Prevalence of Cardiovascular-Kidney-Metabolic Stages in US Adolescents and Relationship to Social Determinants of Health

Importance Given that many risk factors for atherosclerotic cardiovascular disease (ASCVD) begin in childhood, knowledge of the prevalence of cardio-kidney metabolic syndrome (CKM) in adolescents and its risk factors is critical to understanding the etiology of ASCVD risk burden.

To calculate the proportion of US adolescents with CKM stages 0, 1, and 2 and to assess the social factors and behaviors most strongly associated with advanced CKM stage. Design Cross-sectional analysis of 2017-2020 US National Health and Nutrition Examination Survey (NHANES) sample data. Setting United States Participants Adolescents Exposure Social determinants of health, including family income to poverty ratio, health insurance, routine healthcare access, and food security, as well as behaviors including smoking, physical activity, and diet. Main Outcomes and Measures The prevalence of CKM stages 0, 1, and 2 in adolescents was measured using survey-weighted data. Generalized linear models were used to quantify associations between social factors, behaviors, and CKM staging.

Of the 1,774 surveyed adolescents ages 12-18 years, representing 30,327,145 US adolescents, 56% (95% CI 52-60%) had CKM stage 0, 37% (33-40%) had CKM stage 1, and 7% (5-9%) had CKM stage 2. Physical activity score (1 to 100, 100=highest) was lowest among adolescents with CKM stage 2 (physical activity score for CKM 0: 60 (31), CKM 1: 60 (32), and CKM 2 49 (33); p=0.025). Other health behaviors, such as the DASH diet and nicotine scores, did not differ according to the CKM stage (p=0.477 and p=0.932, respectively). According to sex, race, ethnicity, and age-adjusted multivariate logistic regression analyses, a ratio of income to poverty level >1.85, having health insurance, and food security, were associated with a 32% (OR 0.68 [95% CI:0.52,0.89]), 40% (OR 0.60 [95% CI: 0.37, 0.99]), and 45% (OR 0.55 [95% CI: 0.41,0.73]) lower odds of CKM stage 1-2, respectively. After adjustment for all sociodemographic factors, only food security was associated with 41% lower odds of CKM stage 1-2 (OR 0.59 [0.43, 0.81]).

and Relevance CKM stage 1-2 in adolescents is most strongly associated with food insecurity. Improved access to healthy food and policies to address food security may help prevent higher CKM stage, beginning in adolescence. Key Points Question: What is the prevalence of cardio-kidney metabolic syndrome (CKM) in adolescents, and what social determinants of health factors are associated with CKM stages 0,1, and 2 in adolescents? Findings: In this population-based study, 44% of adolescents are in CKM stages 1 and 2, and the presence of CKM stages 1 and 2 in adolescents is most strongly associated with lower household food security. Meaning: By addressing social factors, such as food security in the US, we may improve the cardio-kidney metabolic health of adolescents and improve cardio-kidney metabolic health across the lifespan. Competing Interest Statement The authors have declared no competing interest. Funding Statement Dr. Baker-Smith is supported by Delaware INBRE P20GM103446-23S4. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Nemours I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability NHANES data is publicly available at https://wwwn.cdc.gov/nchs/nhanes/Default.aspx.