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Licensed Unlicensed Requires Authentication Published by De Gruyter March 20, 2017

Associations between obesity, adverse behavioral patterns and cardiovascular risk factors among adolescent inhabitants of a Greek island

  • Anastasia Garoufi EMAIL logo , Evangelos E. Grammatikos , Anastasios Kollias , Emmanuel Grammatikos , George S. Stergiou and Alexandra Soldatou

Abstract

Background:

Excess weight, unhealthy lifestyle habits and their sequelae have become a well-recognized public health problem in most countries. The objective of the study was to examine the relationship of adolescent overweight/obesity with behavioral habits and their association with blood pressure (BP) and lipid profile.

Methods:

Anthropometric parameters, lifestyle, BP and lipid profile of 736 adolescents were evaluated cross-sectionally. The classifications of normal weight, overweight and obese were based on BMI z-scores.

Results:

About 42.1% of adolescents were overweight/obese, 11.3% were smokers, 33.2% consumed alcohol and 34% reported low activity. Males began smoking earlier, consumed alcohol more often, exercised less and spent more screen time than females. Alcohol consumption was more prevalent among smokers and was associated with higher BP and dyslipidemia. Smokers exercised less intensely and had lower high density lipoprotein-cholesterol (HDL-C) than non-smokers. Obesity was a risk factor for higher BP and dyslipidemia. Longer screen time was associated with higher triglycerides, while intense physical activity with lower systolic BP.

Conclusions:

Obesity is related to an adverse lipid and BP profile during adolescence. Clustering of hazardous habits was observed, which is known to aggravate the cardiovascular risk.


Corresponding author: Anastasia Garoufi, MD, PhD, Associate Professor, Second Department of Pediatrics, National and Kapodistrian University of Athens, “P. & A. Kyriakou” Children’s Hospital, Thivon and Levadias str, Goudi, 11527, Athens, Greece, Phone: 0030-213-2009261

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 2006;1:11–25.10.1080/17477160600586747Search in Google Scholar

2. Lobstein T, Jackson-Leach R, Moodie ML, Hall KD, Gortmaker SL, et al. Child and adolescent obesity: part of a bigger picture. Lancet 2015;385:2510–20.10.1016/S0140-6736(14)61746-3Search in Google Scholar

3. Sánchez-Cruz J-J, Jiménez-Moleón JJ, Fernández-Quesada F, Sánchez MJ. Prevalence of child and youth obesity in Spain in 2012. Rev Esp Cardiol 2013;66:371–6.10.1016/j.rec.2012.10.012Search in Google Scholar PubMed

4. Tambalis KD, Panagiotakos DB, Kavouras SA, Kallistratos A, Moraiti IP, et al. Eleven-year prevalence trends of obesity in greek children: first evidence that prevalence of obesity is leveling off. Obesity 2009;18:161–6.10.1038/oby.2009.188Search in Google Scholar PubMed

5. Kollias A, Skliros E, Stergiou GS, Leotsakos N, Saridi M, et al. Obesity and associated cardiovascular risk factors among schoolchildren in Greece: a cross-sectional study and review of the literature. J Pediatr Endocr Met 2011;24:929–38.10.1515/JPEM.2011.309Search in Google Scholar PubMed

6. Tsitsika AK, Andrie EK, Psaltopoulou T, Tzavara CK, Sergentanis TN, et al. Association between problematic internet use, socio-demographic variables and obesity among European adolescents. Eur J Public Health 2016;26:617–22.10.1093/eurpub/ckw028Search in Google Scholar PubMed

7. Hublet A, De Bacquer D, Valimaa R, Godeau E, Schmid H, et al. Smoking trends among adolescents from 1990 to 2002 in ten European countries and Canada. BMC Public Health 2006;6: 280–6.10.1186/1471-2458-6-280Search in Google Scholar PubMed PubMed Central

8. American Academy of Pediatrics. Policy statement-alcohol use by youth and adolescents: a pediatric concern. (2010). Pediatrics 2006;125:1078–87.10.1542/peds.2010-0438Search in Google Scholar PubMed

9. Kyrlesi A, Soteriades ES, Warren CW, Kremastinou J, Papastergiou P, et al. Tobacco use among students aged 13–15 years in Greece: the GYTS project. BMC Public Health 2007;7:3–8.10.1186/1471-2458-7-3Search in Google Scholar PubMed PubMed Central

