Predictors of Platelet Mitochondria Respiration in Children – The Arkansas Active Kids Study

Abstract Objectives Platelets play a critical role in the pathogenesis of atherosclerotic disease (AD). In the absence of a nucleus, platelet function and viability are largely dependent on the health of their mitochondria. The purpose of this study was to evaluate the association between common markers of cardiometabolic health in 7 to 10-year-old children and measures of platelet mitochondria function. Methods Sixty children participated in a single study visit. Fasting blood was collected, and cardiorespiratory fitness (CRF, cycle ergometer test), physical activity (PA, accelerometers), and blood pressure percentiles were determined. Routine respiration (R) was measured by high-resolution respirometry (Oxygraph-2k) before platelets were permeabilized by digitonin. Thereafter, Complex I (CI) supported respiration was assayed in the leak (L), coupled (P) and uncoupled (CIE) states. Complex IV (CIV) activity was assayed as a marker of respiratory capacity. Flux control ratios (FCR) were calculated by dividing respiratory fluxes by CIV. Multiple linear regression analyses were used to model FCRs (dependent variables) with age, sex, race, CRF, PA, Body Mass Index (BMI) percentile, HOMA2-IR, systolic (SBP-P)/diastolic blood pressure percentiles (DBP-P), triglyceride status, and Low Density Lipoprotein (LDL) status (status = high vs. normal) as dependent variables. Results Age, race, LDL status and the interaction between BMI percentiles with SBP-P were retained in the final regression models for R, L, P and CIE FCRs. Specifically, R and CI supported respiration in the L, P and CIE states decreased with age (P < .05), black race (P < .05), and high LDL-cholesterol status (P < .0001). To assess for the interaction between BMI and SBP-P, children were stratified as normal weight (NW) or overweight (OW = BMI ≥ 85th percentile) with high (≥90th percentile) or normal SBP. FCRs did not differ between NW groups. However, FCRs where ∼2 times higher in children with OW + high SBP compared to children with OW + normal SBP (P < 0.05). Conclusions Age, race, LDL cholesterol status, and systolic blood pressure are determinants of platelet bioenergetics in children. SBP-P modifies the association between weight status and platelet mitochondria respiration. Funding Sources USDA-ARS 59-6250-4-001 and 6026-51,000-012-06S. NIH-NIGMS 5P20GM10909, NIH 8UG1OD024945, NIH-NCATS 1UL1TR003107-0.

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Weight cycling is associated with adverse cardiometabolic markers in a cross-sectional representative US sample

Journal of Epidemiology & Community Health ◽

10.1136/jech-2019-213419 ◽

2020 ◽

pp. jech-2019-213419

Author(s):

Lisa Kakinami ◽

Bärbel Knäuper ◽

Jennifer Brunet

Keyword(s):

Blood Pressure ◽

Insulin Sensitivity ◽

Weight Status ◽

Density Lipoprotein ◽

Normal Weight ◽

Lipoprotein Cholesterol ◽

Weight Cycling ◽

Cross Sectional ◽

Weight History ◽

Cardiometabolic Markers

BackgroundWhether weight cycling (repeated weight loss and regain) is associated with cardiometabolic health is unclear. Study objective was to examine whether weight cycling since young adulthood (ie, 25 years of age) was associated with cardiometabolic markers.MethodsData from a nationally representative cross-sectional US sample (National Health and Nutrition Examination Survey, 1999–2014) were used. Weight history was based on self-reported weight at age 25, 10 years prior and 1 year prior to the survey (n=4190, 51% male). Using current self-reported weight as the anchor, participants were classified as (1) stable weight, (2) weight losers, (3) weight gainers and (4) weight cyclers. Cardiometabolic markers included fasting lipids, insulin sensitivity and blood pressure. Multiple linear regressions were used to analyse weight history (reference: stable weight) and adjusted for covariates. Analyses incorporated the sampling design and survey weights and were stratified by sex or weight status.ResultsCompared with females with stable weight, female weight cyclers had worse lipids and homeostasis model assessment for insulin resistance (HOMA-IR) (all ps<0.05). Compared with males with stable weight, male weight cyclers had worse high-density lipoprotein cholesterol (HDL) and HOMA-IR (ps<0.05). Weight cyclers with normal weight had worse HDL and low-density lipoprotein cholesterol (ps<0.05), and weight cyclers with overweight or obesity had worse HOMA-IR (p=0.05). Blood pressure was not associated.ConclusionWeight cycling is adversely associated with cardiometabolic markers but associations differ by sex and weight status. While weight cycling is consistently associated with worse cardiometabolic markers among females, results are mixed among males. Weight cycling is associated with worse lipid measures for normal weight persons, and marginally worse insulin sensitivity for those with overweight/obesity.

