, et al
Cardiometabolic risks and severity of obesity in children and young adults
N Engl J Med
; doi:

Investigators from the University of North Carolina analyzed data from the National Health and Nutrition Examination Survey (NHANES) to assess whether there was a difference in the prevalence of cardiometabolic risk factors according to obesity severity among children and adolescents. Participants included overweight and obese children between ages 3 and 19 years who were enrolled in NHANES between 1999 and 2002. NHANES uses a stratified sample of the US population, and data collection included an interview about health and demographic variables, physical examination findings, and laboratory measurements. The BMI, based on height and weight measurements obtained during the NHANES examination, was categorized as overweight (BMI ≥85th to <95th percentile), class I obesity (BMI ≥95% to <120% of the 95th percentile), class II obesity (BMI ≥120 to <140% of the 95th percentile or a BMI ≥35, whichever was lower), or class III obesity (BMI ≥140% of the 95th percentile or BMI ≥40, whichever was lower). Data on the following cardiometabolic risk factors were collected on study participants: total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein, cholesterol, triglycerides, blood pressure (BP), glycated hemoglobin (collected only for 12- to 19-year-olds), and fasting glucose (collected only for 12- to 19-year-olds). Each of these was classified as normal or abnormal based on predetermined criteria. The prevalence of abnormal cardiometabolic risk factors was compared across different overweight/obese categories using regression analyses, after controlling for confounding variables.

Among the 8,579 participants included in the analysis, 46.9% were overweight, 36.4% had class I obesity, 11.9% had class II obesity, and 4.8% had class III obesity. Across all ages, the prevalence of abnormal cardiometabolic risk factor values was higher with greater severity of obesity. Controlling for age, gender, and race, the rates of the following abnormal risk factors were significantly higher for class III obesity compared to class I obesity: HDL cholesterol (RR = 1.89), triglycerides (RR = 1.63), systolic BP (RR = 2.24), diastolic BP (RR = 4.57), and glycated hemoglobin (RR = 2.59). Rates of all abnormal cardiometabolic risk factors except fasting glucose were significantly lower for the overweight group compared to the class I obesity group. When stratified by gender and controlled for age and race, there were few significant differences in risk factor prevalence by weight category for females, but significant differences continued to be observed for males.

The authors conclude that cardiometabolic risk factors increase with the severity of obesity among children and young adults, most notably in males.

Drs Quinn and Wong have disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Severe obesity is increasing among children and adolescents in the United States. The focus of the current study on obesity...

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