10. Tsoumakas K, Tanaka M, Petsios K, Fildisis G, Gkoutzivelakis A, et al. Alcohol drinking habits and negative experiences among adolescents in Greece. Open J Pediatr 2014;4:222–30.10.4236/ojped.2014.43029Search in Google Scholar

11. Stolle M, Sack PM, Thomasius R. Binge drinking in childhood and adolescence. Epidemiology, consequences, and interventions. Dtsch Ärztebl Int 2009;106:323–8.10.3238/arztebl.2009.0595bSearch in Google Scholar

12. Hoffman JH, Welte JW, Barnes GM. Co-occurrence of alcohol and cigarette use among adolescents. Addict Behav 2001;26:63–78.10.1016/S0306-4603(00)00089-7Search in Google Scholar

13. Johnson PB, Boles SM, Vaughan R, Kleber HD. The co-occurrence of smoking and binge drinking in adolescence. Addict Behav 2000;25:779–83.10.1016/S0306-4603(99)00066-0Search in Google Scholar

14. Wetzels JJ, Kremers SP, Vitoria PD, de Vries H. The alcohol-tobacco relationship: a prospective study among adolescents in six European countries. Addiction 2003;98:1755–63.10.1111/j.1360-0443.2003.00553.xSearch in Google Scholar

15. Jerez SJ, Coviello A. Alcohol drinking and blood pressure among adolescents. Alcohol 1998;16:1–5.10.1016/S0741-8329(97)00152-3Search in Google Scholar

16. Croft JB, Freedman DS, Cresanta LJ, Srinivasan SR, Burke GL, et al. Adverse influences of alcohol, tobacco, and oral contraceptive use on cardiovascular risk factors during transition to adulthood. Am J Epidemiol 1988;126:202–13.10.1093/aje/126.2.202Search in Google Scholar PubMed

17. Craig WY, Palomaki GE, Haddow JE. Cigarette smoking and serum lipid and lipoprotein concentrations: an analysis of published data. Br Med J 1989;298:784–8.10.1136/bmj.298.6676.784Search in Google Scholar PubMed PubMed Central

18. Craig WY, Palomaki GE, Johnson AM, Haddow JE. Cigarette smoking-associated changes in blood lipid and lipoprotein levels in the 8- to 19-year-old age group: a meta-analysis. Pediatrics 1990;85:155–8.10.1542/peds.85.2.155Search in Google Scholar

19. Beauchamp A, Tonkin A, Peeters A, Wolfe R, Turrell G, et al. Associations among smoking status, lifestyle and lipoprotein subclasses. J Clin Lipidol 2010;4:522–30.10.1016/j.jacl.2010.09.003Search in Google Scholar PubMed

20. Mammas IN, Bertsias GK, Linardakis M, Tzanakis NE, Labadarios DN, et al. Cigarette smoking, alcohol consumption, and serum lipid profile among medical students in Greece. Eur J Public Health 2003;13:278–82.10.1093/eurpub/13.3.278Search in Google Scholar PubMed

21. Celermajer DS, Ayer JG. Childhood risk factors for adult cardiovascular disease and primary prevention in childhood. Heart 2003;92:1701–6.10.1136/hrt.2005.081760Search in Google Scholar

22. Hancox RJ, Milne BJ, Poulton R. Association between child and adolescent television viewing and adult health: a longitudinal birth cohort study. Lancet 2004;364:257–62.10.1016/S0140-6736(04)16675-0Search in Google Scholar

23. Nagel G, Rapp K, Wabitsch M, Buchele G, Kroke A, et al. Prevalence and cluster of cardiometabolic biomarkers in overweight and obese schoolchildren: results from a large survey in Southwest Germany. Clin Chem 2008;54:317–25.10.1373/clinchem.2007.094821Search in Google Scholar PubMed

24. Belay B, Belamarich P, Racine AD. Pediatric precursors of adult atherosclerosis. Pediatr Rev 2004;25:4–14.10.1542/pir.25.1.4Search in Google Scholar

25. Parisi SM, Goodman E. Obesity and cardiovascular disease risk in children and adolescents. Curr Cardio Risk Rep 2008;2:47–52.10.1007/s12170-008-0010-7Search in Google Scholar