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Risk factors for cardiovascular diseases and development of prehypertension

ZHurnal «Patologicheskaia fiziologiia i eksperimental`naia terapiia» ◽

10.25557/0031-2991.2018.03.37-43 ◽

2018 ◽

pp. 37-43

Author(s):

В.В. Шерстнев ◽

М.А. Грудень ◽

В.П. Карлина ◽

В.М. Рыжов ◽

А.В. Кузнецова ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Ldl Cholesterol ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Hdl Cholesterol ◽

Serum Levels ◽

Left Ventricular ◽

Optimal Blood Pressure

Цель - исследование взаимосвязи факторов риска сердечно-сосудистых заболеваний и развития предгипертонии. Методика. Проведен сравнительный и корреляционный анализы показателей модифицируемых и немодифицируемых факторов риска сердечно-сосудистых заболеваний у обследованных лиц в возрасте 30-60 лет с «оптимальным» артериальным давлением, (n = 63, АД <120/80 мм рт.ст.) и лиц с предгипертонией (n = 52, АД = 120-139/80-89 мм рт.ст.). Результаты. Показано, что лица с предгипертонией по сравнению с группой лиц, имеющих «оптимальное» артериальное давление характеризуются статистически значимо повышенным содержанием холестерина и холестерина липопротеидов низкой плотности, интеллектуальным характером трудовой деятельности, а также значимыми сочетаниями факторов риска: повышенный уровень холестерина липопротеидов низкой плотности с интеллектуальным характером трудовой деятельности; повышенное содержание креатинина с уровнем триглициридов; наследственная отягощенность по заболеваниям почек и интеллектуальным характером трудовой деятельности; наследственная отягощенность по сахарному диабету и гипертрофия левого желудочка сердца. У лиц с предгипертонией документированы перестройки структуры взаимосвязи (количество, направленность и сила корреляций) между показателями факторов риска в сравнении с лицами, имеющими «оптимальное» артериальное давление. Заключение. Выявленные особенности взаимосвязей факторов риска сердечно-сосудистых заболеваний при предгипертонии рассматриваются как проявление начальной стадии дизрегуляционной патологии и нарушения регуляции физиологических систем поддержания оптимального уровня артериального давления. The aim of the study was to investigate the relationship between risk factors for cardiovascular disease and development of prehypertension. Methods. Comparative and correlation analyses of modifiable and non-modifiable risk factors for cardiovascular disease were performed in subjects aged 30-60 with «optimal» blood pressure (n = 63, BP <120/80 mm Hg) and prehypertension (n = 52, BP = 120-139 / 80-89 mm Hg). Results. The group with prehypertension compared with the «optimal» blood pressure group had significantly increased serum levels of low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol, sedentary/intellectual type of occupation, and significant combinations of risk factors. The risk factor combinations included an increased level of LDL cholesterol and a sedentary/intellectual occupation; increased serum levels of creatinine and triglycerides; hereditary burden of kidney disease and a sedentary/intellectual occupation; hereditary burden of diabetes mellitus and cardiac left ventricular hypotrophy. In subjects with prehypertension compared to subjects with «optimal» blood pressure, changes in correlations (correlation number, direction, and strength) between parameters of risk factors were documented. Conclusion. The features of interrelationships between risk factors for cardiovascular disease observed in prehypertension are considered a manifestation of early dysregulation pathology and disordered regulation of physiological systems, which maintain optimal blood pressure.

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Efficacy of Bilberry and Grape Seed Extract Supplement Interventions to Improve Glucose and Cholesterol Metabolism and Blood Pressure in Different Populations—A Systematic Review of the Literature

Nutrients ◽

10.3390/nu13051692 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1692

Author(s):

Teresa Grohmann ◽

Caroline Litts ◽

Graham Horgan ◽

Xuguang Zhang ◽

Nigel Hoggard ◽

...

