Mediation of obesity-related variables in the association between physical fitness and cardiometabolic risk in children and adolescents: a systematic review and meta-analysis

Date

2025-04-03

Authors

Castro Silveira, João Francisco de
Reuter, Cézane Priscila
Sehn, Ana Paula
Borfe, Letícia
Carvas Junior, Nelson
Pfeiffer, Karin Allor
Guerra, Paulo Henrique
Andersen, Lars Bo

Director

Publisher

BMJ
Acceso abierto / Sarbide irekia
Artículo / Artikulua
Versión publicada / Argitaratu den bertsioa

Project identifier

Impacto
OpenAlexGoogle Scholar
No disponible en Scopus

Abstract

Objective. To examine the mediation of obesity-related variables in the association between physical fitness and cardiometabolic risk in children and adolescents. Design. Systematic review and meta-analysis. Data sources. Studies from electronic databases from inception to 31 December 2023. Eligibility criteria for selecting studies. Included were 123 observational studies (cross-sectional and longitudinal) that assessed risk by constructing a continuous score incorporating cardiometabolic parameters. Studies were considered if they evaluated at least one fitness component as an exposure in children and adolescents (5–19 years). Thirty-one were included in the main meta-analyses. Results. Cross-sectional findings indicate that cardiorespiratory fitness is modestly but beneficially associated with cardiometabolic risk, either indirectly via obesity-related variables (indirect standardized beta coefficient [βIndirect]=−0.17; 95% confidence interval [CI] −0.23; −0.11; inconsistency index [I2]=94.4%) or directly and independently from obesity-related variables (r=−0.11; 95% CI −0.15; −0.07; I2=87.4%), whereas muscular fitness seems to be associated with risk only via obesity-related variables (βIndirect=−0.34; 95% CI −0.47; −0.20; I2=85.1%). There was no cross-sectional difference between biological sexes (p≥0.199). Longitudinal findings indicate no total (r=−0.12; 95% CI −0.24; 0.01; I2=23.1%) and direct (r=−0.03; 95% CI −0.08; 0.03; I2=0%) associations. Conclusion. The association between fitness and risk appears to take place either indirectly through the reduction of obesity-related levels or directly by influencing risk. The latter underscores that the inverse association extends beyond a mere reduction in obesity-related variables, encompassing specific enhancements linked to exercise training, including increased metabolic efficiency, and cardiovascular capacity. PROSPERO registration number. CRD42022354628.

Description

Keywords

Cardiovascular, Metabolism, Performance, Young

Department

Ciencias de la Salud / Osasun Zientziak

Faculty/School

Degree

Doctorate program

item.page.cita

Castro Silveira, J. F. de López-Gil, J. F., Reuter, C. P., Sehn, A. P., Borfe, L., Carvas Junior, N., Pfeiffer, K. A., Guerra, P. H., Andersen, L. B., Garcia-Hermoso, A., Gaya, A. R. (2025) Mediation of obesity-related variables in the association between physical fitness and cardiometabolic risk in children and adolescents: a systematic review and meta-analysis. BMJ Open Sport & Exercise Medicine, 11(2), 1-14. https://doi.org/10.1136/bmjsem-2024-002366.

item.page.rights

© Author(s) (or their employer(s)) 2025. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See rights and permissions. Published by BMJ Group.

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