26. Li S, Chen W, Srinivasan SR, Bond MG, Tang R, et al. Childhood cardiovascular risk factors and carotid vascular changes in adult hood: the bogalusa heart study. J Am Med Assoc 2003;290:2271–6.10.1001/jama.290.17.2271Search in Google Scholar PubMed

27. Landry BW, Discoll SW. Physical activity in children and adolescents. PM R 2012;4:4826–32.10.1016/j.pmrj.2012.09.585Search in Google Scholar PubMed

28. Moreno LA, Gottrand F, Huybrechts I, Ruiz JR, Conzález-Gross M, et al. Nutrition and lifestyle in European adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescents) study. Adv Nutr 2014;5:615S–23.10.3945/an.113.005678Search in Google Scholar PubMed PubMed Central

29. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. Br Med J 2000;320:1240–3.10.1136/bmj.320.7244.1240Search in Google Scholar PubMed PubMed Central

30. Stergiou GS, Yiannes NG, Rarra VC. Validation of the Omron 705 IT oscillometric device for home blood pressure measurement in children and adolescents: the Arsakeion School Study. Blood Press Monit 2006;11:229–34.10.1097/01.mbp.0000209074.38331.16Search in Google Scholar PubMed

31. Georgiadis G, Nassis GP. Prevalence of overweight and obesity in a national representative sample of Greek children and adolescents. Eur J Clin Nutr 2007;61:1072–4.10.1038/sj.ejcn.1602619Search in Google Scholar PubMed

32. Karayiannis D, Yannakoulia M, Terzidou M, Sidossis LS, Kokkevi A. Prevalence of overweight and obesity in Greek school-aged children and adolescents. Eur J Clin Nutr 2003;57:1189–92.10.1038/sj.ejcn.1601743Search in Google Scholar PubMed

33. Tzotzas T, Kapantais E, Tziomalos K, Ioannidis I, Mortoglou A, et al. Epidemiological survey for the prevalence of overweight and abdominal obesity in Greek adolescents. Obesity 2008;16:1718–22.10.1038/oby.2008.247Search in Google Scholar PubMed

34. Krassas GE, Tzotzas T, Tsametis C, Konstantinidis T. Prevalence and trends in overweight and obesity among children and adolescents in Thessaloniki, Greece. J Pediatr Endocr Met 2001;14:1319–26.Search in Google Scholar

35. Kotanidou EP, Grammatikopoulou MG, Spiliotis BE, Kanaka-Gantenbein C, Tsigga M, et al. Ten-Year obesity and overweight prevalence in Greek children: a systematic review and meta-analysis of 2001–2010 data. Hormones 2013;12: 537–49.10.14310/horm.2002.1442Search in Google Scholar PubMed

36. Lobstein T, Frelut M-L. Prevalence of overweight among children in Europe. Obes Rev 2003;4:195–200.10.1046/j.1467-789X.2003.00116.xSearch in Google Scholar

37. Lissau I, Overpeck MD, Ruan WJ, Due P, Holstein BE, et al. Health Behaviour in School-aged Children Obesity Working Group. Body mass index and overweight in adolescents in 13 European countries, Israel, and the United States. Arch Pediatr Adolesc Med 2004;158:27–33.10.1001/archpedi.158.1.27Search in Google Scholar PubMed

38. Mihas C, Mariolis A, Manios Y, Naska A, Panagiotakos D, et al. Overweight/obesity and factors associated with body mass index during adolescence: the VYRONAS study. Acta Paediatr 2009;98:495–500.10.1111/j.1651-2227.2008.01129.xSearch in Google Scholar PubMed

39. Bibiloni M, Pons A, Tur JA. Prevalence of overweight and obesity in adolescents: a systematic review. ISRN Obes 2013; Article ID 392747.10.1155/2013/392747Search in Google Scholar PubMed PubMed Central

40. Veltsista A, Kanaka C, Gika A, Lekea V, Roma E, et al. Tracking of overweight and obesity in greek youth. Obes Facts 2010;3: 166–72.10.1159/000314620Search in Google Scholar PubMed PubMed Central