Keyword(s):

Blood Pressure ◽

Metabolic Syndrome ◽

Ldl Cholesterol ◽

Cholesterol Metabolism ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Grape Seed Extract ◽

Grape Seed ◽

Good Evidence ◽

Seed Extract

Intervention with fruit extracts may lower glucose and lipid levels, as well as blood pressure. We reviewed the efficacy of bilberry and grape seed extracts to affect these outcomes across populations with varying health status, age and ethnicity, across intervention doses and durations, in 24 intervention studies with bilberry and blackcurrant (n = 4) and grape seed extract (n = 20). Bilberry and blackcurrant extract lowered average levels of glycated hemoglobin (HbA1c), at least in Chinese subjects, especially in those who were older, who were diagnosed with Type 2 Diabetes Mellitus (T2DM) and who were participating in longer-term studies. We also found good evidence that across studies and in subjects with hypercholesterolemia, T2DM or metabolic syndrome, intervention with bilberry and blackcurrant extract, and to some extent grape seed extract, significantly lowered total and low density lipoprotein (LDL) cholesterol levels after four weeks. Intervention with grape seed extract may reduce systolic and diastolic blood pressure in subjects with hypertension or metabolic syndrome. Differential responsiveness in cholesterol and blood pressure outcomes between stratified populations could not be explained by age, dose or study duration. In conclusion, bilberry and blackcurrant extract appears effective in lowering HbA1c and total and LDL cholesterol, whereas grape seed extract may lower total and LDL cholesterol, and blood pressure, in specific population groups.

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Weight Status Is Associated with Blood Pressure, Vital Capacity, Dental Decay, and Visual Acuity among School-Age Children in Chengdu, China

Annals of Nutrition and Metabolism ◽

10.1159/000454888 ◽

2016 ◽

Vol 69 (3-4) ◽

pp. 237-245 ◽

Cited By ~ 8

Author(s):

Rong Peng ◽

Shiyun Li ◽

Hongbin Zhang ◽

Honglian Zeng ◽

Biyu Jiang ◽

...

Keyword(s):

Blood Pressure ◽

Visual Acuity ◽

Weight Status ◽

Vital Capacity ◽

Low Vision ◽

Normal Weight ◽

School Age Children ◽

School Age ◽

Obese Children ◽

Dental Decay

Aims: To examine the association of weight status with the prevalence of blood pressure (BP), vital capacity, dental decay, and visual acuity among school-age children in Chengdu, China and to find the potential role of weight status to predict the common and frequently occurring diseases among school-age children. Methods: A cross-sectional study was conducted among 12,297 children aged 6-18 years from 10 schools in the Jinniu District of Chengdu, China. Body height, weight, waist circumference (WC), and BP were measured. Vital capacity, dental decay, and visual acuity were detected. Results: The overall prevalence of underweight, overweight, obesity, abdominal obesity, high BP, bad vital capacity weight index, dental decay, and low vision were 7.18, 13.47, 7.57, 18.90, 2.78, 21.93, 38.81, and 45.79%, respectively. After controlling for age, gender, and WC, it was found that overweight and obese children had a higher risk of developing high BP than normal weight children ([OR 4.20, p < 0.001] and [OR 8.76, p < 0.001], respectively), And adjusting for age, gender, and chest circumference, the risk of having bad vital capacity weight index among children with overweight and obesity was higher ([OR 2.15, p < 0.001] and [OR 5.40, p < 0.001], respectively), and the risk with underweight was lower (OR 0.35, p < 0.001). After eliminating the influential factors of gender and age, children who were underweight were 1.16 times (OR 1.16, p = 0.048) more likely to have caries than children with normal weight, but obese children were found to have a lower prevalence for dental cavities than children with normal weight (OR 0.79, p = 0.002). Underweight and obese children had a higher prevalence of low vision; the OR of the appearance of low vision was 1.21 (p = 0.016) for underweight children and 1.23 (p = 0.009) for obese children after adjusting the age and gender. Conclusions: Abnormal weight status among Chengdu urban school-age children was found to be a severe health problem, and it was strongly associated with BP, vital capacity, dental decay, and visual acuity.

