Health-related quality of life and physical activity in Ukrainian pediatric patients with heterozygous familial hypercholesterolemia

Authors

DOI:

https://doi.org/10.15574/SP.2023.130.24

Keywords:

children, familial hypercholesterolemia, dyslipidemia, health, health-related quality of life, physical activity

Abstract

Introduction. Familial hypercholesterolemia (FH) is a genetically determined disease characterized by elevated low-density lipoprotein levels since birth and predisposes a person to develop atherosclerosis-induced cardiovascular disease. Healthcare providers should monitor the health status and physical activity level in pediatric patients with FH, as a high-risk group for cardiovascular disease.

Purpose - to investigate the self-reported health-related quality of life (HRQoL) and physical activity energy expenditure based on the questionnaire data (PAEEq) in children with heterozygous FH compared with healthy peers to assess the health status.

Materials and methods. The HRQoL scores were assessed using the KINDLR questionnaire in 15 patients with FH and 21 healthy peers. The physical activity level was evaluated using the C(Y)PAQ questionnaire. The KINDLR data together with other variables such as age, weight, height, sex, BMI and the PAEEq scores were analyzed in SAS® OnDemand for Academics.

Results. HRQoL scores in FH children were similar to those of the control group (p>0.05). There was no association between PAEEq and the HRQoL scores in the FH (r=0.37, p=0.29) and the control group (r=0.43, p=0.20). The KINDLR Physical well-being score in the 5-9 years age group was significantly higher for FH children than for controls (p<0.01), while the total HRQoL score was not significantly different between FH children and controls. The group of FH children aged 5-9 with an intermediate level of PAEEq was the most physically active among the surveyed children. The controls aged 15-18 with low levels of PAEEq was the least active. All other age groups were characterized by a low intermediate level of PAEEq.

Conclusions. Children with FH have HRQoL scores that are comparable to those of healthy peers. The FH and control groups were relatively satisfied with their quality of life. Thus, FH children consider themselves to be healthy, and from this underestimation of their cardiovascular risk they may have low adherence. Most FH children were found to have the low intermediate levels of PAEEq, which may indicate a lack of exercise and poor quality of life later on. Children with FH may have significant health problems in adulthood if they are not treated early and appropriately. In a similar manner, low PAEEq levels were demonstrated by the controls, so they should be also informed about the significance of regular physical activity and properly motivated.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patients was obtained for conducting the studies.

No conflict of interests was declared by the authors.

References

Activity MP. (2022, Oct 18). Global status report on physical activity 2022. WHO. World Health Organization. URL: https://www.who.int/publications/i/item/9789240059153.

Akioyamen LE, Genest J, Shan SD, Inibhunu H, Chu A, Tu JV. (2018). Anxiety, depression, and health-related quality of life in heterozygous familial hypercholesterolemia: A systematic review and meta-analysis. Journal of Psychosomatic Research. 109: 32-43. https://doi.org/10.1016/j.jpsychores.2018.03.170; PMid:29773150

Compas BE, Jaser SS, Bettis AH, Watson KH, Gruhn MA, Dunbar JP, Williams E, Thigpen JC. (2017). Coping, emotion regulation, and psychopathology in childhood and adolescence: A meta-analysis and narrative review. Psychological Bulletin. 143 (9): 939-991. https://doi.org/10.1037/bul0000110; PMid:28616996 PMCid:PMC7310319

Corder K, van Sluijs EMF, Wright A, Whincup P, Wareham NJ, Ekelund U. (2009). Is it possible to assess free-living physical activity and energy expenditure in young people by self-report? The American Journal of Clinical Nutrition. 89 (3): 862-870. https://doi.org/10.3945/ajcn.2008.26739; PMid:19144732

Ge P, Liu S-T, Xu S-X, Zhang J-Z, Lai Y-J, Fu R-C et al. (2022). The influence of parents on medication adherence of their children in China: A cross-sectional online investigation based on health belief model. Frontiers in Public Health. 10: 845032. https://doi.org/10.3389/fpubh.2022.845032; PMid:35493366 PMCid:PMC9046660

Harrell JS, McMurray RG, Baggett CD, Pennell ML, Pearce PF, Bangdiwala SI. (2005). Energy costs of physical activities in children and adolescents. Medicine and Science in Sports and Exercise. 37 (2): 329-336. https://doi.org/10.1249/01.MSS.0000153115.33762.3F; PMid:15692331

Hollman G, Ek A-C, Olsson AG, Berterö C. (2004). The meaning of quality of life among patients with familial hypercholesterolemia. The Journal of Cardiovascular Nursing. 19 (4): 243-250. https://doi.org/10.1097/00005082-200407000-00004; PMid:15326980

Kinnear FJ, Wainwright E, Perry R, Lithander FE, Bayly G, Huntley A et al. (2019). Enablers and barriers to treatment adherence in heterozygous familial hypercholesterolaemia: a qualitative evidence synthesis. BMJ Open. 9 (7): e030290. https://doi.org/10.1136/bmjopen-2019-030290; PMid:31371299 PMCid:PMC6677970

