{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T11:37:16Z","timestamp":1786621036072,"version":"build-2736575974"},"reference-count":73,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"unspecified","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Elisabeth von Freyburg Foundation","award":["UMC\/WKZ 23-01"],"award-info":[{"award-number":["UMC\/WKZ 23-01"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,27]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cardiovascular risk assessment and management in the paediatric population is a relatively uncharted territory. However, atherogenesis starts during childhood, making childhood and adolescence an important window of opportunity to prevent atherosclerotic cardiovascular disease (ASCVD) later in life. An emerging group at risk for early ASCVD are children with chronic conditions. This paper describes the rationale, design and methods for the Secondary Manifestations of ARTerial diseases in the Young with a chronic condition (SMART-Youth) study. This study aims to identify disease-associated and lifestyle-associated cardiovascular risk factors for preclinical atherosclerosis in children with a chronic condition. The results of this study may fuel development of tailored cardiovascular risk assessment and management strategies in children at-risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This is a prospective longitudinal cohort study including children aged 8\u201318 years with various chronic conditions (cystic fibrosis, juvenile idiopathic arthritis, systemic autoimmune disease, chronic kidney disease, primary immunodeficiency, autoinflammatory conditions, inflammatory bowel disease, congenital heart disease, premature birth, fetal growth restriction and children with persistent somatic symptoms) at the Wilhelmina Children\u2019s Hospital of the University Medical Center Utrecht in The Netherlands. Assessment of cardiovascular risk factors includes blood pressure, body mass index, visceral and subcutaneous abdominal adipose tissue, nutrition, physical activity, stress, circulating lipids, HbA1c and C-reactive protein measurements. Preclinical atherosclerosis is measured by carotid intima-media thickness, carotid distension and carotid-femoral pulse wave velocity. These assessments are performed at baseline, 2-year follow-up and 17\u201318 years of age. Enrollment runs from August 2024 onwards, with a minimal study duration of 15 years and an estimated final sample of more than 2000 children. State-of-the-art regression-based methods will be used to examine the association of cardiovascular risk factors and preclinical atherosclerosis. Longitudinal data analysis methods will be used to model these associations over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval was granted by the Medical Ethics Review Board of the University Medical Center Utrecht (NL84874.041.23). Written informed consent by participants and their parents is required for participation. Collected data will be made available to researchers upon reasonable request to the Steering Committee. Study findings will be disseminated through peer-reviewed publications, presentations at scientific meetings and meetings with patient organisations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-111707","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T11:10:17Z","timestamp":1786619417000},"page":"e111707","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["The SMART-Youth study: protocol for a longitudinal prospective cohort study to identify disease-associated and lifestyle-associated cardiovascular risk factors for preclinical atherosclerosis in children with a chronic condition"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6430-8161","authenticated-orcid":false,"given":"Isabelle A","family":"van der Linden","sequence":"first","affiliation":[{"name":"Department of Pediatric Pulmonology, Wilhelmina Children\u2019s Hospital University Medical Centre, Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danya","family":"Muilwijk","sequence":"additional","affiliation":[{"name":"Department of Pediatric Pulmonology, Wilhelmina Children\u2019s Hospital University Medical Centre, Utrecht, Utrecht, The Netherlands"},{"name":"University Medical Centre, Utrecht University, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia J D","family":"Raijmakers","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Wilhelmina Children\u2019s Hospital University Medical Centre, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlies","family":"Destoop","sequence":"additional","affiliation":[{"name":"Department of Pediatric Pulmonology, Wilhelmina Children\u2019s Hospital University Medical Centre, Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna W","family":"Hoefnagels","sequence":"additional","affiliation":[{"name":"Department of Social Pediatrics, Utrecht University, Wilhelmina Children\u2019s Hospital University Medical Centre, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fieke","family":"Terstappen","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Wilhelmina