41. Mavrakanas TA, Konsoula G, Patsonis I, Merkouris BP. Childhood obesity and elevated blood pressure in a rural population of northern Greece. Rural Remote Health 2009;9:1150–6.10.22605/RRH1150Search in Google Scholar

42. Athanasopoulos DT, Garopoulou AI, Dragoumanos VP. Childhood obesity and associated factors in a rural Greek island. Rural Remote Health 2011;11:1641.10.22605/RRH1641Search in Google Scholar

43. Soudarssanane MB, Karthigeyan M, Stephen S, Sahai A. Key predictors of high blood pressure and hypertension among adolescents: a simple prescription for prevention. Indian J Community Med 2006;3:164–9.Search in Google Scholar

44. Karatzi K, Protogerou A, Rarra V, Stergiou GS. Home and office blood pressure in children and adolescents: the role of obesity. The Arsakeion School Study. J Hum Hypertens 2009;23:512–20.10.1038/jhh.2008.158Search in Google Scholar PubMed

45. World Health Organization, WHO. WHO report on the global tobacco epidemic, 2011. Geneva: World Health Organization, 2011b.Search in Google Scholar

46. Filippidis FT, Vardavas CL, Loukopoulou A, Behrakis P, Connolly GN, et al. Prevalence and determinants of tobacco use among adults in Greece: 4 year trends. Eur J Public Health 2013;23:772–6.10.1093/eurpub/cks148Search in Google Scholar PubMed

47. Vardavas CI, Kafatos AG. Smoking policy and prevalence in Greece: an overview. Eur J Public Health 2007;17:211–3.10.1093/eurpub/ckl094Search in Google Scholar PubMed

48. Ferrante M, Fiore M, Leon L, Costantidines F, Castaing M, et al. Age of smoking initiation, tobacco habits and risk perception among primary, middle and high school students in Southern Italy. Ital J Public Health 2010;7:262–7.Search in Google Scholar

49. Lazouras L. Normative influences on intentions to smoke among Greek adolescents: the moderating role of smoking status. Tob Induc Dis 2014;12:5–10.10.1186/1617-9625-12-5Search in Google Scholar PubMed PubMed Central

50. MacArthur GS, Smith MC, Melotti R, Heron J, Macleod J, et al. Patterns of alcohol use and multiple risk behavior by gender during early and late adolescence: the ALSPAC cohort. J Public Health 2012;34(S1):i20–30.10.1093/pubmed/fds006Search in Google Scholar PubMed PubMed Central

51. Lutfiyya MN, Shah KK, Johnson M, Bales RW, Cha I, et al. Adolescents’ daily cigarette smoking: is rural residency a risk factor? Rural Remote Health 2008;8:875–86.10.22605/RRH875Search in Google Scholar

52. Spyratos DG, Pelagidou DT, Chloros D, Haidich A-B, Karetsi E, et al. Smoking among adolescents in Northern Greece: a large cross-sectional study about risk and preventive factors. Subst Abuse Treat Prev Policy 2012;7:38–44.10.1186/1747-597X-7-38Search in Google Scholar PubMed PubMed Central

53. Donath C, Graßel E, Baier D, Pfeiffer Ch, Bleich S, et al. Predictors of binge drinking in adolescents: ultimate and distal factors -a representative study. BMC Public Health 2012;12:263–77.10.1186/1471-2458-12-263Search in Google Scholar PubMed PubMed Central

54. Donath C, Grässel E, Baier D, Pfeiffer C, Karagülle D, et al. Alcohol consumption and binge drinking in adolescents: comparison of different migration backgrounds and rural vs. urban residence- a representative study. BMC Public Health 2011;11:1–13.10.1186/1471-2458-11-84Search in Google Scholar PubMed PubMed Central

55. Tsiligianni IG, Vardavas CI, Bouloukaki I, Kosmas E, Verigou E, et al. The association between alcohol and tobacco use among elementary and high school students in Crete, Greece. Tob Induc Dis 2012;10:15.10.1186/1617-9625-10-15Search in Google Scholar

56. Arvanitidou M, Tirodimos I, Kyriakidis I, Tsinaslanidou Z, Seretopoulos D. Decreasing prevalence of alcohol consumption among Greek adolescents. Am J Drug Alcohol Abuse 2007;33:411–7.10.1080/00952990701315384Search in Google Scholar