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Low-cost exercise interventions improve long-term cardiometabolic health independently of a family history of type 2 diabetes: a randomized parallel group trial

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001377 ◽

2020 ◽

Vol 8 (2) ◽

pp. e001377

Author(s):

Niko S Wasenius ◽

Bo A Isomaa ◽

Bjarne Östman ◽

Johan Söderström ◽

Björn Forsén ◽

...

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Exercise Prescription ◽

Low Cost ◽

Density Lipoprotein ◽

Cardiometabolic Health ◽

Supervised Exercise ◽

History Of

IntroductionTo investigate the effect of an exercise prescription and a 1-year supervised exercise intervention, and the modifying effect of the family history of type 2 diabetes (FH), on long-term cardiometabolic health.Research design and methodsFor this prospective randomized trial, we recruited non-diabetic participants with poor fitness (n=1072, 30–70 years). Participants were randomly assigned with stratification for FH either in the exercise prescription group (PG, n=144) or the supervised exercise group (EG, n=146) group and compared with a matched control group from the same population study (CON, n=782). The PG and EG received exercise prescriptions. In addition, the EG attended supervised exercise sessions two times a week for 60 min for 12 months. Cardiometabolic risk factors were measured at baseline, 1 year, 5 years, and 6 years. The CON group received no intervention and was measured at baseline and 6 years.ResultsThe EG reduced their body weight, waist circumference, diastolic blood pressure, and low-density lipoprotein-cholesterol (LDL-C) but not physical fitness (p=0.074) or insulin or glucose regulation (p>0.1) compared with the PG at 1 year and 5 years (p≤0.011). The observed differences were attenuated at 6 years; however, participants in the both intervention groups significantly improved their blood pressure, high-density lipoprotein-cholesterol, and insulin sensitivity compared with the population controls (p≤0.003). FH modified LDL-C and waist circumference responses to exercise at 1 year and 5 years.ConclusionsLow-cost physical activity programs have long-term beneficial effects on cardiometabolic health regardless of the FH of diabetes. Given the feasibility and low cost of these programs, they should be advocated to promote cardiometabolic health.Trial registration numberClinicalTrials.gov identifier NCT02131701.

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Vitamin D in relation to metabolic risk factors, insulin sensitivity and adiponectin in a young Middle-Eastern population

Acta Endocrinologica ◽

10.1530/eje-08-0952 ◽

2009 ◽

Vol 160 (6) ◽

pp. 965-971 ◽

Cited By ~ 108

Author(s):

Marie-Hélène Gannagé-Yared ◽

Rima Chedid ◽

Simon Khalife ◽

Emmanuel Azzi ◽

Fernand Zoghbi ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Ldl Cholesterol ◽

Middle Eastern ◽

Density Lipoprotein ◽

Multivariate Regression Analysis ◽

Metabolic Risk Factors ◽

Metabolic Risk ◽

Model Assessment ◽

Homa Index

ObjectivesSeveral studies suggest a link between circulating 25-hydroxyvitamin D (25(OH)D) and metabolic risk factors. However, this relation has been mainly studied in elderly and/or obese subjects. In addition, the relation between 25(OH)D and adiponectin is unclear. The purpose of this study is to look at these relations in non-obese young individuals.DesignWe investigated the relation between serum 25(OH)D and adiposity, blood pressure, glucose metabolism, lipid profile, and adiponectin in 381 randomly selected university students (201 males and 180 females, mean age 23.9±3.9).ResultsIn the overall population, 25(OH)D is significantly inversely correlated with body mass index (BMI), systolic blood pressure (SBP), waist circumference (WC), fasting plasma glucose (FPG), insulin levels, and homeostasis model assessment of insulin resistance (HOMA index) and positively correlated with adiponectin and high density lipoprotein-cholesterol (P<0.01 for all variables). In males, these correlations are still significant for BMI, SBP, WC, and adiponectin (P=0.02,P=0.01,P=0.04 andP=0.01 respectively); also, 25(OH)D is inversely correlated with low density lipoprotein (LDL)-cholesterol (P=0.007). In females, 25(OH)D is only inversely correlated with FPG and HOMA index (P<0.001 andP=0.03 respectively). In multivariate regression analysis models, after adjustment for sex and BMI, 25(OH)D is an independent predictor of FPG and SBP (P=0.032 andP=0.05 respectively) in the overall population, while in males 25(OH)D is a predictor of LDL-cholesterol and SBP independently of BMI (P=0.007 andP=0.035 respectively).ConclusionIn non-obese young subjects, we observe new relationships between 25(OH)D and several metabolic risk factors and adiponectin. Further research is needed to elucidate the gender differences and to look at the relation between 25(OH)D and adiponectin.