Children\u2019s Hospital University Medical Centre, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2871-9810","authenticated-orcid":false,"given":"Michiel L","family":"Bots","sequence":"additional","affiliation":[{"name":"University Medical Centre, Utrecht University, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilonca C H","family":"Vaartjes","sequence":"additional","affiliation":[{"name":"University Medical Centre, Utrecht University, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Koopal","sequence":"additional","affiliation":[{"name":"Department of Vascular Medicine, Utrecht University, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3951-5223","authenticated-orcid":false,"given":"Frank L J","family":"Visseren","sequence":"additional","affiliation":[{"name":"Department of Vascular Medicine, Utrecht University, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martijn G","family":"Slieker","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Wilhelmina Children\u2019s Hospital University Medical Centre, Utrecht, Utrecht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes M P J","family":"Breur","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Wilhelmina Children\u2019s Hospital University Medical Centre, Utrecht, Utrecht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joost","family":"Frenkel","sequence":"additional","affiliation":[{"name":"Department of Pediatric Immunology and Rheumatology, Wilhelmina Children\u2019s Hospital University Medical Centre, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc R","family":"Lilien","sequence":"additional","affiliation":[{"name":"Department of Pediatric Nephrology, Wilhelmina Children\u2019s Hospital University Medical Centre, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joris","family":"van Montfrans","sequence":"additional","affiliation":[{"name":"Department of Pediatric Immunology and Rheumatology, Wilhelmina Children\u2019s Hospital University Medical Centre, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annet","family":"van Royen-Kerkhof","sequence":"additional","affiliation":[{"name":"Department of Pediatric Immunology and Rheumatology, Wilhelmina Children\u2019s Hospital University Medical Centre, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joost F","family":"Swart","sequence":"additional","affiliation":[{"name":"Department of Pediatric Immunology and Rheumatology, Wilhelmina Children\u2019s Hospital University Medical Centre, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anemone","family":"van den Berg","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology, UMC Utrecht, Wilhelmina Children\u2019s Hospital University Medical Centre, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corine","family":"Koopman-Esseboom","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Wilhelmina Children\u2019s Hospital University Medical Centre, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Millie E","family":"Langemeijer","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Wilhelmina Children\u2019s Hospital University Medical Centre, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelis K","family":"van der Ent","sequence":"additional","affiliation":[{"name":"Department of Pediatric Pulmonology, Wilhelmina Children\u2019s Hospital University Medical Centre, Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1538-5014","authenticated-orcid":false,"given":"Sanne L","family":"Nijhof","sequence":"additional","affiliation":[{"name":"Department of Social Pediatrics, Utrecht University, Wilhelmina Children\u2019s Hospital University Medical Centre, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1997-8060","authenticated-orcid":false,"given":"Henk S","family":"Schipper","sequence":"additional","affiliation":[{"name":"Department of Social Pediatrics, Wilhelmina Children\u2019s Hospital University Medical Centre, Utrecht, The Netherlands"},{"name":"Department of Pediatric Cardiology, Sophia Children\u2019s Hospital, Erasmus Medical Center, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"2026081304100939000_16.8.e111707.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2022.11.005"},{"key":"2026081304100939000_16.8.e111707.2","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/72.5.1307s"},{"key":"2026081304100939000_16.8.e111707.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199806043382302"},{"key":"2026081304100939000_16.8.e111707.4","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2022-057956","article-title":"Atherosclerotic Cardiovascular Risk as an Emerging Priority in Pediatrics","volume":"150","author":"Schipper","year":"2022","journal-title":"Pediatrics"},{"key":"2026081304100939000_16.8.e111707.