Sex Differences in Early Stages of Cardiovascular-Kidney-Metabolic Syndrome in Adolescents: Associations With Dietary and Lifestyle Factors.

PURPOSE: The cardiovascular-kidney-metabolic syndrome (CKM) framework captures interconnected risks of adiposity, metabolic dysregulation, kidney disease, and cardiovascular disease, yet sex-specific differences in CKM stage distribution and lifestyle associations remain underexplored in adolescents. This study examined sex-specific CKM stage prevalence, the distribution of stage-1 features within stage-2 subgroups, and associations with modifiable lifestyle factors in US adolescents.

METHODS

We analyzed National Health and Nutrition Examination Survey 2017-2020 data for 1,387 adolescents aged 12-19 years. Participants were classified into CKM stages 0-2. Survey-weighted multinomial logistic regression was used to examine sex-stratified associations with dietary intake, meal sources, and lifestyle factors after covariate adjustment.

RESULTS

CKM stage prevalence was similar between sexes: among boys, 42.3% were stage-0, 28.4% stage-1, and 29.4% stage-2, compared with 42.2%, 32.9%, and 24.9% in girls. Within stage-2, boys most commonly had hypertriglyceridemia only (39.8%), whereas girls predominantly had moderate-to-high-risk chronic kidney disease only (35.6%). In boys, daily school lunch intake was associated with lower odds of stage-1 (adjusted odds ratio = 0.11, 95% confidence interval = 0.03-0.40). In girls, each additional day of moderate-to-vigorous physical activity was associated with markedly lower odds of stage-1 (adjusted odds ratio = 0.78, 95% confidence interval = 0.67-0.91). Trying to lose weight showed the strongest associations with CKM stages in both sexes. After adjustment for multiple comparisons, daily school lunch in boys and trying to lose weight in both sexes remained associated with CKM stages.

DISCUSSION: CKM stage distribution and related lifestyle associations differed by sex in US adolescents, highlighting the importance of sex-specific prevention strategies and longitudinal research.