57. Roditis ML, Parlapani ES, Tzotzas T, Hassapidou M, Krassas G. Epidemiology and predisposing factors in obesity in Greece: from the second world war until today. J Pediatr Endocr Met 2009;22:389–405.10.1515/JPEM.2009.22.5.389Search in Google Scholar

58. Xin X, He J, Frontini MG, Ogden LG, Motsamai OI, et al. Effects of Alcohol reduction on blood pressure. A meta-analysis of randomized controlled trials. Hypertention 2001;38:1112–7.10.1161/hy1101.093424Search in Google Scholar

59. Kautiainen S, Koivusilta L, Lintonen T, Virtanen SM, Rimpelä A. Use of information and communication technology and prevalence of overweight and obesity among adolescents. Int J Obesity 2005;29:925–33.10.1038/sj.ijo.0802994Search in Google Scholar

60. Ercan S, Dallar YB, Onen S, Engiz O. Prevalence of obesity and associated risk factors among adolescents in Ankara, Turkey. J Clin Res Pediatr Endocrinol 2012;4:204–7.Search in Google Scholar

61. Vasconcellos F, Seabra A, Katzmarzyk PT, Kraemer-Aquiar LG, Bouskela E, et al. Physical activity in overweight and obese adolescents: systemic review of the effects on physical fitness components and cardiovascular risk factors. Sports Med 2014;44:1139–52.10.1007/s40279-014-0193-7Search in Google Scholar

62. Adair LS, Gordon-Larsen P, Du S, Zhang B, Popkin BM. The emergence of cardiometabolic disease risk in Chinese children and adults: consequences of changes in diet, physical activity, and obesity. Obes Rev 2014;15:49–59.10.1111/obr.12123Search in Google Scholar

63. Jarvis CM, Hayman LL, Braun LT, Schwertz DW, Ferrans CE, et al. Cardiovascular risk factors and metabolic syndrome in alcohol and nicotine-dependent men and women. J Cardiovasc Nurs 2007;22:429–35.10.1097/01.JCN.0000297387.21626.88Search in Google Scholar

64. Morrison JA, Kelly K, Mellies M, deGroot I, Khoury P, et al. Cigarette smoking, alcohol intake, and oral contraceptives: relationships to lipids and lipoproteins in adolescent school-children. Metabolism 1979;28:1166–70.10.1016/0026-0495(79)90157-4Search in Google Scholar

65. Sanchez Bayle M, Gonzalez Requejo A, Ruiz-Jarabo C, Vila S, Arnaiz P, et al. Smoking and apolipoproteins in adolescents. The Niño Jesus Group. J Adolescent Health 1992;13:524–7.10.1016/1054-139X(92)90018-7Search in Google Scholar

66. Guedes DP, Guedes JE, Barbosa DS, de Oliviera JA, Stanganelli LC. Cardiovascular risk factors in adolescents: biological and behavioral indicators. Arq Bras Cardiol 2006;86:439–50.10.1590/S0066-782X2006000600006Search in Google Scholar

67. Afrin L, Rahman MR, Hoque MN, Amin MR. Effect of cigarette smoking on HDL-C in adolescent. Journal of Shaheed Suhrawardy Medical College 2009;2:14–6.Search in Google Scholar

68. Pitsavos C, Skoumas J, Dernellis J, Toutouza M, Doulalas A, et al. Influence of biological factors on lipid and fibrinogen measurements in young men. An epidemiological study in 2009 recruits. Eur Heart J 1998;19:1642–7.10.1053/euhj.1998.1124Search in Google Scholar PubMed

69. Clarke WR, Srinivasan SR, Shear CL, Hunter SM, Croft JB, et al. Cigarette smoking initiation and longitudinal changes in serum lipids and lipoproteins in early adulthood. The Bogalusa heart study. Am J Epidemiol 1986;124:207–19.10.1093/oxfordjournals.aje.a114379Search in Google Scholar PubMed

70. Lipperman-Kreda S, Lee JP. Boost your high: cigarette smoking to enhance alcohol and drug effects among Southeast Asian American Youth. J Drug Issues 2011;41:509–21.10.1177/002204261104100404Search in Google Scholar PubMed PubMed Central

Received: 2016-4-5
Accepted: 2017-1-16
Published Online: 2017-3-20
Published in Print: 2017-4-1

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