Racial and Ethnic Heterogeneity in the Association Between Total Cholesterol and Pediatric Obesity

Abstract

Total cholesterol (TC) directly correlates with overweight/obesity, but it remains unclear if this association varies by race and ethnicity. We assessed the association as well as the racial/ethnic heterogeneity in this relationship. Data on 63,863 children were assessed using electronic medical records between 2010 and 2011. A cross-sectional design was utilized with log-binomial regression model and chi-squared statistic to examine the data. Overall, abnormal total cholesterol (ATC) was 7.5% (4812). Significant racial variability in ATC was observed: Black/African American (AA) (7.4%), White (7.0%), Asian (5.1%) and some other race (SOR) children (11.3%), χ² (5) = 141.5, p < 0.0001. Black/AA (34.7%) and SOR children (41.2%) were predominantly overweight/obese, unlike the Asian children, (25.8%), χ² (5) = 324.6, p < 0.0001. The BMI percentile was highest among SOR (69.0 ± 28.6) and Black/AA children (65.2 ± 29.1), but lowest among Asian children (55.7 ± 31.5). A significant racial variability was also observed in weight, with the highest mean among Black/AA children (36.8kg ± 23.0) and the lowest among Asian children (28.7kg ± 16.8), f = 7.2, p < 0.001. Relative to normal TC, children with ATC were 2.6 times as likely to have abnormal BMI, relative risk (RR) =2.60, 99% CI, 2.54-2.68). Compared to non-Hispanic (RR = 2.62, 99% CI, 2.54-2.69), the risk was lower among Hispanics (RR = 2.34, 99%, 2.21-2.48). Among children with ATC, risk for abnormal BMI was highest among Asians, adjusted RR = 2.91, 99% CI, 2.34-3.62), intermediate among AA (ARR = 2.68, 99% CI, 2.59-2.77), but lowest among Whites (ARR = 2.40, 99% CI, 2.39-2.64), and SOR (ARR = 2.33, 99% CI, 2.19-2.50). In a large sample of children, total cholesterol directly correlates with BMI, with an observed racial and ethnic heterogeneity.

Keywords: BMI; health disparities; obesity; pediatric; racial heterogeneity; total cholesterol.

Figure 1

BMI and total cholesterol by race. NTC: Normal total cholesterol, ATC: abnormal total cholesterol.

Figure 2

The overall and adjusted RR on the association between BMI and Total Cholesterol in Children, AA: African American; AI: American Indian; AN: Alaska Native; SOR: Some Other Race.