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.07.061"},{"key":"2026081304100939000_16.8.e111707.6","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2022-057957","article-title":"Cardiovascular Risk Assessment and Management for Pediatricians","volume":"150","author":"Schipper","year":"2022","journal-title":"Pediatrics"},{"key":"2026081304100939000_16.8.e111707.7","first-page":"1054","article-title":"The Future of CV Risk Prediction","volume":"7","author":"Blaha","year":"2014","journal-title":"JACC: Cardiovascular Imaging"},{"key":"2026081304100939000_16.8.e111707.8","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.717033"},{"key":"2026081304100939000_16.8.e111707.9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.104"},{"key":"2026081304100939000_16.8.e111707.10","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2019-316782"},{"key":"2026081304100939000_16.8.e111707.11","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1016\/S0140-6736(07)60370-5","article-title":"Adolescents with a chronic condition: challenges living, challenges treating","volume":"369","author":"Sawyer","year":"2007","journal-title":"The Lancet"},{"key":"2026081304100939000_16.8.e111707.12","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.amjcard.2016.09.023","article-title":"Risk Estimates for Atherosclerotic Cardiovascular Disease in Adults With Congenital Heart Disease","volume":"119","author":"Lui","year":"2017","journal-title":"Am J Cardiol"},{"key":"2026081304100939000_16.8.e111707.13","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000094"},{"key":"2026081304100939000_16.8.e111707.14","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1007\/s10654-022-00889-y","article-title":"The PROactive cohort study: rationale, design, and study procedures","volume":"37","author":"Nap-van der Vlist","year":"2022","journal-title":"Eur J Epidemiol"},{"key":"2026081304100939000_16.8.e111707.15","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-066952","article-title":"Cohort profile: the Utrecht Cardiovascular Cohort-Second Manifestations of Arterial Disease (UCC-SMART) Study-an ongoing prospective cohort study of patients at high cardiovascular risk in the Netherlands","volume":"13","author":"Castelijns","year":"2023","journal-title":"BMJ Open"},{"key":"2026081304100939000_16.8.e111707.16","unstructured":"Nijhof S , van de Putte E , Hoefnagels JW . PROactive cohort study. 2021."},{"key":"2026081304100939000_16.8.e111707.17","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000161816.52136.66"},{"key":"2026081304100939000_16.8.e111707.18","first-page":"37","article-title":"The natural history of coronary atherosclerosis","volume":"40","author":"STRONG","year":"1962","journal-title":"Am J Pathol"},{"key":"2026081304100939000_16.8.e111707.19","first-page":"B33","article-title":"The pathogenesis of atherosclerosis","volume":"34","author":"McGill","year":"1988","journal-title":"Clin Chem"},{"key":"2026081304100939000_16.8.e111707.20","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1007\/BF03346475","article-title":"The effect of puberty on insulin resistance in obese children","volume":"32","author":"Pilia","year":"2009","journal-title":"J Endocrinol Invest"},{"key":"2026081304100939000_16.8.e111707.21","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1111\/j.2047-6310.2013.00202.x","article-title":"Cardiometabolic risk factors and insulin resistance in obese children and adolescents: relation to puberty","volume":"10","author":"Tobisch","year":"2015","journal-title":"Pediatr Obes"},{"key":"2026081304100939000_16.8.e111707.22","unstructured":"van Zoonen R , Vlasblom E , van Dommelen P . JGZ-richtlijn lengtegroei. 2019."},{"key":"2026081304100939000_16.8.e111707.23","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.320.7244.1240"},{"key":"2026081304100939000_16.8.e111707.24","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ijo.0801734"},{"key":"2026081304100939000_16.8.e111707.25","doi-asserted-by":"publisher","DOI":"10.3109\/07853890.2011.558520"},{"key":"2026081304100939000_16.8.e111707.26","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2017-1904","article-title":"Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents","volume":"140","author":"Flynn","year":"2017","journal-title":"Pediatrics"},{"key":"2026081304100939000_16.8.e111707.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2011.09.009"},{"key":"2026081304100939000_16.8.e111707.28","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1515\/cclm-2023-0341","article-title":"Determination of cortisone and cortisol in human scalp hair using an improved LC-MS\/MS-based method","volume":"62","author":"Mirzaian","year":"2024","journal-title":"Clin Chem Lab Med"},{"key":"2026081304100939000_16.8.e111707.29","unstructured":"Crocker PRE . The Physical Activity Questionnaire for Older Children (PAQ-C) and Adolescents (PAQ-A) Manual.. 2004."