross M, Gutierrez A, Sjostrom M, Castillo MJ (2011) Physical fitness levels among European adolescents: the HELENA study. Br J Sports Med 45(1):20–29
Pahkala K, Heinonen OJ, Lagstrom H, Hakala P, Hakanen M, Hernelahti M, Ruottinen S, Sillanmaki L, Ronnemaa T, Viikari J, Raitakari OT, Simell O (2012) Clustered metabolic risk and leisure-time physical activity in adolescents: effect of dose? Br J Sports Med 46(2):131–137
Patrick K, Norman GJ, Calfas KJ, Sallis JF, Zabinski MF, Rupp J, Cella J (2004) Diet, physical activity, and sedentary behaviors as risk factors for overweight in adolescence. Arch Pediatr Adolesc Med 158(4):385–390
Raitakari OT, Porkka KV, Rasanen L, Viikari JS (1994) Relations of life-style with lipids, blood pressure and insulin in adolescents and young adults. The Cardiovascular Risk in Young Finns Study Atherosclerosis 111(2):237–246
Reinehr T, Andler W, Denzer C, Siegried W, Mayer H, Wabitsch M (2005) Cardiovascular risk factors in overweight German children and adolescents: relation to gender, age and degree of overweight. Nutr Metab Cardiovasc Dis 15(3):181–187
Ribeiro JC, Guerra S, Oliveira J, Teixeira-Pinto A, Twisk JW, Duarte JA, Mota J (2004) Physical activity and biological risk factors clustering in pediatric population. Prev Med 39(3):596–601
Rizzo NS, Ruiz JR, Hurtig-Wennlof A, Ortega FB, Sjostrom M (2007) Relationship of physical activity, fitness, and fatness with clustered metabolic risk in children and adolescents: the European youth heart study. J Pediatr 150(4):388–394
Sanchez A, Norman GJ, Sallis JF, Calfas KJ, Cella J, Patrick K (2007) Patterns and correlates of physical activity and nutrition behaviors in adolescents. Am J Prev Med 32(2):124–130
Shay CM, Ning H, Daniels SR, Rooks CR, Gidding SS, Lloyd-Jones DM (2013) Status of cardiovascular health in US adolescents: prevalence estimates from the national health and nutrition examination surveys (NHANES) 2005–2010. Circulation 127(13):1369–1376
Shi L, Morrison JA, Wiecha J, Horton M, Hayman LL (2011) Healthy lifestyle factors associated with reduced cardiometabolic risk. Br J Nutr 105(5):747–754
Smpokos EA, Linardakis M, Papadaki A, Kafatos A (2011) Secular changes in anthropometric measurements and blood pressure in children of Crete, Greece, during 1992/93 and 2006/07. Prev Med 52(3–4):213–217
Sullivan GM, Feinn R (2012) Using effect size—or why the P value is not enough. J Grad Med Educ 4(3):279–282
Twisk JW, Kemper HC, Van Mechelen W, Post GB (2001) Clustering of risk factors for coronary heart disease. The longitudinal relationship with lifestyle. Ann Epidemiol 11(3):157–165
Vergetaki A, Linardakis M, Papadaki A, Kafatos A (2011) Presence of metabolic syndrome and cardiovascular risk factors in adolescents and University students in Crete (Greece), according to different levels of snack consumption. Appetite 57(1):278–285
WHO (2005) Preventing chronic diseases a vital investment. WHO, Geneva
WHO (2010) Global status report on noncommunicable diseases. WHO, Geneva
WHO (2011) Noncommunicable diseases country profiles 2011: WHO global report. WHO, Geneva
WHO (2012) Tobacco free initiative. WHO, Geneva
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Smpokos, E., Linardakis, M., Papadaki, A. et al. Clustering of chronic disease behavioral risk factors among adolescents in Crete (Greece): associations with biological factors and cardiorespiratory fitness levels. J Public Health 22, 433–442 (2014). https://doi.org/10.1007/s10389-014-0629-4
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DOI: https://doi.org/10.1007/s10389-014-0629-4