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The Impact of the Weight Status on Cardiovascular Parameters Related to Physical Effort in Young Athletes

Sustainability ◽

10.3390/su12103964 ◽

2020 ◽

Vol 12 (10) ◽

pp. 3964

Author(s):

Gabriele Mascherini ◽

Cristian Petri ◽

Laura Stefani ◽

Loira Toncelli ◽

Vittorio Bini ◽

...

Keyword(s):

Blood Pressure ◽

Weight Status ◽

Physical Exertion ◽

Normal Weight ◽

Excess Weight ◽

Young Athletes ◽

Physical Effort ◽

Cardiovascular Parameters ◽

Graded Exercise ◽

The Impact

Excess weight leads to an impaired cardiovascular response to physical exertion even at a young age. Sports training during youth promotes cardiovascular adaptations. The aim of the study is to verify the impact of weight status on cardiovascular parameters related to physical effort in young people who engage in competitive sports. A retrospective study was conducted on 8307 young athletes (5578 males and 2729 females) aged 6–18 years (mean age 13.9 ± 2.2 years). The data concerning graded exercise tests of young athletes in normal weight and overweight were compared. Approximately, 13.4% of the sample had excess weight. Young overweight athletes show a higher resting heart rate as well as systolic and diastolic pressure than young normal weight athletes. Excess weight condition leads to a reduction in the duration of the graded exercise test, reaching higher blood pressure values at the end of the test compared to those with normal weight. After four min from the end of the test, heart rate and systolic/diastolic blood pressure remained higher in the young overweight athletes. Excess weight affects cardiovascular parameters both at rest and in response to physical exertion during youth; however, competitive sport seems to be able to keep these parameters within the normal range even in young overweight athletes.

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Effect of Sprint Interval Exercise on Postexercise Metabolism and Blood Pressure in Adolescents

International Journal of Sport Nutrition and Exercise Metabolism ◽

10.1123/ijsnem.22.1.47 ◽

2012 ◽

Vol 22 (1) ◽

pp. 47-54 ◽

Cited By ~ 17

Author(s):

Stephen F. Burns ◽

Hnin Hnin Oo ◽

Anh Thanh Thuy Tran

Keyword(s):

Blood Pressure ◽

Oxygen Consumption ◽

Oxygen Uptake ◽

Interval Training ◽

Fat Oxidation ◽

Substrate Oxidation ◽

Cycle Ergometer ◽

Normal Weight ◽

Interval Exercise ◽

Total Fat

The current study examined the effect of sprint interval exercise on postexercise oxygen consumption, respiratory-exchange ratio (RER), substrate oxidation, and blood pressure in adolescents. Participants were 10 normal-weight healthy youth (7 female), age 15–18 years. After overnight fasts, each participant undertook 2 trials in a random balanced order: (a) two 30-s bouts of sprint interval exercise on a cycle ergometer and (b) rested in the laboratory for an equivalent period. Timematched measurements of oxygen consumption, RER, and blood pressure were made 90 min into recovery, and substrate oxidation were calculated over the time period. Total postexercise oxygen uptake was significantly higher in the exercise than control trial over the 90 min (mean [SD]: control 20.0 [6.0] L, exercise 24.8 [9.8] L; p = .030). After exercise, RER was elevated above control but then fell rapidly and was lower than control 30–60 min postexercise, and fat oxidation was significantly higher in the exercise than control trial 45–60 min postexercise. However, total fat oxidation did not differ between trials (control 4.5 [2.5] g, exercise 5.4 [2.7] g; p = .247). Post hoc tests revealed that systolic blood pressure was significantly lower than in control at 90 min postexercise (control 104 [10] mm Hg, exercise 99 [10] mm Hg; p < .05). These data indicate that acute sprint interval exercise leads to short-term increases in oxygen uptake and reduced blood pressure in youth. The authors suggest that health outcomes in response to sprint interval training be examined in children.

