{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T01:46:21Z","timestamp":1791251181428,"version":"4.1.0"},"reference-count":30,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: Childhood obesity represents the most common nutritional and metabolic disorder in industrialized countries and constitutes a major public health concern. In Italy, 20\u201325% of school-aged children are overweight and 10\u201314% are obese, with marked regional variability. Excess adiposity in childhood is frequently associated with hypertension, dyslipidemia, insulin resistance, and non-alcoholic fatty liver disease (NAFLD), predisposing to future cardiovascular disease (CVD). Objective: To investigate anthropometric indicators of cardiometabolic risk in 810 children and adolescents aged 7\u201317 years who underwent assessment for competitive sports eligibility at the Sports Medicine Unit of Modena, evaluate baseline knowledge of cardiovascular health aligned with ESC, AAP (2023), and EASO guidelines. Methods: 810 children and adolescents aged 7\u201317 years undergoing competitive sports eligibility assessment at the Sports Medicine Unit of Modena underwent evaluation of BMI percentile, waist circumference (WC), waist-to-height ratio (WHtR), and blood pressure. Cardiovascular knowledge and lifestyle habits were assessed via a previously used questionnaire. Anthropometric parameters, blood pressure (BP), and lifestyle-related knowledge and behaviors were assessed using standardized procedures. Overweight and obesity were defined according to WHO BMI-for-age percentiles. Elevated BP was classified based on the 2017 American Academy of Pediatrics age-, sex-, and height-specific percentiles. Statistical analyses included descriptive statistics, group comparisons, chi-square tests with effect size estimation, correlation analyses, and multivariable logistic regression models. Results: Overall, 22% of participants were overweight and 14% obese. WHtR &gt; 0.5 was observed in 28% of the sample and was more frequent among overweight\/obese children (p &lt; 0.001). Elevated BP was detected in 12% of participants with available measurements (n = 769) and was significantly associated with excess adiposity (\u03c72 = 7.21, p &lt; 0.01; Cram\u00e9r\u2019s V = 0.27). In multivariable logistic regression analyses adjusted for age and sex, WHtR &gt; 0.5 (OR 2.14, 95% CI 1.32\u20133.47, p = 0.002) and higher sedentary time (OR 1.41 per additional daily hour, 95% CI 1.10\u20131.82, p = 0.006) were independently associated with elevated BP, whereas BMI percentile lost significance when WHtR was included in the model. Lifestyle knowledge scores were significantly lower among overweight and obese participants compared with normal-weight peers (p &lt; 0.01). Conclusions: WHtR is a sensitive early marker of cardiometabolic risk, often identifying at-risk children missed by BMI alone. Baseline cardiovascular knowledge was suboptimal. The observed gaps in cardiovascular knowledge underscore the importance of integrating anthropometric screening with structured educational interventions to promote healthy lifestyles and long-term cardiovascular prevention.<\/jats:p>","DOI":"10.3390\/jcdd13010057","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T18:35:56Z","timestamp":1769193356000},"page":"57","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Anthropometric Indicators and Early Cardiovascular Prevention in Children and Adolescents: The Role of Education and Lifestyle"],"prefix":"10.3390","volume":"13","author":[{"given":"Elisa","family":"Lodi","sequence":"first","affiliation":[{"name":"CHIMOMO Department, University of Modena e Reggio Emilia, Via del Pozzo, 71, 41124 Modena, Italy"},{"name":"Centro P.A.S.C.I.A. (Programma Assistenziale Scompenso Cardiaco, Cardiopatie dell\u2019Infanzia e A Rischio) AOU Policlinico di Modena, Via del Pozzo 71, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Luisa","family":"Poli","sequence":"additional","affiliation":[{"name":"CHIMOMO Department, University of Modena e Reggio Emilia, Via del Pozzo, 71, 41124 Modena, Italy"},{"name":"Centro P.A.S.C.I.A. (Programma Assistenziale Scompenso Cardiaco, Cardiopatie dell\u2019Infanzia e A Rischio) AOU Policlinico di Modena, Via del Pozzo 71, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuela","family":"Paoloni","sequence":"additional","affiliation":[{"name":"CHIMOMO Department, University of Modena e Reggio Emilia, Via del Pozzo, 71, 41124 Modena, Italy"},{"name":"Centro P.A.S.C.I.A. (Programma Assistenziale Scompenso Cardiaco, Cardiopatie dell\u2019Infanzia e A Rischio) AOU Policlinico di Modena, Via del Pozzo 71, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Lodi","sequence":"additional","affiliation":[{"name":"CHIMOMO Department, University of Modena e Reggio Emilia, Via del Pozzo, 71, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo","family":"Savino","sequence":"additional","affiliation":[{"name":"Servizio di Medicina dello Sport, Azienda USL di Modena, Via Rita Levi Montalcini, 60, 41122 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Tampieri","sequence":"additional","affiliation":[{"name":"CHIMOMO Department, University of