title: Obesity as a Mediator between Cardiorespiratory Fitness and Blood Pressure in Preschoolers.
abstract: OBJECTIVE
  To analyze the relationships between body mass index (BMI), cardiorespiratory fitness (CRF), and blood pressure (BP), and to examine whether obesity acts as a mediator between fitness and BP in children.
  
  
  METHODS
  A cross-sectional analysis using a population-based sample of 1604 school children aged 4-7 years attending 21 schools from the provinces of Ciudad Real and Cuenca, Spain, was undertaken. Data on anthropometric variables, BP measurements, and CRF were collected. The relationships between body composition (BMI, percent body fat, and waist circumference), CRF, and mean arterial pressure was estimated using Pearson correlation coefficients. ANCOVA tested the differences in BP measurements by categories of BMI and CRF, controlling for different sets of confounders. The PROCESS macro developed by Preacher and Hayes was used for mediation analysis.
  
  
  RESULTS
  BP values were significantly higher in school children with excess weight and poorer CRF. In addition, BMI acts as a full mediator in the association between CRF and mean arterial pressure in boys at 62.28% (z = -5.433; P ≤ .001) and a partial mediator in girls at 35.24% (z = -5.246; P ≤ .001).
  
  
  CONCLUSIONS
  BMI mediates the relationship between CRF and mean arterial pressure. These findings highlight the importance of maintaining a healthy weight for the prevention of high BP levels in childhood.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT01971840.
authors.affiliation: Social and Health Care Research Center, University of Castilla-La Mancha, Cuenca, Spain.
authors.forename: Diana P
authors.initials: DP
authors.lastname: Pozuelo-Carrascosa
authors.affiliation: Social and Health Care Research Center, University of Castilla-La Mancha, Cuenca, Spain; School of Education, University of Castilla-La Mancha, Ciudad Real, Spain.
authors.forename: Mairena
authors.initials: M
authors.lastname: Sánchez-López
authors.affiliation: Social and Health Care Research Center, University of Castilla-La Mancha, Cuenca, Spain.
authors.forename: Iván
authors.initials: I
authors.lastname: Cavero-Redondo
authors.affiliation: School of Nursing and Physiotherapy, University of Castilla-La Mancha, Toledo, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Torres-Costoso
authors.affiliation: Social and Health Care Research Center, University of Castilla-La Mancha, Cuenca, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Bermejo-Cantarero
authors.affiliation: Social and Health Care Research Center, University of Castilla-La Mancha, Cuenca, Spain; Faculty of Health Sciences, Autonomous University of Chile, Talca, Chile. Electronic address: Vicente.Martinez@uclm.es.
authors.forename: Vicente
authors.initials: V
authors.lastname: Martínez-Vizcaíno
mesh_terms: D001794:Blood Pressure / Q000502:physiology*; D001823:Body Composition / Q000502:physiology*; D015992:Body Mass Index; D000072599:Cardiorespiratory Fitness / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D063766:Pediatric Obesity / Q000503:physiopathology*; D012307:Risk Factors; D013030:Spain
keywords: blood pressure; cardiorespiratory fitness; children; mediation analysis; obesity