},{"key":"2026081304100939000_16.8.e111707.30","doi-asserted-by":"publisher","DOI":"10.1017\/S136898001700091X"},{"key":"2026081304100939000_16.8.e111707.31","doi-asserted-by":"publisher","DOI":"10.1016\/S0929-8266(99)00033-6"},{"key":"2026081304100939000_16.8.e111707.32","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2024.34699","article-title":"Early-Life Risk Factors for Carotid Intima-Media Thickness and Carotid Stiffness in Adolescence","volume":"7","author":"van der Linden","year":"2024","journal-title":"JAMA Netw Open"},{"key":"2026081304100939000_16.8.e111707.33","doi-asserted-by":"publisher","DOI":"10.1038\/jhh.2013.144"},{"key":"2026081304100939000_16.8.e111707.34","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0b013e32834fa8b0"},{"key":"2026081304100939000_16.8.e111707.35","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.atherosclerosis.2020.04.026","article-title":"Distance measurement for pulse wave velocity estimation in pediatric age: Comparison with intra-arterial path length","volume":"303","author":"Reusz","year":"2020","journal-title":"Atherosclerosis"},{"key":"2026081304100939000_16.8.e111707.36","unstructured":"Cohen J . Statistical Power Analysis for the Behavioral Sciences 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates, 1988."},{"key":"2026081304100939000_16.8.e111707.37","unstructured":"pwr CS . Pwr: basic functions for power analysis. CRAN: Contributed Packages; 2006."},{"key":"2026081304100939000_16.8.e111707.38","doi-asserted-by":"publisher","DOI":"10.1023\/B:EJEP.0000040530.98310.0c"},{"key":"2026081304100939000_16.8.e111707.39","doi-asserted-by":"crossref","DOI":"10.1038\/sdata.2016.18","article-title":"The FAIR Guiding Principles for scientific data management and stewardship","volume":"3","author":"Wilkinson","year":"2016","journal-title":"Sci Data"},{"key":"2026081304100939000_16.8.e111707.40","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39335.541782.AD"},{"key":"2026081304100939000_16.8.e111707.41","doi-asserted-by":"crossref","first-page":"2895","DOI":"10.1016\/j.jacc.2020.10.027","article-title":"Inflammatory Bowel Disease and Atherosclerotic Cardiovascular Disease: JACC Review Topic of the Week","volume":"76","author":"Cainzos-Achirica","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2026081304100939000_16.8.e111707.42","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-209775"},{"key":"2026081304100939000_16.8.e111707.43","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1001\/jamapediatrics.2019.1324","article-title":"Cardiovascular Risk in Adults Born Preterm: Time to Act","volume":"173","author":"Flahault","year":"2019","journal-title":"JAMA Pediatr"},{"key":"2026081304100939000_16.8.e111707.44","doi-asserted-by":"crossref","first-page":"e603","DOI":"10.1161\/CIR.0000000000000618","article-title":"Cardiovascular Risk Reduction in High-Risk Pediatric Patients: A Scientific Statement From the American Heart Association","volume":"139","author":"de Ferranti","year":"2019","journal-title":"Circulation"},{"key":"2026081304100939000_16.8.e111707.45","doi-asserted-by":"crossref","first-page":"1995","DOI":"10.1007\/s00467-021-05389-x","article-title":"Scoping review of the dietary intake of children with chronic kidney disease","volume":"37","author":"Melhuish","year":"2022","journal-title":"Pediatr Nephrol"},{"key":"2026081304100939000_16.8.e111707.46","doi-asserted-by":"crossref","DOI":"10.1183\/16000617.0010-2022","article-title":"Physical activity and its correlates in people with cystic fibrosis: a systematic review","volume":"31","author":"Kinaupenne","year":"2022","journal-title":"Eur Respir Rev"},{"key":"2026081304100939000_16.8.e111707.47","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajpc.2021.100171","article-title":"Prevalence of cardiovascular risk factors in a nationally representative adult population with inflammatory bowel disease without atherosclerotic cardiovascular disease","volume":"6","author":"Agrawal","year":"2021","journal-title":"Am J Prev Cardiol"},{"key":"2026081304100939000_16.8.e111707.48","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.diabres.2017.05.026","article-title":"Alcohol and recreational drug use in young adults with type 1 diabetes","volume":"130","author":"Pastor","year":"2017","journal-title":"Diabetes Res Clin Pract"},{"key":"2026081304100939000_16.8.e111707.49","doi-asserted-by":"crossref","first-page":"110697","DOI":"10.1016\/j.diabres.2023.110697","article-title":"Youth with type 1 diabetes mellitus are more inactive and sedentary than apparently healthy peers: A systematic review and meta-analysis","volume":"200","author":"Huerta-Uribe","year":"2023","journal-title":"Diabetes Res Clin Pract"},{"key":"2026081304100939000_16.8.e111707.50","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.arcped.2020.10.008","article-title":"Physical activity assessment in children and adolescents with juvenile idiopathic arthritis compared with controls","volume":"28","author":"Fazaa","year":"2021","journal-title":"Arch Pediatr"},{"key":"2026081304100939000_16.8.e111707.51","doi-asserted-by":"crossref","DOI":"10.1017\/jns.2013.27","article-title":"Children and young adults with familial hypercholesterolaemia (FH) have healthier food choices particularly with respect to dietary fat sources compared with non-FH children","volume":"2","author":"Molven","year":"2013","journal-title":"J Nutr Sci"},{"key":"2026081304100939000_16.8.e111707.52","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2010.311"},{"key":"2026081304100939000_16.8.e111707.53","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1017\/S1047951120004448","article-title":"Subclinical