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. 2018 Jan:192:105-114.
doi: 10.1016/j.jpeds.2017.09.066.

Impact of Severe Obesity on Cardiovascular Risk Factors in Youth

Gali Zabarsky  1 , Cherise Beek  1 , Emilia Hagman  1 , Bridget Pierpont  2 , Sonia Caprio  2 , Ram Weiss  3
Affiliations

Impact of Severe Obesity on Cardiovascular Risk Factors in Youth

Gali Zabarsky et al. J Pediatr. 2018 Jan.

Abstract

Objective: To compare cardiovascular risk factor clustering (CVRFC) in severely obese youth with those with lower degrees of obesity.

Study design: We divided a childhood obesity clinic derived cohort into the degrees of obesity (class I, II, and III) and added a "class IV" category corresponding to >160% of the 95th centile of body mass index (BMI) for age and sex. In a cross-sectional analysis, we investigated the presence of CVRFC in 2244 participants; in 621 who were followed longitudinally, we investigated the determinants of endpoint CVRFC.

Results: Class IV obesity was associated with increased risk for CVRFC compared with overweight (OR = 17.26, P < .001) at a similar magnitude to class III obesity (OR = 17.26, P < .001). Male children were at greater risk for presence of CVRFC (OR = 1.57, P = .03) compared with female children. Adiponectin (OR = 0.90, P < .001) and leptin levels (OR = 0.98, P = .008) were protective, independent of degree of obesity. Baseline class IV obesity was associated with increased risk compared with overweight of having CVRFC at follow-up (OR = 5.76, P = .001), to a similar extent as class III obesity (OR = 5.36, P = .001). Changes in the degree of obesity were significant predictors of CVRFC on follow-up (OR = 1.04, P < .01 per percent BMI change).

Conclusions: The metabolic risk associated with obesity in childhood is conferred prior to reaching class IV obesity. An individualized risk stratification approach in children with severe obesity should be based on presence of complications rather than simple BMI cutoffs.

Trial registration: ClinicalTrials.gov NCT01967849.

Keywords: cardiovascular risk factors, metabolic syndrome; severe obesity.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1. Relation of metabolic parameters, obesity category and pubertal status
White bars- pre-pubertal, black bars – pubertal, * p<0.001 for class IV vs. class III obesity category
Figure 2
Figure 2. Change in BMI and weight by baseline obesity categories
* p<0.001 for class IV obese vs. all other obesity categories. ** p=0.003 vs. class III obese, p<0.001 vs. all other obesity categories)
See this image and copyright information in PMC

References

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