Elsevier

The Journal of Pediatrics

Volume 150, Issue 1, January 2007, Pages 12-17.e2
The Journal of Pediatrics

Original article
Cardiovascular Risk Factors and Excess Adiposity Among Overweight Children and Adolescents: The Bogalusa Heart Study

https://doi.org/10.1016/j.jpeds.2006.08.042Get rights and content

Objective

To explore the accuracy of various body mass index (BMI) cutpoints in identifying children who have excess adiposity (based on skinfold thicknesses), adverse levels of lipids, insulin, and blood pressures, and a high risk for severe adult obesity.

Study design

Cross-sectional (n = 10,099) and longitudinal (n = 2392) analyses were performed among subjects who participated in the Bogalusa Heart Study.

Results

Of children with a BMI ≥95th percentile (P) of the Centers for Disease Control (CDC) growth charts, 39% had at least two risk factors, 65% had excess adiposity, and 65% had an adult BMI of ≥35 kg/m2. Of those with a BMI ≥99th P, 59% had at least two risk factors, 94% had excess adiposity, and 88% had an adult BMI of ≥35 kg/m2. About 4% of children in the US now have a BMI ≥99th P.

Conclusions

The 99th P of BMI-for-age may be appropriate for identifying children who are at very high risk for biochemical abnormalities and severe adult obesity. More aggressive weight control strategies may be warranted for this subgroup.

Section snippets

Study Population

The Bogalusa (Louisiana) Heart Study is a community-based study of cardiovascular disease risk factors in early life.16 Seven cross-sectional examinations of schoolchildren in Bogalusa were conducted between 1973 and 1994. Adults (18 to 37 years of age) who had been previously examined as children were examined in four studies from 1982 to 1996.

Our cross-sectional analyses are restricted to 5- to 17-year-olds who were fasting, and who had recorded values for weight, height, and levels of six

Results

The mean age of the examined children in the cross-sectional sample was 11.4 years (range, 5 to 17 years), and mean levels of various characteristics are shown in Table I (available at www.jpeds.com). About 12% of the children were overweight, and 2% had a BMI ≥CDC 99th P. Several of the sex differences in risk factor levels varied by age, but girls had higher levels of triglycerides, LDL cholesterol, insulin, and DBP, whereas among 5- to 10-year-olds, boys had higher levels of HDL cholesterol

Discussion

Children and adolescents who have high levels of BMI relative to their sex and age peers are likely to have multiple risk factors, excess adiposity, and a high risk for adult obesity. Because levels of BMI and metabolic risk factors are continuous, the classification of “very overweight” children will always be somewhat arbitrary, but we have shown that the 99th P of BMI-for-age (1) is associated with a greatly increased frequency of biochemical abnormalities, (2) has a high predictive value

References (40)

  • D.S. Freedman et al.

    The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study

    Pediatrics

    (1999)
  • J.J. Reilly et al.

    Health consequences of obesity

    Arch Dis Child

    (2003)
  • G.S. Berenson et al.

    Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults

    New Engl J Med

    (1998)
  • C. Power et al.

    Measurement and long-term health risks of child and adolescent fatness

    Int J Obes Relat Metab Disord

    (1997)
  • X. Li et al.

    Childhood adiposity as a predictor of cardiac mass in adulthood: the Bogalusa Heart Study

    Circulation

    (2004)
  • A. Engeland et al.

    Obesity in adolescence and adulthood and the risk of adult mortality

    Epidemiology

    (2004)
  • W.H. Dietz et al.

    Clinical practiceOverweight children and adolescents

    N Engl J Med

    (2005)
  • M.T. Story et al.

    Management of child and adolescent obesity: attitudes, barriers, skills, and training needs among health care professionals

    Pediatrics

    (2002)
  • CDC National Center for Health Statistics. 2000 CDC Growth Charts: United States. Percentile Data Files with LMS...
  • Preventing Childhood Obesity: Health in the Balance

    (2004)
  • Cited by (0)

    The findings and conclusions in this report are those of the authors and do not necessarily represent those of the CDC.

    Supported by National Institutes of Aging Grant AG-16592.

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