Modena e Reggio Emilia, Via del Pozzo, 71, 41124 Modena, Italy"},{"name":"Centro P.A.S.C.I.A. (Programma Assistenziale Scompenso Cardiaco, Cardiopatie dell\u2019Infanzia e A Rischio) AOU Policlinico di Modena, Via del Pozzo 71, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4704-4663","authenticated-orcid":false,"given":"Maria Grazia","family":"Modena","sequence":"additional","affiliation":[{"name":"CHIMOMO Department, University of Modena e Reggio Emilia, Via del Pozzo, 71, 41124 Modena, Italy"},{"name":"Centro P.A.S.C.I.A. (Programma Assistenziale Scompenso Cardiaco, Cardiopatie dell\u2019Infanzia e A Rischio) AOU Policlinico di Modena, Via del Pozzo 71, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"key":"ref_1","unstructured":"Istituto Superiore di Sanit\u00e0 (ISS) (2025, December 12). OKkio Alla SALUTE\u2014Indagine Nazionale 2023: I Dati Nazionali. EpiCentro. Available online: https:\/\/www.epicentro.iss.it\/okkioallasalute\/indagine-2023-dati."},{"key":"ref_2","unstructured":"World Health Organization, Regional Office for Europe (2025, December 12). Italy: Over 20% of Children Are Overweight, Says New Report. WHO Europe News Release. Available online: https:\/\/www.who.int\/europe\/news\/item\/09-12-2020-italy-over-20-of-children-are-overweight-says-new-report."},{"key":"ref_3","first-page":"e223","article-title":"Fighting obesity in children from European World Health Organization member states: Epidemiological data, medical-social aspects and prevention programs","volume":"170","author":"Nittari","year":"2019","journal-title":"Clin. Ter."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3227","DOI":"10.1093\/eurheartj\/ehab484","article-title":"2021 ESC Guidelines on cardiovascular disease prevention in clinical practice","volume":"42","author":"Visseren","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e2022060640","DOI":"10.1542\/peds.2022-060640","article-title":"Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity","volume":"151","author":"Hampl","year":"2023","journal-title":"Pediatrics"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1159\/000527540","article-title":"EASO and EFAD Position Statement on Medical Nutrition Therapy for the Management of Overweight and Obesity in Children and Adolescents","volume":"16","author":"Hassapidou","year":"2023","journal-title":"Obes. Facts."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Herti\u0161 Petek, T., and Mar\u010dun Varda, N. (2024). Childhood Cardiovascular Health, Obesity, and Some Related Disorders: Insights into Chronic Inflammation and Oxidative Stress. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25179706"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Calcaterra, V., Regalbuto, C., Porri, D., Pelizzo, G., Mazzon, E., Vinci, F., Zuccotti, G., Fabiano, V., and Cena, H. (2020). Inflammation in Obesity-Related Complications in Children: The Protective Effect of Diet and Its Potential Role as a Therapeutic Agent. Biomolecules, 10.","DOI":"10.3390\/biom10091324"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Delvecchio, M., Pastore, C., Valente, F., and Giordano, P. (2020). Cardiovascular Implications in Idiopathic and Syndromic Obesity in Childhood: An Update. Front. Endocrinol., 11.","DOI":"10.3389\/fendo.2020.00330"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Mihuta, M.-S., Paul, C., Ciulpan, A., Dacca, F., Velea, I.P., Mozos, I., and Stoian, D. (2021). Subclinical Atherosclerosis Progression in Obese Children with Relevant Cardiometabolic Risk Factors Can Be Assessed through Carotid Intima Media Thickness. Appl. Sci., 11.","DOI":"10.3390\/app112210721"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Zong, X., Kelishadi, R., Hong, Y.M., Schwandt, P., Matsha, T.E., Mill, J.G., Whincup, P.H., Pacifico, L., L\u00f3pez-Bermejo, A., and Caserta, C.A. (2023). Establishing international optimal cut-offs of waist-to-height ratio for predicting cardiometabolic risk in children and adolescents aged 6\u201318 years. BMC Med., 21.","DOI":"10.1186\/s12916-023-03169-y"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1186\/s13098-021-00688-7","article-title":"Performance of waist-to-height ratio as a screening tool for identifying cardiometabolic risk in children: A meta-analysis","volume":"13","author":"Jiang","year":"2021","journal-title":"Diabetol. Metab. Syndr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"9524","DOI":"10.1038\/s41598-021-88951-9","article-title":"Distribution of waist-to-height ratio and cardiometabolic risk in children and adolescents: A population-based study","volume":"11","author":"Lee","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.4158\/EP161291.OR","article-title":"Diagnostic performance of waist circumference measurements for predicting cardiometabolic risk in mexican children","volume":"22","year":"2016","journal-title":"Endocr. Pract."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1960","DOI":"10.1111\/apa.14323","article-title":"Waist-to-height ratio remains an accurate and practical way of identifying cardiometabolic risks in children and adolescents","volume":"107","author":"Jiang","year":"2018","journal-title":"Acta Paediatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.orcp.2024.07.002","article-title":"Evidence for central obesity risk-related thresholds for adolescents aged 11 to 18 years in England using the LMS method","volume":"18","author":"Gray","year":"2024","journal-title":"Obes. Res. Clin. Pract."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"492","DOI":"10.2459\/JCM.0000000000001488","article-title":"Cardiovascular prevention in childhood: A consensus document of the Italian Society of Cardiology Working Group on Congenital Heart Disease and Cardiovascular Prevention in Paediatric Age","volume":"24","author":"Martino","year":"2023","journal-title":"J. Cardiovasc. Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Tully, L., Arthurs, N., Wyse, C., Browne, S., Case, L., McCrea, L., O\u2019cOnnell, J.M., O\u2019gOrman, C.S., Smith, S.M., and Walsh, A. (2022). Guidelines for treating child and adolescent obesity: A narrative review of recommendations. Front. Nutr., 9.","DOI":"10.3389\/fnut.2022.902865"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1186\/s13052-023-01458-z","article-title":"The treatment of obesity in children and adolescents: Consensus position statement of the Italian Society of Pediatric Endocrinology and Diabetology and the Italian Society of Pediatric Surgery","volume":"49","author":"Maffeis","year":"2023","journal-title":"Ital. J. Pediatr."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Mokha, J.S., Srinivasan, S.R., DasMahapatra, P., Fernandez, C., Chen, W., Xu, J., and Berenson, G.S. (2010). Utility of waist-to-height ratio in assessing the status of central obesity and related cardiometabolic risk profile among normal weight and overweight\/obese children: The Bogalusa Heart Study. BMC Pediatr., 10.","DOI":"10.1186\/1471-2431-10-73"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1016\/j.jacc.2013.01.026","article-title":"Role of waist-to-height ratio in the assessment of cardiometabolic risk in children classified by body mass index","volume":"62","author":"Khoury","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e041486","DOI":"10.1161\/JAHA.125.041486","article-title":"Screen Time Is Associated With Cardiometabolic and Cardiovascular Disease Risk in Childhood and Adolescence","volume":"14","author":"Horner","year":"2025","journal-title":"J. Am. Heart Assoc."},{"key":"ref_23","first-page":"e79975","article-title":"Association Between Obesity, Digital Screen Time, and Early-Onset Hypertension in Adolescents: A Prospective Cohort Study","volume":"17","author":"Yasin","year":"2025","journal-title":"Cureus"},{"key":"ref_24","unstructured":"European Commission (2025, December 12). Prevention of Overweight and Obesity in Children. Health Promotion Knowledge Gateway. Available online: https:\/\/knowledge4policy.ec.europa.eu\/health-promotion-knowledge-gateway\/prevention-overweight-obesity-children_en."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1339516","DOI":"10.1155\/ijpe\/1339516","article-title":"Unraveling the Impact of COVID-19 Lockdowns on Youth Sports and Physical Activity: Insights From a Retrospective Cohort Study in Italy","volume":"2025","author":"Lodi","year":"2025","journal-title":"Int. J. Pediatr."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Manojlovic, M., Roklicer, R., Trivic, T., Milic, R., Maksimovi\u0107, N., Tabakov, R., Sekulic, D., Bianco, A., and Drid, P. (2023). Effects of school-based physical activity interventions on physical fitness and cardiometabolic health in children and adolescents with disabilities: A systematic review. Front. Physiol., 14.","DOI":"10.3389\/fphys.2023.1180639"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Marsigliante, S., G\u00f3mez-L\u00f3pez, M., and Muscella, A. (2023). Effects on Children\u2019s Physical and Mental Well-Being of a Physical-Activity-Based School Intervention Program: A Randomized Study. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20031927"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1001\/jamacardio.2023.2231","article-title":"School-Based Cardiovascular Health Promotion in Adolescents: A Cluster Randomized Clinical Trial","volume":"8","author":"Bodega","year":"2023","journal-title":"JAMA Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.pedhc.2014.12.003","article-title":"Analysis of pediatric waist-to-hip ratio relationship to metabolic syndrome markers","volume":"29","author":"Moore","year":"2015","journal-title":"J. Pediatr. Health Care"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3911","DOI":"10.1038\/s41598-025-88098-x","article-title":"Evaluating waist-to-hip ratio in youth using frequency-modulated continuous wave radar and machine learning","volume":"15","author":"Park","year":"2025","journal-title":"Sci. Rep."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/1\/57\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T18:58:35Z","timestamp":1769194715000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/1\/57"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,22]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcdd13010057"],"URL":"https:\/\/doi.org\/10.3390\/jcdd13010057","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,22]]}}}