Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, Meibergdreef 9, room J2-209, 1100 DE, Amsterdam, The Netherlands.
Department of Sports Science and Physical Education, University of Agder, PO BOX 422, 4604, Kristiansand, Norway.
Int J Behav Nutr Phys Act. 2021 Mar 6;18(1):33. doi: 10.1186/s12966-021-01090-2.
The American Heart Association (AHA) developed a definition of ideal cardiovascular health (ICH) based on the presence of both ideal health behaviours (diet, physical activity, weight status and smoking) and ideal health factors (glucose, total cholesterol and blood pressure levels). However, research of ICH in the paediatric population is scarce. We aimed to study ICH at age 5-6 years by extending the original ICH score with the health behaviours: sleep duration, screen time and prenatal smoke exposure, and to evaluate its association with cardiometabolic outcomes at age 11-12.
A total of 1666 children aged 5-6 years were selected from the database of the ABCD-study, a prospective cohort study on the health and development of children born in Amsterdam, the Netherlands. Of these, 846 (50.8%) were boys and 1460 (87.6%) had a healthy weight. Data on self-reported health behaviours and health factors were used to calculate the ICH scores (original and extended) by adding the frequency of scoring 'healthy' on each indicator, based on international cut-offs. The children were followed up for 6 years and cardiometabolic outcomes (carotid intima-media thickness (CIMT), blood pressure, glucose and lipids) were measured. Associations between ICH (both original and extended) and cardiometabolic outcomes were examined using multivariable regression models.
At age 5-6 years, 11% scored poor (score 1-5), 56% intermediate (score 6-7) and 33% good (score 8-9) on extended ICH. Healthy diet and normal total cholesterol concentrations were the least prevalent. Neither the original nor the extended ICH scores were associated with CIMT at age 11-12. A higher score on the extended ICH was associated with lower total cholesterol (p for trend < 0.001), lower systolic (p for trend = 0.012) and diastolic blood pressure (p for trend = 0.011), and lower body mass index (BMI) (p < 0.001) at age 11-12. The original ICH score was associated with lower total cholesterol (p < 0.001) and BMI (p < 0.001) only.
Our findings suggest that extending the ICH score in young children with additional health behaviours improves prediction of some cardiometabolic outcomes, but not CIMT in preadolescence, compared to the original ICH score. We would recommend other researchers to incorporate objective measures of health behaviours and longer follow-up to find out whether associations persist into adulthood.
美国心脏协会（AHA）基于理想健康行为（饮食、身体活动、体重状况和吸烟）和理想健康因素（血糖、总胆固醇和血压水平）的存在，制定了理想心血管健康（ICH）的定义。然而，儿科人群中 ICH 的研究很少。我们旨在通过扩展原始 ICH 评分，纳入健康行为（睡眠时长、屏幕时间和产前吸烟暴露），来研究 5-6 岁儿童的 ICH，并评估其与 11-12 岁时心血管代谢结局的关系。
从荷兰阿姆斯特丹 ABCD 研究的数据库中选择了 1666 名 5-6 岁的儿童，该研究是一项关于儿童健康和发育的前瞻性队列研究。其中，846 名（50.8%）为男孩，1460 名（87.6%）体重健康。根据国际临界值，使用自我报告的健康行为和健康因素数据，通过在每个指标上“健康”评分的频率来计算 ICH 评分（原始和扩展）。对这些儿童进行了 6 年的随访，并测量了心血管代谢结局（颈动脉内膜-中层厚度（CIMT）、血压、血糖和血脂）。使用多变量回归模型研究 ICH（原始和扩展）与心血管代谢结局之间的关系。
在 5-6 岁时，11%的儿童得分较差（得分 1-5），56%的儿童得分中等（得分 6-7），33%的儿童得分较好（得分 8-9）。健康饮食和正常总胆固醇浓度是最不常见的。原始和扩展的 ICH 评分均与 11-12 岁时的 CIMT 无关。扩展的 ICH 评分较高与总胆固醇（p 趋势<0.001）、收缩压（p 趋势=0.012）和舒张压（p 趋势=0.011）以及 BMI（p<0.001）较低相关。原始 ICH 评分仅与总胆固醇（p<0.001）和 BMI（p<0.001）相关。
我们的研究结果表明，与原始 ICH 评分相比，在幼儿中扩展 ICH 评分并纳入其他健康行为可以改善某些心血管代谢结局的预测，但不能改善青春期前的 CIMT。我们建议其他研究人员纳入健康行为的客观测量和更长的随访时间，以确定这些关联是否会持续到成年期。
