Cardiac risk factors more prevalent in obese children

1. Greater severity of weight class in pediatric patients associated with higher risk ratios of cardiometabolic risk factors including systolic and diastolic blood pressure (BP), HbA1c and triglycerides. 

2. Male participants in higher obesity classes more likely to show significant differences in cardiometabolic risk factors, compared to female participants

Evidence Rating: 3 (Average)  

Study Rundown: Obesity is a growing health concern in pediatric patients aged 2 to 19 years. In 2011-2012, the prevalence of severe obesity was estimated to be 6% in this population. Cardiometabolic parameters such as LDL, HDL, HbA1c, glucose, systolic and diastolic blood pressures have been assessed in overweight and obese children. However, sparse research has evaluated these risk factors within different obesity classes (i.e. Class I, II and III). The researchers, in this cross-sectional analysis of data from the National Health and Nutrition Examination Survey (NHANES), reported the prevalence of abnormal cardiometabolic parameters by weight status as well as differences in these risk factors based on obesity class and gender. They found that low HDL, high triglycerides, high systolic and diastolic BPs, high HbA1c’s and glucoses were significantly greater in patients within the higher obesity category. Researchers also found that these differences, when analyzed in terms of sex, tended to be more prevalent between male participants in the different weight classes.

Click to read the study, published today in NEJM

Relevant Reading: Prevalence and trends in obesity and severe obesity among children in the United States

In-Depth [cross-sectional study]: In this cross-sectional study, researchers analyzed cardiometabolic risk factors in 8579 obese pediatric patients (ages 3-19 years-old) that were surveyed in the NHANES study from 1999 to 2012. Only participant’s greater or equal to the 85^th percentile for age-specific BMI were included in the study. The participants were then divided into different categories. These categories were as follows: overweight (≥ 85th to <95^th percentile), class I obesity (≥95th to <120% of the 95^th percentile), class II obesity (≥120% to <140% of the 95^th percentile, or BMI≥35), and class III obesity (≥140% of the 95^th percentile, or BMI≥40). Cardiometabolic risk factors assessed in relation to severity of obesity included HDL, LDL, triglycerides, BP, HbA1c and fasting blood glucose. With regards to mean values, cardiometabolic risk factors increased with increasing severity of obesity, with the exception of HDL, which was lower with increasing severity of obesity. Comparing to class I obese category, the risk ratios of the class III obese participants of systolic BP (RR=2.24, 95%[CI]=1.42-3.54, p<0.001), diastolic BP (RR=4.57, 95%[CI]=1.88-11.06, p<0.001), triglyceride level (RR=1.63, 95%[CI]=1.08-2.47, p=0.02) and HbA1c level (RR=2.59, 95%[CI]=1.55-4.34, p<0.001) were significantly greater. Comparing to class I obese participants, class II obese participants demonstrated significantly higher risk ratios for systolic BP (RR=1.67, 95%[CI]=1.10-2.53, p=0.02) and glucose (RR=1.67, 95%[CI]=2.22, p<0.001). Overall, male participants demonstrated these risk factors at a significantly higher level compared to females.

Image: PD

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