Abstract TU128: Longitudinal Association Between Healthy Lifestyles and Cardiometabolic Risk in School-Aged Children

Background: Cardiometabolic risk (CMR) factors in childhood are strong predictors of future cardiovascular health. Identifying strategies to prevent or mitigate CMR early in life is essential. While individual lifestyle factors have been linked to CMR, the combined effect of multiple healthy behaviors remains unclear. This study aimed to develop a composite healthy lifestyle score (CHLS) for school-aged children and to evaluate its longitudinal association with CMR. Methods: A total of 1,272 children (mean age 6.6 years) from the PROC study were followed up to age 11.3 years. Anthropometric measurements, blood biochemical tests, and lifestyle questionnaires were collected at both time points. CMR was defined using the 2013 criteria by Shafiee et al., incorporating waist circumference, blood pressure, fasting glucose, triglycerides, and HDL-C. Logistic regression was used to develop a β-weighted CHLS and to assess the association between baseline lifestyle and follow-up CMR. Longitudinal relationships were examined using generalized estimating equations (GEE), and changes in CHLS categories were analyzed with logistic regression. Results: The prevalence of CMR increased from 4.1% at baseline to 9.7% at follow-up (P < 0.001). Mean CHLS declined from 8.02 (SD = 5.23) to 4.56 (SD = 5.14) over time (P < 0.001). GEE analysis showed a lower risk of CMR among children with high (RR = 0.70, 95% CI: 0.52–0.94, P = 0.019) or moderately high (RR = 0.56, 95% CI: 0.38–0.84, P = 0.005) CHLS compared with those with low scores. Logistic regression further indicated reduced odds of CMR among children whose lifestyle scores improved from low to high (OR = 0.51, 95% CI: 0.28–0.94, P = 0.032), declined from high to low (OR = 0.44, 95% CI: 0.26–0.75, P = 0.003), or remained consistently high (OR = 0.29, 95% CI: 0.16–0.52, P < 0.001), relative to consistently low scorers. In conclusion, adherence to healthy lifestyles substantially reduces cardiometabolic risk in childhood. Even temporary improvement offers measurable benefits, whereas sustained healthy behaviors confer the greatest long-term protection.