Examining the Relationship Between Tobacco Exposure, Abdominal Obesity, and Metabolic Syndrome in Adolescents (The STRONG Kids Study)

Metabolic syndrome is a term that is used to describe a group of risk factors for
cardiovascular disease. The risk factors include obesity, insulin resistance, high
cholesterol, and high blood pressure. Two of the most common risk factors for
cardiovascular disease-tobacco exposure and abdominal obesity—are also known to influence
the development of metabolic syndrome. Metabolic syndrome risk factors, as well as higher
obesity levels, are being observed increasingly in adolescents. It is important to
understand the relationship between tobacco exposure, abdominal obesity, and metabolic
syndrome during early adolescence, as this time period is when lifestyle habits, including
diet, exercise, and tobacco use, develop. The purpose of the study is to determine how
changes in abdominal obesity and tobacco exposure among adolescents affect the development
of metabolic syndrome risk factors, including glucose intolerance and increased levels of
cholesterol and blood pressure.

This 3-year study will enroll children with a body mass index in the 50th to 98th percentile
and one of their parents. At a baseline study visit, children and parents will complete
questionnaires on health, nutrition, physical activity, smoke exposure, and stress levels.
Children will undergo a blood and saliva collection; physical examination; measurements of
blood pressure, height, weight, and waist circumference; a dual-energy x-ray absorptiometry
(DEXA) scan to measure body fat and muscle; and skin fold measurements to measure body fat.
Parents will undergo a saliva collection and measurements of blood pressure, height, weight,
and waist circumference. Some children will wear an activity monitor for 7 days, and some
children will complete a glucose tolerance test, which will involve an additional blood
collection. Every 6 months, study researchers will contact parents to confirm the family's
contact information. Once a year for 3 years, all participants will complete questionnaires
and a saliva collection. Additionally, at Year 3, all participants will also undergo repeat
measurements of blood pressure, height, weight, and waist circumference.

Inclusion Criteria:

- BMI in the 50th to 98th percentile range

- Parent or caregiver must agree to participate in the study

Exclusion Criteria for All Participants:

- Inability to speak and understand English

- Family residence outside the greater Rochester area (more than 50 miles from the
clinical research center)

- Family is planning to leave the greater Rochester area (move more than 50 miles from
the clinical research center) in the 24 months after study entry

Exclusion Criteria for Children:

- Significant medical condition, including cystic fibrosis, type 1 or type 2 diabetes,
or other conditions that could interfere with the assessment of metabolic-related
outcome measures

- Tanner stage 3 or greater

- Currently taking medications that alter appetite and/or glucose metabolism