The Trajectory study aims to determine whether childhood aerobic fitness, sleep quality, and diet quality predict cardiometabolic health during puberty and early adulthood, independently of adiposity.

The Trajectory study is a longitudinal observational study. Participants will be recalled from two existing pediatric cohorts: the Arkansas Active Kids study (ClinicalTrials.gov ID: NCT03221673; IRB #206217) and the MI Energy study (ClinicalTrials.gov ID: NCT04427462; IRB #260376). Both were cross-sectional studies with comparable designs, recruiting children between ages 7 and 10 years, regardless of sex, BMI, or ethnicity. The Trajectory study serves as the follow-up component during adolescence or early adulthood (ages 13-21). It is anticipated that approximately 250 participants will complete the follow-up visit.

During the follow-up visit at the Arkansas Children's Nutrition Center (ACNC), the following key measurements will be conducted:

• Body Composition: Dual-Energy X-ray Absorptiometry (DXA)
• Metabolic Profile: Fasting blood markers, including glucose, lipid profile, and insulin resistance
• Continuous Glucose Monitoring: Interstitial sensor-based glucose
• Vascular Function: Ultrasound (brachial artery flow-mediated dilation)
• Liver Examination: Ultrasound (liver steatosis and stiffness)
• Resting Metabolic Rate: Indirect calorimetry
• Aerobic Capacity: Cardiopulmonary exercise test (spirometry)
• Muscle Strength: Dynamometry
• Physical Activity & Sleep: Accelerometry
• Dietary Intake: Food frequency questionary

Inclusion Criteria:

• Ages 13 to 21 years.
• Boys or girls.
• All ethnicities.
• All BMIs.
• Previous participation in the Arkansas Active Kids study and the MI Energy study.
• Participants who previously agreed to be contacted for future research at ACNC.
• Participants who agree to the use of their previously collected information and samples from the AAK or MI Energy studies for the follow-up study.

Exclusion Criteria:

• Asthma that requires daily use of inhalers to keep symptoms under control.
• Asthma that requires use of rescue inhalers (e.g., albuterol) >2 days per week.
• Exercise-induced asthma.
• Autism spectrum disorder (e.g., Autistic disorder, Rett disorder, Asperger disorder, childhood disintegrative disorder, pervasive developmental disorder not otherwise specified (PDD-NOS).
• Neurological disorders (e.g. epilepsy or seizures).
• Cancer.
• Hormonal disease (e.g., hypothyroidism and growth hormone deficiency).
• Autoimmune diseases (e.g., lupus, thyroiditis, juvenile idiopathic arthritis).
• Bleeding disorders (e.g., hemophilia).
• Chronic infections (e.g., HIV, hepatitis B, hepatitis C).
• Other pre-existing medical conditions or medications as determined by the investigators to affect the outcomes of interest.
• Pregnancy (verbal assessment).

Adolescents (13 to 17 years) and young adults (18 to 21 years) who previously participated in the Arkansas Active Kids study (clinicaltrials.gov #NCT03221673; IRB #206217) and the MI Energy study (clinicaltrials.gov #NCT04427462; IRB #260376).