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Glycaemic Control, Lipid Profile, Blood Pressure and Body Weight Status Among Diabetics in Rural Malaysia

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v8i2.753 ◽

2020 ◽

Vol 8 (2) ◽

Author(s):

Hazizi AS ◽

Zaitun Y ◽

Kandiah M ◽

Chan SP

Keyword(s):

Blood Pressure ◽

Body Weight ◽

Blood Glucose ◽

Glycaemic Control ◽

Lipid Profile ◽

Weight Status ◽

Density Lipoprotein ◽

Lipoprotein Cholesterol ◽

Body Weight Status

Introduction: Diabetes is associated with a high risk of cardiovascular disease. The management of blood glucose, dyslipidaemia and other modifiable risk factor, is a key element in the multifactorial approach to prevent complications of type 2 diabetes. Materials and Methods: A cross sectional study was conducted to determine the level of glycaemic control, lipid profile, blood pressure and body weight status among type 2 diabetics in rural Malaysia. A total of 237 diabetic subjects participated in this study. Physical examination was carried out, including measurements of height, weight, waist and hip circumferences, and systolic and diastolic blood pressure. Fasting venous blood samples were collected to determine the glucose level and lipid profile. Results: About 70% of the subjects had a high body mass index (BMI), equal to or above 25 kg/ m2. More than 60% of the subjects had systolic blood pressure ≥ 140 mmHg and/or diastolic ≥ 90 mmHg. Mean fasting blood glucose was 9.84±4.54 mmol/L. Mean total cholesterol was 5.18±1.35 mmol/L. High density lipoprotein cholesterol (HDLC) and triglyceride (TG) and glucose levels were higher in male than in female, but not statistically significant (p>0.05). However, low density lipoprotein cholesterol (LDLC) was higher in females than males (p<0.05). Mean HDLC was below 1.0 mmol/L in all subjects. Conclusion: Glycaemic control, lipid profile, blood pressure and body weight status were not satisfactory and may increase the risk of microvascular and macrovascular complications among these subjects. Appropriate intervention programs should be implemented for better diabetes control among rural subjects.

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The Clustering of Low Diet Quality, Low Physical Fitness, and Unhealthy Sleep Pattern and Its Association with Changes in Cardiometabolic Risk Factors in Children

Nutrients ◽

10.3390/nu12020591 ◽

2020 ◽

Vol 12 (2) ◽

pp. 591

Author(s):

Xianwen Shang ◽

Yanping Li ◽

Haiquan Xu ◽

Qian Zhang ◽

Ailing Liu ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Blood Pressure ◽

Diet Quality ◽

Cardiometabolic Risk ◽

Fasting Glucose ◽

Density Lipoprotein ◽

Sleep Pattern ◽

Cardiometabolic Health ◽

Z Scores

The clustering of diet quality, physical activity, and sleep and its association with cardiometabolic risk (CMR) factors remains to be explored. We included 5315 children aged 6–13 years in the analysis. CMR score (CMRS) was computed by summing Z-scores of waist circumference, an average of systolic and diastolic blood pressure, fasting glucose, high-density lipoprotein cholesterol (multiplying by −1), and triglycerides. Low diet quality and low cardiorespiratory fitness (CRF) were more likely to be seen in a pair, but low diet quality was less likely to be clustered with unhealthy sleep patterns. Low diet quality, low CRF, and unhealthy sleep pattern was associated with a 0.63, 0.53, and 0.25 standard deviation (SD) higher increase in CMRS, respectively. Compared to children with no unhealthy factor (−0.79 SD), those with ≥1 unhealthy factor had a higher increase (−0.20 to 0.59 SD) in CMRS. A low diet quality-unhealthy sleep pattern resulted in the highest increase in CMRS, blood pressure, and triglycerides. A low diet quality–low CRF-unhealthy sleep pattern resulted in the highest increase in fatness and fasting glucose. Unhealthy factor cluster patterns are complex; however, their positive associations with changes in CMR factors are consistently significant in children. Some specific patterns are more harmful than others for cardiometabolic health.

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