Baker-Smith Carissa, Gauen Abigail M, Petito Lucia C, Khan Sadiya S, Allen Norrina Bai
Preventive Cardiology Program, Nemours Cardiac Center, Nemours Children's Health, Wilmington, Delaware, USA.
Center for Cardiovascular Research and Innovation, Nemours Cardiac Center, Nemours Children's Health, Wilmington, Delaware, USA.
medRxiv. 2024 Nov 27:2024.11.25.24317946. doi: 10.1101/2024.11.25.24317946.
Given that many risk factors for atherosclerotic cardiovascular disease (ASCVD) begin in childhood, knowledge of the prevalence of cardio-kidney metabolic syndrome (CKM) in adolescents and its risk factors is critical to understanding the etiology of ASCVD risk burden.
To calculate the proportion of US adolescents with CKM stages 0, 1, and 2 and to assess the social factors and behaviors most strongly associated with advanced CKM stage.
Cross-sectional analysis of 2017-2020 US National Health and Nutrition Examination Survey (NHANES) sample data.
United States.
Adolescents.
Social determinants of health, including family income to poverty ratio, health insurance, routine healthcare access, and food security, as well as behaviors including smoking, physical activity, and diet.
The prevalence of CKM stages 0, 1, and 2 in adolescents was measured using survey-weighted data. Generalized linear models were used to quantify associations between social factors, behaviors, and CKM staging.
Of the 1,774 surveyed adolescents ages 12-18 years, representing 30,327,145 US adolescents, 56% (95% CI 52-60%) had CKM stage 0, 37% (33-40%) had CKM stage 1, and 7% (5-9%) had CKM stage 2. Physical activity score (1 to 100, 100=highest) was lowest among adolescents with CKM stage 2 (physical activity score for CKM 0: 60 (31), CKM 1: 60 (32), and CKM 2 49 (33); p=0.025). Other health behaviors, such as the DASH diet and nicotine scores, did not differ according to the CKM stage (p=0.477 and p=0.932, respectively). According to sex, race, ethnicity, and age-adjusted multivariate logistic regression analyses, a ratio of income to poverty level >1.85, having health insurance, and food security, were associated with a 32% (OR 0.68 [95% CI:0.52,0.89]), 40% (OR 0.60 [95% CI: 0.37, 0.99]), and 45% (OR 0.55 [95% CI: 0.41,0.73]) lower odds of CKM stage 1-2, respectively. After adjustment for all sociodemographic factors, only food security was associated with 41% lower odds of CKM stage 1-2 (OR 0.59 [0.43, 0.81]).
CKM stage 1-2 in adolescents is most strongly associated with food insecurity. Improved access to healthy food and policies to address food security may help prevent higher CKM stage, beginning in adolescence.
鉴于动脉粥样硬化性心血管疾病（ASCVD）的许多危险因素始于儿童期，了解青少年中心肾代谢综合征（CKM）的患病率及其危险因素对于理解ASCVD风险负担的病因至关重要。
计算美国处于CKM 0期、1期和2期的青少年比例，并评估与晚期CKM阶段最密切相关的社会因素和行为。
对2017 - 2020年美国国家健康与营养检查调查（NHANES）样本数据进行横断面分析。
美国。
青少年。
健康的社会决定因素，包括家庭收入与贫困率、健康保险、常规医疗保健可及性和食品安全，以及包括吸烟、体育活动和饮食在内的行为。
使用调查加权数据测量青少年中CKM 0期、1期和2期的患病率。采用广义线性模型量化社会因素、行为与CKM分期之间的关联。
在接受调查的1774名12 - 18岁青少年中（代表30327145名美国青少年），56%（95%置信区间52 - 60%）处于CKM 0期，37%（33 - 40%）处于CKM 1期，7%（5 - 9%）处于CKM 2期。体育活动得分（1至100分，100分为最高）在CKM 2期青少年中最低（CKM 0期的体育活动得分：60（31），CKM 1期：60（32），CKM 2期：49（33）；p = 0.025）。其他健康行为，如得舒饮食（DASH diet）和尼古丁得分，在不同CKM阶段并无差异（分别为p = 0.477和p = 0.932）。根据性别、种族、民族和年龄调整后的多因素逻辑回归分析，收入与贫困水平之比>1.85、拥有健康保险和食品安全分别与CKM 1 - 2期较低的患病几率相关，分别降低32%（比值比[OR]0.68[95%置信区间：0.52,0.89]）、40%（OR 0.60[95%置信区间：0.37,0.99]）和45%（OR 0.55[95%置信区间：0.41,0.73]）。在对所有社会人口学因素进行调整后，只有食品安全与CKM 1 - 2期较低的患病几率相关，降低41%（OR 0.59[0.43,0.81]）。
青少年中的CKM 1 - 2期与食品不安全最为密切相关。改善健康食品的可及性以及解决食品安全问题的政策可能有助于预防从青少年期开始的更高CKM阶段。
