Low Muscle Strength Is Associated with Metabolic Risk Factors in Colombian Children: The ACFIES Study

et al. (2014) Low Muscle Strength Is Associated with Metabolic Risk Factors in Colombian Children: The ACFIES Study. PLoS ONE 9(4): e93150. doi:10.1371/journal.pone.0093150 Low Muscle Strength Is Associated with Metabolic Risk Factors in Colombian Children: The ACFIES Study Daniel Dylan Cohen 0 Diego Go mez-Arbela ez 0 Paul Anthony Camacho 0 Sandra Pinzon 0 Claudia Hormiga 0 Juanita Trejos-Suarez 0 John Duperly 0 Patricio Lopez-Jaramillo 0 Guillermo Lo pez Lluch, Universidad Pablo de Olavide, Centro Andaluz de Biologa del Desarrollo-CSIC, Spain 0 1 Direccio n de Investigaciones, Fundacio n Oftalmolo gica de Santander (FOSCAL) , Floridablanca, Santander , Colombia , 2 Facultad de la Ciencias de la Salud, Universidad de Santander (UDES) , Bucaramanga, Santander , Colombia , 3 Facultad de Medicina, Universidad de Los Andes , Bogota , Colombia Purpose: In youth, poor cardiorespiratory and muscular strength are associated with elevated metabolic risk factors. However, studies examining associations between strength and risk factors have been done exclusively in high income countries, and largely in Caucasian cohorts. The aim of this study was to assess these interactions in schoolchildren in Colombia, a middle income Latin American country. Methods: We measured body mass index, body composition, handgrip strength (HG), cardiorespiratory fitness (CRF) and metabolic risk factors in 669 low-middle socioeconomic status Colombian schoolchildren (mean age 11.5261.13, 47% female). Associations between HG, CRF and metabolic risk factors were evaluated. Results: HG and CRF were inversely associated with blood pressure, HOMA index and a composite metabolic risk score (p, 0.001 for all) and HG was also inversely associated with triglycerides and C-reactive protein (CRP) (both p,0.05). Associations between HG and risk factors were marginally weakened after adjusting for CRF, while associations between CRF and these factors were substantially weakened after adjusting for HG. Linear regression analyses showed inverse associations between HG and systolic BP (b = 20.101; p = 0.047), diastolic BP (b = 20.241; p. = 0.001), HOMA (b = 20.164; p = 0.005), triglycerides (b = 20.583; p = 0.026) and CRP (b = 20.183; p = 0.037) but not glucose (p = 0.698) or HDL cholesterol (p = 0.132). The odds ratios for having clustered risk in the weakest quartile compared with the strongest quartile were 3.0 (95% confidence interval: 1.81-4.95). Conclusions: In Colombian schoolchildren both poorer handgrip strength/kg body mass and cardiorespiratory fitness were associated with a worse metabolic risk profile. Associations were stronger and more consistent between handgrip and risk factors than between cardiorespiratory fitness and these risk factors. Our findings indicate the addition of handgrip dynamometry to non-invasive youth health surveillance programs would improve the accuracy of the assessment of cardiometabolic health. - In youth, poor performance in measures of cardiorespiratory and muscular fitness are associated with elevated clustered metabolic risk and cardiovascular risk factors such as triglycerides, HOMA index and inflammatory markers [14]. Fitness tracks from youth into adulthood [5], where both low cardiorespiratory fitness (CRF) and muscular strength are associated with elevated risk of cardiovascular (CV) disease and total mortality [6]. Evidence that both of these components of fitness are declining in children internationally [7,8] is therefore worrying from a public health perspective. Based on associations with health and the feasibility of implementing these measures on a large scale in schools [9,10], it is argued that the assessment of CRF and muscular strength should be included as part of health monitoring in youth [11]. Nonetheless, to justify their inclusion in surveillance efforts, particularly in countries where resources are limited, these tests must be validated as markers of CV risk in diverse populations. While associations between CRF and CV risk factors have been evaluated in youth from both high- and low-middle income countries [14,12,13], studies examining interactions between muscular strength and risk factors have been done exclusively in high income countries, and largely in Caucasian cohorts [14]. There is a need to also assess these associations in low-middle income countries, where there is a larger and more rapidly increasing burden of non-communicable disease [15]. The primary aim of this study was to assess relationships between muscular strength, CRF and cardio-metabolic health profile in schoolchildren in Colombia, a middle income Latin American country. Materials and Methods Study Population During the 20112012 school year, we conducted the crosssectional component of the ACFIES study (Association between Cardiorespiratory Fitness, Muscular Strength and Body Composition with Metabolic Risk Factors in Colombian Children). The sample comprised 669 low-middle socioeconomic status (SES 13 on a scale of 16 defined by the Colombian government) schoolchildren (aged 8 to 14 years, 47% female) enrolled in public elementary and high schools (grades 5 and 6) in the city of Bucaramanga, Colombia. Ethics Statement The health research ethics board of the Ophthalmological Foundation of Santander approved all study procedures. The children expressed their interest in participating in the study, and parents or legal guardians gave written informed consent before the children were included in the study. Measures Body weight was measured in underwear and no shoes, using electronic scales (Tanita BC544, Tokyo, Japan). Height was measured using a mechanical stadiometer platform (Seca 274, Hamburg, Germany). Body mass index (BMI) was calculated by dividing body weight (kg) by height squared (cm2). Waist circumference was measured at the midpoint between the last rib and the iliac crest using a tape measure (Ohaus 8004-MA, NJ, USA). Body composition was estimated using bioelectrical impedance analysis (Tanita BC544, Tokyo, Japan). Blood pressure was assessed after a period of sitting using an automatic oscillometric device (Omron HEM 757 CAN, Hoofddorp, Holland) with a pediatric cuff. Sexual maturation was determined by stage of secondary sexual development by a physician following the methodology described by Tanner and Whitehouse [16]. Blood samples of 20 ml were taken from the antecubital vein between 07:00 and 09:00 am after an overnight fast. Participants were asked not to do any prolonged exercise in the previous 24 hours. The tests were processed in the laboratory of the School of Bacteriology, University of Santander. The glucose and lipid profile were assessed using a routine colorimetric method (BTS303 Biosystem photometric, Barcelona, Spain). hsCRP was quantified using a turbid metric test (SPINREACT, Spain). Insulin levels were determined using an insulin microplate ELISA test (Monobind, USA). Metabolic Risk We calculated a continuous composite meta (...truncated)