title: Combined impact of negative lifestyle factors on cardiovascular risk in children: a randomized prospective study.
abstract: OBJECTIVE
  Negative lifestyle factors are known to be associated with increased cardiovascular risk (CVR) in children, but research on their combined impact on a general population of children is sparse. Therefore, we aimed to quantify the combined impact of easily assessable negative lifestyle factors on the CVR scores of randomly selected children after 4 years.
  
  
  METHODS
  Of the 540 randomly selected 6- to 13-year-old children, 502 children participated in a baseline health assessment, and 64% were assessed again after 4 years. Measures included anthropometry, fasting blood samples, and a health assessment questionnaire. Participants scored one point for each negative lifestyle factor at baseline: overweight; physical inactivity; high media consumption; little outdoor time; skipping breakfast; and having a parent who has ever smoked, is inactive, or overweight. A CVR score at follow-up was constructed by averaging sex- and age-related z-scores of waist circumference, blood pressure, glucose, inverted high-density lipoprotein, and triglycerides.
  
  
  RESULTS
  The age-, sex-, pubertal stage-, and social class-adjusted probabilities (95% confidence interval) for being in the highest CVR score tertile at follow-up for children who had at most one (n = 48), two (n = 64), three (n = 56), four (n = 41), or five or more (n = 14) risky lifestyle factors were 15.4% (8.9-25.3), 24.3% (17.4-32.8), 36.0% (28.6-44.2), 49.8% (38.6-61.0), and 63.5% (47.2-77.2), respectively.
  
  
  CONCLUSIONS
  Even in childhood, an accumulation of negative lifestyle factors is associated with higher CVR scores after 4 years. These negative lifestyle factors are easy to assess in clinical practice and allow early detection and prevention of CVR in childhood.
authors.affiliation: Centre on Aging and Mobility, University of Zürich, Zürich, Switzerland; Department of Human Movement Science, Maastricht University, Maastricht, The Netherlands; Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.
authors.forename: Ursina
authors.initials: U
authors.lastname: Meyer
authors.affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Schindler
authors.affiliation: Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.
authors.forename: Tamara
authors.initials: T
authors.lastname: Bloesch
authors.affiliation: Department of Sports Science, University of Konstanz, Konstanz, Germany.
authors.forename: Eliane
authors.initials: E
authors.lastname: Schmocker
authors.affiliation: Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.
authors.forename: Lukas
authors.initials: L
authors.lastname: Zahner
authors.affiliation: Service of Endocrinology, Diabetes and Metabolism, Centre Hospitalier Universitaire Vaudoise, University of Lausanne, Lausanne, Switzerland.
authors.forename: Jardena J
authors.initials: JJ
authors.lastname: Puder
authors.affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Institute of Social and Preventive Medicine, University of Zürich, Zürich, Switzerland. Electronic address: susi.kriemler@ifspm.uzh.ch.
authors.forename: Susi
authors.initials: S
authors.lastname: Kriemler
mesh_terms: D000293:Adolescent; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology*; D002648:Child; D015444:Exercise; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D050177:Overweight / Q000453:epidemiology; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D057185:Sedentary Behavior; D013557:Switzerland / Q000453:epidemiology; D014028:Tobacco Smoke Pollution / Q000706:statistics & numerical data; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference
chemical_list: D014028:Tobacco Smoke Pollution; D014280:Triglycerides
keywords: Behavior; Breakfast; Longitudinal; Media consumption; Metabolic syndrome; Overweight; Parents; Physical activity