Sex-specific thresholds of peak oxygen consumption for detecting cardiometabolic risk in children and adolescents with type 1 diabetes

To establish sex-specific peak oxygen consumption (VO2peak) thresholds that accurately discriminate cardiometabolic risk (CMR) in children and adolescents with type 1 diabetes and to validate these cut-off points using an independent cohort. This longitudinal study included 83 participants (aged 8-18 years) with type 1 diabetes from the Diactive-1 cohort. VO2peak was assessed via maximal exercise testing with direct gas analysis, and CMR was calculated using a composite z-score of waist circumference, lipid profile, HbA1c, and blood pressure. VO2peak thresholds for CMR were identified by sex using logistic regression and receiver operating characteristic analysis, and externally validated in a Brazilian cohort (n = 36). A total of 62 individuals completed the 2-year follow-up assessment. Optimal VO2peak thresholds were 40.8 ml/kg/min for boys and 33.7 ml/kg/min for girls, with areas under the curve of 0.71 and 0.78, respectively. Participants below these thresholds had significantly higher lipids and overall CMR. These associations persisted at the two-year follow-up and were confirmed in the Brazilian cohort, which also showed elevated HbA1c among high-risk individuals. Our study supports the clinical utility of these thresholds as a non-invasive marker of metabolic health and reinforce the importance of cardiorespiratory fitness promotion in this population.