More than 3 million children in the United States who are severely obese may be at a higher risk of developing heart disease and diabetes than overweight children, according to a new study by researchers at the University of North Carolina and Wake Forest Baptist Medical Center. The study, to be published in the Oct. 1 issue of the New England Journal of Medicine, found that children with the more severe forms of obesity showed early signs of heart disease and diabetes, with the differences most notable in boys and young men.
"Our findings show a direct correlation between higher levels of obesity and adverse cardiometabolic risk factors that can lead to future disease," said the study's lead investigator, Asheley Cockrell Skinner, PhD, an associate professor of pediatrics at the UNC School of Medicine and of Health Policy at the UNC Gillings School of Global Public Health. "Understanding elevated risk of disease in children and adolescents with more severe obesity is important, because it can help us more appropriately and cost-effectively target testing and interventions. For example, we see boys with more severe obesity at greater risk than girls, so this may be a relevant group to target for early screening and treatment."
Researchers analyzed data from the National Health and Nutrition Examination Survey of children with overweight or obesity, ages 3 to 19, assessing the prevalence of cardiometabolic risk factors -- such as blood pressure and cholesterol and blood sugar levels -- according to the severity of obesity using classifications developed in recent years. The more severe forms of obesity were defined as a body-mass index (BMI) greater than 120 percent of the 95th percentile (class II) and greater than 140 percent of the 95th percentile (class III).
Among 8,579 children with a BMI at the 85th percentile or higher, 46.9 percent were classified as overweight, 36.4 percent had Class I obesity, 11.9 percent had Class II obesity, and 4.8 percent had Class III obesity. The study showed that the greater the severity of obesity, the higher the risks of a low HDL cholesterol level, high systolic and diastolic blood pressures, and high triglycerides and hemoglobin A1C levels -- all markers for heart disease and diabetes.
"We should be looking at prevention and intervention strategies to help reduce obesity early in life, particularly in those children most at risk, not waiting until the risk factors lead to disease," said study co-author, Eliana Perrin, MD, MPH, a professor of pediatrics at the UNC School of Medicine and general pediatrician at N.C. Children's Hospital.
"These findings could change how we screen and treat obesity in children," added Joseph Skelton, MD, an associate professor of pediatrics at Wake Forest Baptist and senior author of the study. "For kids with less severe obesity, perhaps it may not be necessary to put them through drawing blood and testing cholesterol, and instead only screen those at higher levels of obesity and focus treatment on the children at greatest risk."
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