Königstein K, Meier J, Angst T, Maurer DJ, Kröpfl JM, Carrard J et al. (2022). VascuFit: vascular effects of non-linear periodized exercise training in sedentary adults with elevated cardiovascular risk - protocol for a randomized controlled trial. BMC Cardiovascular Disorders. 22 (1): 449. https://doi.org/10.1186/s12872-022-02905-1; PMid:36303113 PMCid:PMC9615395

Krogh HW, Mundal L, Holven KB, Retterstøl K. (2016). Patients with familial hypercholesterolaemia are characterized by presence of cardiovascular disease at the time of death. European Heart Journal. 37 (17): 1398-1405. https://doi.org/10.1093/eurheartj/ehv602; PMid:26586781

Lane DC, Pala Ö, Barlas Y. (2015). Health, demographic change and well-being: The European union's horizon 2020 programme and system dynamics: Selected papers from the sixth European system dynamics workshop, at koç university, Istanbul, turkey. Systems Research and Behavioral Science. 32 (4): 407-413. https://doi.org/10.1002/sres.2333

Marker AM, Steele RG, Noser AE. (2018). Physical activity and health-related quality of life in children and adolescents: A systematic review and meta-analysis. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association. 37 (10): 893-903. https://doi.org/10.1037/hea0000653; PMid:30234348

Mortensen GL, Madsen IB, Kruse C, Bundgaard H. (2016). Familial hypercholesterolaemia reduces the quality of life of patients not reaching treatment targets. Danish Medical Journal. 63: 5.

Mulder JWCM, Kranenburg LW, Treling WJ, Hovingh GK, Rutten JHW, Busschbach JJ, Roeters van Lennep JE. (2022). Quality of life and coping in Dutch homozygous familial hypercholesterolemia patients: A qualitative study. Atherosclerosis. 348: 75-81. https://doi.org/10.1016/j.atherosclerosis.2022.03.015; PMid:35361489

Nader PR, Bradley RH, Houts RM, McRitchie SL, O'Brien M. (2008). Moderate-to-vigorous physical activity from ages 9 to 15 years. JAMA: The Journal of the American Medical Association. 300 (3): 295-305. https://doi.org/10.1001/jama.300.3.295; PMid:18632544

Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, George SM, Olson RD. (2018). The Physical Activity Guidelines for Americans. JAMA: The Journal of the American Medical Association. 320 (19): 2020-2028. https://doi.org/10.1001/jama.2018.14854; PMid:30418471 PMCid:PMC9582631

Pinquart M. (2013). Self-esteem of children and adolescents with chronic illness: a meta-analysis: Self-esteem and chronic illness. Child: Care, Health and Development. 39 (2): 153-161. https://doi.org/10.1111/j.1365-2214.2012.01397.x; PMid:22712715

Rajmil L, Herdman M. (2019). Advances and challenges in the measurement of health related quality of life in the child and adolescent population. Anales de Pediatría (English Edition). 90 (5): 261-262. https://doi.org/10.1016/j.anpede.2019.01.006; PMid:30765283

Ravens-Sieberer U, Bullinger M. (1998). Assessing health-related quality of life in chronically ill children with the German KINDL: first psychometric and content analytical results. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation. 7 (5): 399-407. https://doi.org/10.1023/A:1008853819715; PMid:9691720

Reiner Z, Catapano AL, De Backer G, Graham I, Taskinen M-R, Wiklund O et al. (2011). ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). European Heart Journal. 32 (14): 1769-1818. https://doi.org/10.1093/eurheartj/ehr158; PMid:21712404

Seid M, Varni JW, Jacobs JR. (2000). Pediatric health-related quality-of-life measurement technology: intersections between science, managed care, and clinical care. Journal of Clinical Psychology in Medical Settings. 7 (1): 17-27. https://doi.org/10.1023/A:1009541218764

Sesso HD, Paffenbarger Jr RS, Lee IM. (2000). Physical activity and coronary heart disease in men: The Harvard Alumni Health Study: The Harvard alumni health study. Circulation. 102 (9): 975-980. https://doi.org/10.1161/01.CIR.102.9.975; PMid:10961960

Stockwell S, Trott M, Tully M, Shin J, Barnett Y, Butler L, McDermott D, Schuch F, Smith L. (2021). Changes in physical activity and sedentary behaviours from before to during the COVID-19 pandemic lockdown: a systematic review. BMJ Open Sport & Exercise Medicine. 7 (1): e000960. https://doi.org/10.1136/bmjsem-2020-000960; PMid:34192010 PMCid:PMC7852071

Wiegman A, Gidding SS, Watts GF, Chapman MJ, Ginsberg HN, Cuchel M et al. (2015). Familial hypercholesterolaemia in children and adolescents: gaining decades of life by optimizing detection and treatment. European Heart Journal. 36 (36): 2425-2437. https://doi.org/10.1093/eurheartj/ehv157; PMid:26009596 PMCid:PMC4576143

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2023-03-28

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