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Abstract Background and aims International reference values for cardiometabolic risk variables, to allow for standardization of continuous risk scores in children, are not currently available. The aim of this study was to provide international age- and gender-specific reference values for cardiometabolic risk factors in children and adolescents. Methods Cohorts of children sampled from different parts of Europe (North, South, Mid and Eastern) and from the United States were pooled. In total, 22,479 observations (48.7% European vs. 51.3% American), 11,234 from girls and 11,245 from boys, aged 6–18 years were included in the study. Linear mixed-model regression analysis was used to analyze the associations between age and each cardiometabolic risk factor. Results Reference values for 14 of the most commonly used cardiometabolic risk variables in clustered risk scores were calculated and presented by age and gender: systolic blood pressure (SBP), diastolic blood pressure (DBP), waist circumference (WC), body mass index (BMI), sum of 4 skinfolds (sum4skin), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), TC:HDL-C ratio, glucose, insulin, homeostatic model assessment-score (HOMA-score), and cardiorespiratory fitness (CRF). Conclusions This study suggests a common standard to define cardiometabolic risk in children. Adapting this approach makes single risk factors and clustered cardiometabolic disease risk scores comparable to the reference material itself and comparable to cardiometabolic risk values in studies using the same strategy. This unified approach therefore increases the prospect to estimate and compare prevalence and trends of cardiometabolic risk in children when using continuous cardiometabolic risk scores. Highlights • Reference values for 14 cardiometabolic risk factors in 6–18 year olds are provided. • Based on 22,479 observations from European and American studies. • Easy to apply to standardize cardiometabolic risk factors. • No similar reference material is available. • Make comparability of continuous clustered risk scores between populations possible. [ABSTRACT FROM AUTHOR]

Abstract Background and aims The profile of cholesterol metabolism, i.e., high absorption vs. high synthesis, may have a role in the development of atherosclerosis, the early lesions of which can be present already in childhood. Since there is no information on cholesterol metabolism in children from birth to adolescence, we evaluated cholesterol metabolism in 0–15 year-old children and adolescents without dyslipidemia. Methods The study population consisted of 96 children (39 girls, 57 boys) divided into age groups <1 (n = 14), 1–5 (n = 37), 6–10 (n = 24), and 11–15 (n = 21) years. Cholesterol metabolism was assessed by analysing serum non-cholesterol sterols, biomarkers of cholesterol synthesis and absorption, with gas-liquid chromatography. Results Serum non-cholesterol sterol ratios to cholesterol did not differ between gender. Cholesterol precursors squalene, cholestenol, and desmosterol were higher in the <1 year than in the older age groups, whereas lathosterol was highest in the 11–15 year old. Plant sterols were low in the age group <1 year, after which they did not differ between the groups. Cholestanol was not age-dependent. From the age of 1 year, cholesterol homeostasis was intact. Cholesterol absorption prevailed cholesterol synthesis from 1 to 10 years of age (e.g., lathosterol/cholestanol ratio 0.35 ± 0.03 and 0.45 ± 0.05 in 1–5 and 6–10 vs. 0.66 ± 0.08 in 11–15 year-old (mean ± SE, p < 0.001). Conclusions Serum non-cholesterol sterols had different individual profiles by age in childhood and adolescence. From 1 to 10 years of age, cholesterol absorption prevailed cholesterol synthesis. This novel finding emphasizes the importance of dietary aspects related to cardiovascular risk even from early childhood. Highlights • We evaluated cholesterol metabolism in 0–15 year-old children without dyslipidemia. • Serum non-cholesterol sterols depicted cholesterol synthesis and absorption. • From the age of 1 year, cholesterol homeostasis was intact. • From the age of 1–10 years cholesterol absorption prevailed cholesterol synthesis. • This new finding emphasizes the importance of healthy diet from early childhood. [ABSTRACT FROM AUTHOR]

Background: Cross-sectional data have suggested an inverse relation between physical activity and cardiometabolic risk factors that is independent of sedentary time. However, little is known about which subcomponent of physical activity may predict cardiometabolic risk factors in youths. Objective: We examined the independent prospective associations between objectively measured sedentary time and subcomponents of physical activity with individual and clustered cardiometabolic risk factors in healthy children aged 10 y. Design: We included 700 children (49.1% males; 50.9% females) in which sedentary time and physical activity were measured with the use of accelerometry. Systolic blood pressure, waist circumference (WC), and fasting blood sample (total cholesterol, high-density lipoprotein cholesterol, triglycerides, glucose, fasting insulin) were measured with the use of standard clinical methods and analyzed individually and as a clustered cardiometabolic risk score standardized by age and sex (z score). Exposure and outcome variables were measured at baseline and at follow-up 7 mo later. Results: Sedentary time was not associated with any of the individual cardiometabolic risk factors or clustered cardiometabolic risk in prospective analyses. Moderate physical activity at baseline predicted lower concentrations of triglycerides (P = 0.021) and homeostatic model assessment for insulin resistance (P = 0.027) at follow-up independent of sex, socioeconomic status, Tanner stage, monitor wear time, or WC. Moderate-to-vigorous physical activity (P = 0.043) and vigorous physical activity (P = 0.028) predicted clustered cardiometabolic risk at follow-up, but these associations were attenuated after adjusting for WC. Conclusions: Physical activity, but not sedentary time, is prospectively associated with cardiometabolic risk in healthy children. Public health strategies aimed at improving children's cardiometabolic profile should strive for increasing physical activity of at least moderate intensity rather than reducing sedentary time. This trial was registered at clinicaltrials.gov as NCT02132494. [ABSTRACT FROM AUTHOR]

