“Fat but Fit” Paradox and Cardiometabolic Risk in Children: The Role of Physical Activity

Pozuelo‐Carrascosa, Diana P.; Martínez‐Vizcaíno, Vicente; Torres‐Costoso, Ana; Martínez, Montserrat Solera; Rodríguez‐Gutiérrez, Eva; Garrido‐Miguel, Miriam

doi:10.1089/chi.2022.0073

Cited by 6 publications

(3 citation statements)

References 45 publications

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“…This "fat but fit" paradigm has been less studied in children. Pozuelo-Carrascosa et al (2023) have found similar results, albeit without hard endpoints, in 312 children aged 9-12 years. Their results indicate that "fat-fit" and "unfit-fit" children had better levels of high-density Frontiers in Physiology frontiersin.org lipoprotein cholesterol, triglycerides, insulin levels, vigorous PA amount and metabolic syndrome index than their peers in the "fat-unfit" and "unfit-unfit" categories.…”

Section: Discussionsupporting

confidence: 59%

Cardiorespiratory fitness and development of childhood cardiovascular risk: The EXAMIN YOUTH follow-up study

Hauser,

Lichtenstein,

Nebiker

et al. 2023

Front. Physiol.

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Background: Obesity- and hypertension-related cardiovascular (CV) risk has been shown to originate in childhood. Higher body mass index (BMI) and blood pressure (BP) have been associated with increased large artery stiffness and a lower microvascular arteriolar-to-venular diameter ratio (AVR) in children. This study aimed to investigate the association of cardiorespiratory fitness (CRF) with development of BMI, BP and vascular health during childhood.Methods: In our prospective cohort study, 1,171 children aged 6–8 years were screened for CRF, BMI, BP, retinal vessel diameters and pulse wave velocity using standardized protocols. Endurance capacity was assessed by 20 m shuttle run test. After 4 years, all parameters were assessed in 664 children using the same protocols.Results: Children with a higher CRF at baseline developed a significantly lower BMI (β [95% CI] −0.09 [−0.11 to −0.06] kg/m2, p < 0.001), a lower systolic BP (β [95% CI] −0.09 [−0.15 to −0.03] mmHg, p = 0.004) and a higher AVR (β [95% CI] 0.0004 [0.00004 to 0.0007] units, p = 0.027) after 4 years. The indirect association of CRF with development of retinal arteriolar diameters was mediated by changes in BMI.Conclusion: Our results identify CRF as a key modulator for the risk trajectories of BMI, BP and microvascular health in children. Obesity-related CV risk has been shown to track into adulthood, and achieving higher CRF levels in children may help counteract the development of CV risk and disease not only in pediatric populations, but may also help reduce the burden of CVD in adulthood.Registration:http://www.clinicaltrials.gov/ (NCT02853747).

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Section: Discussionsupporting

confidence: 59%

Cardiorespiratory fitness and development of childhood cardiovascular risk: The EXAMIN YOUTH follow-up study

Hauser,

Lichtenstein,

Nebiker

et al. 2023

Front. Physiol.

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“…Therefore, the general belief that being normal weight is equal to being healthy could be wrong since studies have indicated that normal-weight/ unfit subjects could be at a higher risk of developing cardiovascular disease than obese/fit subjects [ 7 , 8 ]. Some studies reinforce the fat-but-fit paradigm, indicating that CRF could counteract the effect of obesity in cardiometabolic risk factors in children [ 9 ], while others shows that both CRF and adiposity are important for having a low cardiometabolic risk [ 10 , 11 ]. In this context, considering the role of sexual maturation, it is essential due to its influence on physical activity, fitness and cardiometabolic risk factors, in which evidence indicates that early sexual maturation was positively associated with obesity in both girls and boys and also that pubertal stage has an interaction effect on the association of cardiometabolic risk with body mass index [ 12 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

Fitness and fatness in children and adolescents: investigating their role in the association between physical activity and cardiometabolic health

Brand,

Sehn,

Fochesatto

et al. 2024

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To verify the role of the combination of fitness and fatness in the relationship between physical activity (PA) and cardiometabolic risk in children and adolescents. This is a cross-sectional study performed with 2786 children and adolescents (6 to 17 years). Fitness was determined by the cardiorespiratory fitness (CRF) six-minute walking and running test. Waist circumference (WC) was considered a fatness indicator. A selfreported questionnaire was used to determine PA practice, whereas the clustered cardiometabolic risk score (cMetS) was calculated by summing z-scores of triglycerides, total cholesterol/HDL-C ratio, systolic blood pressure, glucose, and WC. Considering the combination of CRF (fitness) and WC (fatness), the following phenotypes were created: Fit/Unfat, Fit/Fat, Unfit/Unfat and Unfit/Fat. Moderation analyses were tested using linear regression models. Significant interactions were found between PA and Unfit/Fat category (β = -0.001; p = 0.001) only for adolescents. The interaction observed in the Unfit/Fat phenotype indicated that adolescents who practise PA for 330 minutes per week presented lower cMetS compared to those who do not practise or practise for 60 minutes respectively. The combination of fitness and fatness moderates the relationship between PA and cardiometabolic risk, suggesting that adolescents, particularly those who are less fit and present high adiposity, should be encouraged to engage in regular PA to improve their metabolic health.

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“…Obesity in childhood and adolescence is detrimental to both the physical and mental health of youth. 19 , 20 , 21 Studies that have examined the so-called “fat but fit” phenomenon in children have documented that higher fitness mitigates some of the negative effects of obesity, being associated with better cardiometabolic health, 22 , 23 and general well-being. 24 For a condition in which obesity coexists with a fully healthy metabolic profile that is present in 10–30% of adults and in 6–36% of children/adolescents, the conclusion that obesity (but also for the metabolically unhealthy phenotype) is associated with a higher risk of all-cause, CVD and cancer mortality is modified (i.e., no difference is present in the prognosis between metabolically healthy but with obesity and metabolically healthy but with normal weight individuals) when cardiorespiratory fitness is accounted for.…”

Section: Introductionmentioning

confidence: 99%

Physical fitness among children with diverse weight status during and after the COVID-19 pandemic: a population-wide, cohort study based on the Slovenian physical fitness surveillance system (SLOfit)

Martinko,

Sorić,

Jurak

et al. 2023

The Lancet Regional Health - Europe

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“Fat but Fit” Paradox and Cardiometabolic Risk in Children: The Role of Physical Activity

Cited by 6 publications

References 45 publications

Cardiorespiratory fitness and development of childhood cardiovascular risk: The EXAMIN YOUTH follow-up study

Cardiorespiratory fitness and development of childhood cardiovascular risk: The EXAMIN YOUTH follow-up study

Fitness and fatness in children and adolescents: investigating their role in the association between physical activity and cardiometabolic health

Physical fitness among children with diverse weight status during and after the COVID-19 pandemic: a population-wide, cohort study based on the Slovenian physical fitness surveillance system (SLOfit)

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