Mediation of obesity-related variables in the association between physical fitness and cardiometabolic risk in children and adolescents: a systematic review and meta-analysis.
João Francisco de Castro Silveira, José Francisco López-Gil, Cézane Priscila Reuter, Ana Paula Sehn, Letícia Borfe, Nelson Carvas Junior, Karin Allor Pfeiffer, Paulo Henrique Guerra, Lars Bo Andersen, Antonio Garcia-Hermoso, Anelise Reis Gaya
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引用次数: 0
Abstract
Objective: To examine the mediation of obesity-related variables in the association between physical fitness and cardiometabolic risk in children and adolescents.
Design: Systematic review and meta-analysis.
Data sources: Studies from electronic databases from inception to 31 December 2023.
Eligibility criteria for selecting studies: Included were 123 observational studies (cross-sectional and longitudinal) that assessed risk by constructing a continuous score incorporating cardiometabolic parameters. Studies were considered if they evaluated at least one fitness component as an exposure in children and adolescents (5-19 years). Thirty-one were included in the main meta-analyses.
Results: Cross-sectional findings indicate that cardiorespiratory fitness is modestly but beneficially associated with cardiometabolic risk, either indirectly via obesity-related variables (indirect standardized beta coefficient [βIndirect]=-0.17; 95% confidence interval [CI] -0.23; -0.11; inconsistency index [I2]=94.4%) or directly and independently from obesity-related variables (r=-0.11; 95% CI -0.15; -0.07; I2=87.4%), whereas muscular fitness seems to be associated with risk only via obesity-related variables (βIndirect=-0.34; 95% CI -0.47; -0.20; I2=85.1%). There was no cross-sectional difference between biological sexes (p≥0.199). Longitudinal findings indicate no total (r=-0.12; 95% CI -0.24; 0.01; I2=23.1%) and direct (r=-0.03; 95% CI -0.08; 0.03; I2=0%) associations.
Conclusion: The association between fitness and risk appears to take place either indirectly through the reduction of obesity-related levels or directly by influencing risk. The latter underscores that the inverse association extends beyond a mere reduction in obesity-related variables, encompassing specific enhancements linked to exercise training, including increased metabolic efficiency, and cardiovascular capacity.
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