{"id":855,"date":"2015-10-19T15:16:17","date_gmt":"2015-10-19T15:16:17","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=855"},"modified":"2017-08-21T11:27:04","modified_gmt":"2017-08-21T11:27:04","slug":"primary-care-corner-with-geoffrey-modest-md-obesity-in-kids-and-cardiometabolic-risk","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/10\/19\/primary-care-corner-with-geoffrey-modest-md-obesity-in-kids-and-cardiometabolic-risk\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: Obesity in Kids and Cardiometabolic Risk"},"content":{"rendered":"<p><strong>By Dr. Geoffrey Modest<\/strong><\/p>\n<p>So, no great surprise, but it seems that cardiometabolic risk factors track the degree of obesity in children\u00a0and young adults (see\u00a0N Engl J Med 2015;373:1307-17\u200b). A cross-sectional analysis of overweight and obese kids\/young adults (age 3-19) in the National Health and Nutrition Examination Survey from 1999-2012 looked at measured height and weight, along with an array of cardiometabolic risk factors (lipids, A1c, etc.), assessing the relationship over different obesity levels.<\/p>\n<p>Background (from the CDC):<\/p>\n<ul>\n<li>Childhood obesity\u00a0(defined as BMI\u00a0&gt;95th\u00a0%ile) has\u00a0more than doubled in children and quadrupled in adolescents in past 30 years:\u00a0% of\u00a0children aged 6-11 in the US who were obese increased from 7% in 1980 to 18% in 2012; for adolescents 12-19yo, it increased from 5% to 21%.<\/li>\n<li>In 2012 &gt;1\/3 of children and adolescents were overweight or obese<\/li>\n<li>Despite recent declines in obesity prevalence in preschool-aged kids, obesity is still way too prevalent: overall\u00a0for those 2-19\u00a0yo, the prevalence\u00a0&#8220;has remained fairly stable at about 17% and affects about 12.7 million children and adolescents for the past decade&#8221;, though the prevalence in those 2-5\u00a0yo has decreased significantly from 13.9% in 2003-4 to 8.4% in 2011-2, at which time the prevalence was 17.7% in 6-11\u00a0yo and 20.5% in 12-19\u00a0yo; the\u00a0prevalence was highest in Hispanics (22.4%) and non-Hispanic blacks (20.2%) vs non-Hispanic whites (14.1%)<\/li>\n<\/ul>\n<p>Details of study:<\/p>\n<ul>\n<li>8579 individuals (53.7% white, 16.5% black, 24.0% Hispanic; 52% male)\u00a0with BMI&gt;85th %ile, of whom 46.9% were overweight (BMI 85-95th%), 36.4% had class I obesity (95-120% of the 95th %ile), 11.9% had class II obesity (120-140% of the 95th %ile or\u00a0BMI\u226535), and 4.8% had class III obesity (\u2265140% of the 95th %ile, or\u00a0BMI\u226540).<\/li>\n<\/ul>\n<p>Results, as progress from overweight to class I to class II to class III obesity:<\/p>\n<ul>\n<li>LDL: 94.6, 98.4, 98.2, 96.5 (p=0.131, non-significant)<\/li>\n<li>HDL: 49.4, 46.7, 43.5, 41.3 (p&lt;0.001)<\/li>\n<li>Systolic BP: 108.5, 111.0, 112.6,116.2\u00a0(p&lt;0.001)<\/li>\n<li>Diastolic BP 57.0, 58.8, 58.7, 64.5\u00a0(p&lt;0.001)<\/li>\n<li>Fasting\u00a0triglycerides: 91.0, 113.2, 113.3, 143.2\u00a0(p&lt;0.001)<\/li>\n<li>Glycohemoglobin 5.15, 5.20, 5.30, 5.37\u00a0(p&lt;0.001)<\/li>\n<li>Fasting\u00a0glucose: 93.2, 95.1, 96.7, 96.5\u00a0(p=0.001)<\/li>\n<li>And, overall, these risk factors did have a sex difference: males did worse. In fact, the only significant ones for females were: HDL, systolic\/diastolic BP, glycohemoglobin and glucose; and for each of these, the prevalence in males was much higher.<\/li>\n<\/ul>\n<p>So, although this study tracked only the\u00a0surrogate markers of cardiometabolic parameters (not so likely to have cardiac clinical events at this age&#8230;..),\u00a0this study is important because:<\/p>\n<ul>\n<li>Obesity in kids tracks with obesity in adults<\/li>\n<li>This study, vs older ones, looks at levels of obesity and differences in risk factors, showing a graded response overall: the worse the obesity, the worse the risk factors. And, this study, I think, justifies subdividing obesity in kids into different levels (since there are differences in attributable cardiometabolic\u00a0risks), as is done with adults.<\/li>\n<li>And, though clinical events are the gold standard, autopsy studies have shown that there are fatty streaks in pretty much everyone aged 15-34; and there are advanced atherosclerotic lesions in 2% of men\/0% of women\u200b\u00a0aged 15-19\u00a0and 20% of men\/8% of women aged 30-34. So, actual disease does begin early and, per usual, is seems\u00a0better to deal with risk factors early on, before clinical disease manifests itself&#8230;.<\/li>\n<\/ul>\n<p>Also, for prior blog on the relationship between pediatric\u00a0obesity and increased left ventricular mass\u00a0from the Bogalusa Heart Study,\u00a0see\u00a0<a href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/01\/25\/primary-care-corner-with-geoffrey-modest-md-obesity-and-left-ventricular-mass-in-kids\/\">https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/01\/25\/primary-care-corner-with-geoffrey-modest-md-obesity-and-left-ventricular-mass-in-kids\/<\/a><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Primary Care Corner with Geoffrey Modest MD: Obesity in Kids and Cardiometabolic Risk  [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/10\/19\/primary-care-corner-with-geoffrey-modest-md-obesity-in-kids-and-cardiometabolic-risk\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-855","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/855","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=855"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/855\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=855"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=855"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=855"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}