This study was planned in order to determine physical activity levels of visually impaired children and adolescents and to investigate the effect of gender and level of vision on physical activity level in visually impaired children and adolescents. A total of 30 visually impaired children and adolescents (16 low vision and 14 blind) aged between 8 and 16years participated in the study. The physical activity level of cases was evaluated with a physical activity diary (PAD) and one-mile run/walk test (OMR–WT). No difference was found between the PAD and the OMR–WT results of low vision and blind children and adolescents. The visually impaired children and adolescents were detected not to participate in vigorous physical activity. A difference was found in favor of low vision boys in terms of mild, moderate activities and OMR–WT durations. However, no difference was found between physical activity levels of blind girls and boys. The results of our study suggested that the physical activity level of visually impaired children and adolescents was low, and gender affected physical activity in low vision children and adolescents. [Copyright &y& Elsevier]

The purpose of this study was to describe the BMI status of children and youth with intellectual disabilities by world region, gender and age. A total of 9678 children and youth records were available from the Special Olympics International Health Promotion database after data cleaning (6084 boys and 3594 girls). Children were defined as 8–11 year olds (n =2035), and youth were defined as 12–18 year olds (n =7643). BMI prevalence rates were computed using the International Obesity Task Force (IOTF) cut-points, and logistic regression was used to determine if either age or gender was associated with being overweight or obese. Approximately 30% of the sample was overweight or obese; however, the prevalence rates in North America were much higher, particularly among girls. Fifty-four percent of girls (95% confidence interval [CI], 51.4–57.2%) were overweight or obese. Logistic regression revealed that both age and gender were significant predictors in North America; however this pattern was not consistent throughout the world regions. BMI status is a significant indicator of health, and these findings suggest that overweight and obesity are significant health concerns for children and youth with intellectual disabilities around the world. Obesity rates in this population are particularly high in North America, and the odds of becoming overweight or obese increased with age in North America. It is critical that health professionals increase Health Promotion efforts, including physical activity and healthy eating behaviors for children and youth with intellectual disabilities. [Copyright &y& Elsevier]

Objectives: To examine whether the free swimming initiative in Bristol was associated with higher uptake in more affluent areas ('inverse use law'). Study design: Secondary analysis of statistical data on free swimming session attendances in Bristol, recorded from January to June 2010. Individual postcode data were linked to lower-layer super output area (LSOA) of residence and the specific pool attended. Methods: The dataset comprised 58,582 swims by 13,881 unique individuals between January and June 2010. The influence of age group, gender, season, distance from pool and area deprivation score (English Index of Multiple Deprivation) on swimming uptake rates was examined. Results: Higher uptake rates were found amongst girls and older children. Higher attendance was also related to proximity to pool and warmer season. No association was found between area deprivation and uptake rate (P = 0.31). Lower uptake rates in deprived areas were more marked if they were further away from a pool and in the winter season (P-value for interactions <0.001). Conclusions: The termination of the free swimming initiative in England may have removed an opportunity to promote physical activity across the social gradient. The evaluation of public health initiatives should examine effects across the social gradient, and clarify which aspects of interventions enhance the participation of poorer sections of society. [ABSTRACT FROM AUTHOR]

Abstract: The National Center for Injury Prevention and Control (NCIPC) has a focus on preventing interpersonal violence against children and youth. Prevention of violence against children and youth involves fostering healthy relationships and building healthy environments in which young people can flourish. We review NCIPC''s work over the past 20years that has contributed to this goal by highlighting surveillance systems that identify the magnitude of violence, etiological research that identifies risk and protective factors that are associated with violence, evaluation research that has expanded the evidence base of what works to prevent violence, and comprehensive, broad-based programs that engage and empower communities to prevent violence. NCIPC''s work demonstrates that violence is preventable and the Center is working to move the promise of effective prevention into practice. These efforts all work toward protecting the health and well-being of children and youth and set the stage for NCIPC''s future work. [Copyright &y& Elsevier]

