title: Independent associations of physical activity and cardiorespiratory fitness with metabolic risk factors in children: the European youth heart study.
abstract: OBJECTIVE
  High levels of cardiorespiratory fitness (CRF) and physical activity (PA) are associated with a favourable metabolic risk profile. However, there has been no thorough exploration of the independent contributions of cardiorespiratory fitness and subcomponents of activity (total PA, time spent sedentary, and time spent in light, moderate and vigorous intensity PA) to metabolic risk factors in children and the relative importance of these factors.
  
  
  METHODS
  We performed a population-based, cross-sectional study in 9- to 10- and 15- to 16-year-old boys and girls from three regions of Europe (n = 1709). We examined the independent associations of subcomponents of PA and CRF with metabolic risk factors (waist circumference, BP, fasting glucose, insulin, triacylglycerol and HDL-cholesterol levels). Clustered metabolic risk was expressed as a continuously distributed score calculated as the average of the standardised values of the six subcomponents.
  
  
  RESULTS
  CRF (standardised beta = -0.09, 95% CI -0.12, -0.06), total PA (standardised beta = -0.08, 95% CI -0.10, -0.05) and all other subcomponents of PA were significantly associated with clustered metabolic risk. After excluding waist circumference from the summary score and further adjustment for waist circumference as a confounding factor, the magnitude of the association between CRF and clustered metabolic risk was attenuated (standardised beta = -0.05, 95% CI -0.08, -0.02), whereas the association with total PA was unchanged (standardised beta = -0.08 95% CI -0.10, -0.05).
  
  
  CONCLUSIONS
  PA and CRF are separately and independently associated with individual and clustered metabolic risk factors in children. The association between CRF and clustered risk is partly mediated or confounded by adiposity, whereas the association between activity and clustered risk is independent of adiposity. Our results suggest that fitness and activity affect metabolic risk through different pathways.
authors.affiliation: MRC Epidemiology Unit, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, CB1 9NL, UK. Ulf.ekelund@mrc-epid.cam.ac.uk.
authors.forename: U
authors.initials: U
authors.lastname: Ekelund
authors.affiliation: Department of Sports Medicine, Norwegian University of Sport Sciences, Oslo, Norway.
authors.forename: S A
authors.initials: SA
authors.lastname: Anderssen
authors.affiliation: Institute of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Froberg
authors.affiliation: Faculty of Human Movement Sciences, Technical University of Lisbon, Lisbon, Portugal.
authors.forename: L B
authors.initials: LB
authors.lastname: Sardinha
authors.affiliation: Department of Sports Medicine, Norwegian University of Sport Sciences, Oslo, Norway.
authors.forename: L B
authors.initials: LB
authors.lastname: Andersen
authors.affiliation: MRC Epidemiology Unit, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, CB1 9NL, UK.
authors.forename: S
authors.initials: S
authors.lastname: Brage
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D003430:Cross-Sectional Studies; D005060:Europe; D005260:Female; D006321:Heart / Q000502:physiology*; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D010809:Physical Fitness; D012143:Respiratory Physiological Phenomena; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology