Cardiovascular
Individual- and school-level factors associated with adolescent metabolic syndrome: A multilevel structural equation modeling study Yu-Ting Chin* Yu-Ting Chin Wei-Ting Lin Pei-Wen Wu Sharon Tsai Chien-Hung Lee
Underlying pathophysiological mechanisms contribute to the aggregation of abnormal cardiovascular factors that form metabolic syndrome (MetS). This phenomenon is influenced by factors at various levels, highlighting the importance of adopting a multilevel perspective when investigating its determinants in adolescents. This study used a multilevel structural equation modeling to assess the effects of individual- and school-level factors on the confirmatory factor analysis-derived score for MetS (csMS) in adolescents. A representative cohort of 2,727 adolescents was randomly selected from 36 schools in three economically diverse areas in Taiwan. The participants’ individual- and school-level factors, as well as their cardiovascular profiles, were evaluated. In terms of individual factors, adolescents with the intake of >500 mL/day of SSB had a direct effect on csMS score (a 0.17 elevation) after accounting for covariates. Mediation analysis indicated that higher levels of uric acid mediated 5.2% of the association, while body mass index (BMI) mediated 51.3%. Regarding school-level factors, students in schools with >11 sports venues within a 600 m radius had a 0.25 lower csMS score compared to those in schools with ≤11 sports venues. In the cross-level assessment, the number of sports venues was found to modify the association between SSB consumption and BMI in the multilevel structural equation modeling. This study presents data that demonstrate the multilevel structural association between SSB intake and the latent MetS construct in adolescents.