Abstract: Community arts projects are widely believed to have positive impacts on health, wellbeing and social inclusion. Such beliefs underpinned the UK Government-funded SingUp programme for children. Drawing on data from participant observation, extended interviews, focus groups and a questionnaire survey, we examine the experiences of children in three SingUp choirs. We focus specifically on social and emotional wellbeing as they relate to social capital: this being one of the key pathways through which arts participation is thought to impact on health and wellbeing more widely. For many (particularly girls from relatively privileged backgrounds), the experience has been largely positive, providing opportunities to develop social capital, make new friends and build confidence. However, others’ experiences have been more equivocal, entailing risks of disconnection from existing networks of friends. We argue that, while arts projects can impact positively on young people’s social and emotional wellbeing, we cannot assume that the changes will be unequivocally good or straightforward. We follow Bourdieu and other critical theorists in arguing that social capital operates in association with economic and cultural capital, and cannot be understood in isolation from the wider constraints of people’s lives. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this study was to assess perceived physical activity (PA) opportunities and barriers for inner-city youth. Data were collected via interviews with 59 children, 8 school staff, and 13 youth workers plus objective neighborhood data. Analyses revealed three themes that influenced PA: neighborhood characteristics, family involvement, and adult-supervised programs. The neighborhood was highly walkable and multiple play spaces were available, but safety concerns restricted access. Children were rarely allowed out alone, but family accompaniment facilitated PA. Organized programs provided adult-supervised PA, but programs faced staffing problems that served to limit the provision of PA opportunities. Multiple ecological factors constrain or enable PA among inner-city youth. [Copyright &y& Elsevier]

Many studies report few socioeconomic (SES) differences in health in youth, a pattern contrasting with that of health inequalities in childhood and adulthood. This paper focuses on the child–youth transition to examine the hypothesis of equalisation in health over this period. Specifically, we test two hypotheses: (a) that equalisation is more likely for health state measures (physical and malaise symptoms and accidents) than health status ([limiting] longstanding illness and self-rated health) or health potential (height), and (b) that the patterning of health over this period is similar between occupational (social class) and non-occupational (deprivation, housing tenure and family affluence) SES measures. Data are derived from the West of Scotland 11 to 16 cohort, followed from late childhood (aged 11) through early (13) to mid (15) adolescence. The results showed very little evidence of SES differences in (limiting) longstanding illness at any age for both sexes, while self-rated health exhibited some differentiation, and height (as expected) consistent gradients throughout. By contrast, among males evidence of equalisation was found for both physical and malaise symptoms and pedestrian road traffic accidents (RTAs). Among females, equalisation was confined to specific physical symptoms, pedestrian RTAs, sports injuries and burns/scalds, while for malaise symptoms a reverse gradient at age 11 strengthened with age. These patterns were generally unaffected by the SES measure used. We conclude that while some of the evidence is consistent with the equalisation hypothesis, it needs extending to accommodate patterns of no SES differences, and particularly reverse gradients, in childhood. These patterns may reflect the increasingly pervasive influence of youth culture, suggesting that in the UK the boundary between childhood and youth should be set at an earlier age. This in turn suggests that international comparisons have considerable analytic potential for identifying the conditions under which equalisation does and does not occur. [Copyright &y& Elsevier]

Despite the apparent relationship between neighborhood characteristics and health, few studies of child health address neighborhood-level barriers, which may contribute to clinic no-show rates and difficulties following treatment plans in children and youth. We used longitudinal data from an outpatient hypertension clinic to examine neighborhood social disorganization, built environments, and their associations with patients' clinic attendance and the risk of obesity/hypertension using mixed-effects regression models. Patients from disorganized neighborhoods were less likely to attend a baseline visit, and more likely to develop overweight/obesity and hypertension during follow-up. High-level fast-food expenditures in the neighborhood were associated with higher BMI percentiles and SBP during follow-up. [ABSTRACT FROM AUTHOR]

Background: Field tests measuring the same construct, in this case, aerobic capacity, use different scales, which makes fitness assessment of children and youth potentially confusing. The Primary Field Test Centered Equating Method has been developed to set tests on the same scale, as illustrated by the conversion of Progressive Aerobic Capacity Endurance Run (PACER) scores to 1-mile run/walk times to estimate VO2max. Purpose: The purpose of this study was to cross-validate the Primary Field Test Centered Equating Method by using a data set of middle school students to assess its effectiveness. Methods: PACER scores of 135 middle school students were converted to 1-mile run/walk times (Mile PEQ) using the proposed method. Several estimates of VO2max using PACER scores were then compared to estimated VO2max using Mile PEQ and measured VO2max. The obtained measures were classified according to the healthy fitness zone (HFZ; FITNESSGRAM®, version 9) and compared to measured VO2max. BMI estimates based on the sample data and the national average also were considered to assess the method''s flexibility. Results: Agreement levels with actual values were similar for VO2max predicted using Mile PEQ and predictions using PACER laps and speed (73%–75%). The t-tests showed no significant difference between actual VO2max (M=44.43, SD= 8.36) and VO2max predicted using Mile PEQ (M=44.33, SD=5.88). Using BMI averages from sample data and the national data to estimate VO2max using Mile PEQ also yields high agreement levels, 70% and 73%, respectively. Conclusions: The Primary Field Test Centered Equating Method performs as well or better in estimating VO2max as several other models using PACER scores, especially for boys, and thus may be successfully used in practice. More research is needed to understand the relatively low prediction and classification accuracy in girls. [Copyright &y& Elsevier]