J Pediatr Endocrinol Metab 2017; aop Anastasia Garoufi*, Evangelos E. Grammatikos, Anastasios Kollias, Emmanuel Grammatikos, George S. Stergiou and Alexandra Soldatou Associations between obesity, adverse behavioral patterns and cardiovascular risk factors among adolescent inhabitants of a Greek island DOI 10.1515/jpem-2016-0134 Received April 5, 2016; accepted January 16, 2017 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 over- weight/obesity with behavioral habits and their associa- tion with blood pressure (BP) and lipid profile. Methods: Anthropometric parameters, lifestyle, BP and lipid profile of 736 adolescents were evaluated cross-sec- tionally. 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 car- diovascular risk. Keywords: alcohol consumption; cigarette smoking; lipid profile; physical activity; unhealthy habits. Introduction The prevalence of obesity among children and adoles- cents has increased globally at an alarming rate in the past decades, especially in economically developed coun- tries and in urban areas [1, 2]. Although further increases were not observed recently, in many countries, including Greece, percentages remain inappropriately high [3–6]. In addition, the prevalence of unhealthy behaviors such as tobacco smoking and alcohol consumption among adolescents in many countries is high [7, 8]. According to the Global Youth Tobacco Survey (GYTS), the largest study conducted in Greece, 16.2% of adolescents aged 13–15 years used tobacco products and the vast majority had initiated smoking before the 10th year of life [9]. In a recent study, a significant percentage of adolescents con- sumed alcohol, despite knowing the possibility of alcohol addiction and its adverse health effects [10]. Pediatric and adolescent binge drinking has also been reported to be as a serious problem in Germany [11]. Moreover, a strong positive correlation between alcohol intake and cigarette smoking in adolescents has been demonstrated. Adoles- cent smokers are more likely to consume alcohol and vice versa [12–14]. Many studies, mainly in adults, have shown an asso- ciation between these two adverse habits with known cardiovascular risk factors such as hypertension and atherogenic lipid profile [15–18]. Smoking at any age adversely alters the serum lipid profile to a more athero- genic one, independently of other risk factors including obesity [16, 19, 20]. Furthermore, certain risk factors, such as smoking, obesity, dyslipidemia and elevated BP seem to persist and/or track from childhood to adulthood and to aggravate the atherosclerotic process which initiates early *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, E-mail: garoufi@yahoo.gr Evangelos E. Grammatikos and Alexandra Soldatou: Second Department of Pediatrics, National and Kapodistrian University of Athens, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece Anastasios Kollias and George S. Stergiou: Hypertension Center STRIDE-7, Third University Department of Medicine, Sotiria Hospital, Athens, Greece Emmanuel Grammatikos: Health Center of Karlovasi, Samos, Greece Brought to you by | University of Pennsylvania Authenticated Download Date | 3/27/17 9:03 PM