atherosclerosis in children and adolescents with congenital heart disease","volume":"31","author":"Cardoso","year":"2021","journal-title":"Cardiol Young"},{"key":"2026081304100939000_16.8.e111707.54","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1007\/s00246-017-1750-2","article-title":"Prevalence of Coronary Artery Disease Risk Factors and Metabolic Syndrome in Children with Heart Disease","volume":"39","author":"Ware","year":"2018","journal-title":"Pediatr Cardiol"},{"key":"2026081304100939000_16.8.e111707.55","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.12659\/MSM.896116","article-title":"Inflammatory and Lipid-Associated Markers of Cardiovascular Diseases in Children with First Exacerbation of Inflammatory Bowel Disease","volume":"22","author":"Pac-Ko\u017cuchowska","year":"2016","journal-title":"Med Sci Monit"},{"key":"2026081304100939000_16.8.e111707.56","doi-asserted-by":"crossref","DOI":"10.1186\/s12969-021-00538-w","article-title":"Biomarkers of lipid metabolism in patients with juvenile idiopathic arthritis: relationship with disease subtype and inflammatory activity","volume":"19","author":"Rodrigues","year":"2021","journal-title":"Pediatr Rheumatol Online J"},{"key":"2026081304100939000_16.8.e111707.57","doi-asserted-by":"crossref","first-page":"585","DOI":"10.4103\/2230-8210.98016","article-title":"Dyslipidemia in racially admixtured children with cystic fibrosis","volume":"16","author":"Alves","year":"2012","journal-title":"Indian J Endocrinol Metab"},{"key":"2026081304100939000_16.8.e111707.58","doi-asserted-by":"crossref","first-page":"1823","DOI":"10.1016\/S0140-6736(07)60821-6","article-title":"Acute and chronic complications of type 2 diabetes mellitus in children and adolescents","volume":"369","author":"Pinhas-Hamiel","year":"2007","journal-title":"The Lancet"},{"key":"2026081304100939000_16.8.e111707.59","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000625"},{"key":"2026081304100939000_16.8.e111707.60","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2009-2107C"},{"key":"2026081304100939000_16.8.e111707.61","doi-asserted-by":"crossref","first-page":"3939","DOI":"10.1210\/jc.2019-01338","article-title":"Primary Prevention of ASCVD and T2DM in Patients at Metabolic Risk: An Endocrine Society* Clinical Practice Guideline","volume":"104","author":"Rosenzweig","year":"2019","journal-title":"J Clin Endocrinol Metab"},{"key":"2026081304100939000_16.8.e111707.62","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2020.10.058"},{"key":"2026081304100939000_16.8.e111707.63","unstructured":"Herink M , Ito MK . Medication Induced Changes in Lipid and Lipoproteins. 2000."},{"key":"2026081304100939000_16.8.e111707.64","first-page":"1437","article-title":"Higher prevalence of familial hypercholesterolemia than expected in adult patients of four family practices in Netherlands","volume":"144","author":"Lansberg","year":"2000","journal-title":"Ned Tijdschr Geneeskd"},{"key":"2026081304100939000_16.8.e111707.65","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2014.12.029"},{"key":"2026081304100939000_16.8.e111707.66","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.122.024675","article-title":"Preclinical Aortic Atherosclerosis in Adolescents With Chronic Disease","volume":"11","author":"Ververs","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"2026081304100939000_16.8.e111707.67","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2019.08.026"},{"key":"2026081304100939000_16.8.e111707.68","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.atherosclerosis.2021.06.925","article-title":"Abdominal aorta plaques are better in predicting future cardiovascular events compared to carotid intima-media thickness: A 20-year prospective study","volume":"330","author":"Parkkila","year":"2021","journal-title":"Atherosclerosis"},{"key":"2026081304100939000_16.8.e111707.69","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.031857"},{"key":"2026081304100939000_16.8.e111707.70","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw152"},{"key":"2026081304100939000_16.8.e111707.71","doi-asserted-by":"publisher","DOI":"10.1016\/S0031-3955(16)34532-1"},{"key":"2026081304100939000_16.8.e111707.72","doi-asserted-by":"publisher","DOI":"10.2337\/dci18-0052"},{"key":"2026081304100939000_16.8.e111707.73","doi-asserted-by":"crossref","unstructured":"Hampl SE , Hassink SG , Skinner AC , et al . Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023;151. doi:10.1542\/peds.2022-060640","DOI":"10.1542\/peds.2022-060640"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-111707","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T11:10:27Z","timestamp":1786619427000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-111707"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":73,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,13]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1136\/bmjopen-2025-111707"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-111707","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]}}}