Department of Pediatrics and Center for Pediatric Obesity Medicine University of Minnesota Medical School Minneapolis MN.
HealthPartners Institute Bloomington MN.
J Am Heart Assoc. 2024 Sep 17;13(18):e032492. doi: 10.1161/JAHA.123.032492. Epub 2024 Sep 9.
Previous studies have found that exposure to childhood environmental stress is associated with cardiometabolic risk. However, it is not known whether individual health behaviors disrupt this relationship. This study prospectively evaluated the relationship between cumulative environmental stress in a low-income sample and cardiometabolic risk in middle childhood and examined whether child health behaviors attenuated this relationship.
In a cohort of children (n=338; 57% Hispanic children; 25% Black children), environmental stressors (family and neighborhood factors representing disadvantage/deprivation) and child health behaviors (accelerometry measured physical activity; parent-reported screen time and diet recalls) were measured over 5 time points beginning when children were aged 2 to 4 years and ending when they were aged 7 to 11 years. Children's cardiometabolic risk factors (body mass index, blood pressure, triglyceride/high-density lipoprotein ratio, glucose, hemoglobin A, C-reactive protein) were measured at 7 to 11 years. Emerging cardiometabolic risk was defined as having ≥1 elevations that exceeded clinical thresholds. In adjusted path analyses, greater cumulative environmental stress was associated with higher likelihood of emerging cardiometabolic risk in middle childhood (<0.001). Higher levels of moderate to vigorous physical activity and fewer sedentary minutes attenuated the positive relationship between stress and cardiometabolic risk (<0.05). Children with 2 hours of average daily screen time had a higher likelihood of elevated cardiometabolic risk (<0.01), but screen time did not moderate the stress-cardiometabolic risk relationship. Dietary intake was not related to cardiometabolic risk.
Interventions that promote moderate to vigorous physical activity and limit sedentary behavior may have particular importance for the cardiometabolic health of children exposed to high levels of cumulative environmental stress.
先前的研究发现，儿童时期环境应激暴露与心血管代谢风险相关。然而，目前尚不清楚个体健康行为是否会破坏这种关系。本研究前瞻性评估了低收入样本中累积环境应激与儿童中期心血管代谢风险的关系，并检验了儿童健康行为是否会减弱这种关系。
在一项队列研究中（n=338；57%西班牙裔儿童；25%非裔儿童），在儿童 2 至 4 岁时开始，至 7 至 11 岁时结束，共进行了 5 次测量，评估了环境应激源（代表劣势/剥夺的家庭和邻里因素）和儿童健康行为（加速度计测量的体力活动；父母报告的屏幕时间和饮食记录）。在 7 至 11 岁时测量儿童的心血管代谢风险因素（体重指数、血压、甘油三酯/高密度脂蛋白比值、血糖、血红蛋白 A、C 反应蛋白）。出现心血管代谢风险定义为出现≥1 次超过临床阈值的升高。在调整后的路径分析中，累积环境应激越大，儿童中期出现心血管代谢风险的可能性越高（<0.001）。较高水平的中等到剧烈体力活动和较少的久坐时间可减弱应激与心血管代谢风险之间的正相关关系（<0.05）。每天平均有 2 小时屏幕时间的儿童发生心血管代谢风险升高的可能性更高（<0.01），但屏幕时间并不能调节应激与心血管代谢风险的关系。饮食摄入与心血管代谢风险无关。
促进中等到剧烈体力活动和限制久坐行为的干预措施对于暴露于高水平累积环境应激的儿童的心血管代谢健康可能尤为重要。
