Abstract
Childhood overweight (body mass index (BMI)>90th centile) poses a major public health problem in so far as adult diseases manifest themselves already during childhood. In this review, after examining the prevalence of metabolic and cardiovascular diseases, the issue of whether BMI or other clinical parameters are valid tools to predict co-morbidities in children is discussed. Data of 2001–2008 are reviewed, including several studies conducted on more than 260 000 overweight and obese children in Germany and Switzerland. Apart from non-metabolic co-morbidities, namely musculoskeletal complications and attention deficit/hyperactivity disorders in up to 74% and up to 58% of overweight children, respectively, at least one cardiovascular and metabolic risk factor was seen in 52% of the overweight children, mostly high blood pressure (35%) with increased left ventricular mass or arterial stiffness. Signs of fatty liver disease or dyslipidemia were found in up to 29 and 32% of the children, respectively. Type 2 diabetes was found in less than 0.7% of the children, and an elevated fasting glucose or glucose intolerance in 3%. Irrespective of BMI, the quality of fat and protein intake predicted hypertension or insulin resistance, and fructose predicted lower (and more atherogenic) particle size of low-density lipoprotein-cholesterol. Out of the adiposity markers, waist circumference was closely correlated with insulin resistance and the components of the metabolic syndrome. In conclusion, risk factors are found in more than half of the overweight children, most frequently high blood pressure or dyslipidemia, and were mainly related to waist circumference, but also to BMI and fat mass. Even in the presence of normal BMI, screening for cardiovascular risk factors is advocated in each child with elevated waist circumference, but its cut-off points still remain to be validated. The increased occurrence of orthopedic and psychiatric complaints may detrimentally influence health-related lifestyle and obesity therapy.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Stewart ST, Cutler DM, Rosen AB . Forecasting the effects of obesity and smoking on U.S. life expectancy. N Engl J Med 2009; 361: 2252–2260.
Schmid A, Schneider H, Golay A, Keller U . Economic burden of obesity and its comorbidities in Switzerland. Soz Praventivmed 2005; 50: 87–94.
Muller MJ . How are we going to turn the obesity prevention experience? Obes Rev 2010; 11: 101–104.
Aeberli I, Ammann RS, Knabenhans M, Molinari L, Zimmermann MB . Decrease in the prevalence of paediatric adiposity in Switzerland from 2002 to 2007. Public Health Nutr 2010; 13: 806–811.
Plachta-Danielzik S, Pust S, Asbeck I, Czerwinski-Mast M, Langnase K, Fischer C et al. Four-year follow-up of school-based intervention on overweight children: the KOPS study. Obesity (Silver Spring) 2007; 15: 3159–3169.
l’Allemand D, Wiegand S, Reinehr T, Müller J, Wabitsch M, Widhalm K, APV-Study GROUP et al. Cardiovascular risk in 26 008 European overweight children as established by a multicenter database. Obesity 2008; 16: 1672–1679.
l’Allemand D, Farpour-Lambert N, Laimbacher J . Definition, diagnostisches vorgehen und therapie-indikationen bei übergewicht im kindes- und jugendalter. Paediatrica 2006; 17: 14–18.
Wabitsch M, Kunze D . Leitlinie Adipositas im Kindes- und Jugendalter. In: von Schnakenburg E (ed). Leitlinien Kinder- und Jugendmedizin DGKJ. Urban & Fischer: München, 2006. pp 1–36.
Reinehr T, Widhalm K, l’Allemand D, Wiegand S, Wabitsch M, Holl RW, APV Wiss Study Group. Two-year follow-up in 21 784 overweight children and adolescents with lifestyle intervention. Obesity 2009; 17: 1196–1199.
Aggoun Y, Farpour-Lambert NJ, Marchand L, Golay E, Maggio A, Beghetti M . Impaired endothelial and smooth muscle functions and arterial stiffness appear before puberty in obese children and are associated with elevated ambulatory blood pressure. Eur Heart J 2008; 29: 792–799.
Farpour-Lambert N, Maggio A, Matin X, Aggoun Y, Mach F, Beghetti M . Associations between physical activity level, cardiorespiratory fitness and cardiovascular diseases risk factors among obese children and their mother. Swiss Med Wkly 2009; 22 (Suppl 172): 17 (abstract).
Maggio A, Marchand M, Martin X, Herrmann F, Beghetti M, Farpour-Lambert NJ . Associations among obesity, blood pressure, and left ventricular mass. J Pediatr 2007; 152: 489–493.
Aeberli I, Spinas G, Lehmann R, l’Allemand D, Molinari L, Zimmermann MB . Diet determines features of the metabolic syndrome in overweight children. Int J Vitam Nutr Res 2009; 79: 14–23.
Aeberli I, Molinari L, Spinas G, Lehmann R, l’Allemand D, Zimmermann MB . Dietary intakes of fat and antioxidant vitamins are predictors of subclinical inflammation in overweight Swiss children. Am J Clin Nutr 2006; 84: 748–755.
Aeberli I, Kaspar M, Zimmerman M . Dietary intake and physical activity of normal weight and overweight 6 to 14 year old Swiss children. Swiss Med Wkly 2007; 137: 424–430.
Cole TJ, Flegal K, Dietz WH . Detecting obesity based on skinfold thicknesses. Am J Clin Nutr 2005; 81: 196–197.
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH . Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240–1243.
Kromeyer-Hauschild K, Wabitsch M, Kunze D, Kromeyer-Hauschild K, Wabitsch M, Geller F et al. Perzentile für den Body-mass-Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben. Monatsschr Kinderheilk 2001; 149: 807–818.
Nagel G, Wabitsch M, Galm C, Berg S, Brandstetter S, Fritz M et al. Secular changes of anthropometric measures for the past 30 years in South-West Germany. Eur J Clin Nutr 2009; 63: 1440–1443.
Cole TJ, Faith MS, Pietrobelli A, Heo M . What is the best measure of adiposity change in growing children: BMI, BMI %, BMI z-score or BMI centile? Eur J Clin Nutr 2005; 59: 419–425.
Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury V, O’Malley C, Stolk R et al. Interventions for treating obesity in children. Cochrane Database Syst Rev 2009. DOI: 10.1002/14651858.CD001872.pub2/1:1-132.
Blüher M . The distinction of metabolically ‘healthy’ from ‘unhealthy’ obese individuals. Curr Opin Lipidol 2010; 21: 38–43.
Taylor ED, Theim KR, Mirch MC, Ghorbani S, Tanofsky-Kraff M, dler-Wailes DC et al. Orthopedic complications of overweight in children and adolescents. Pediatrics 2006; 117: 2167–2174.
l’Allemand D, Kirchhoff E, Sempach R, Farpour-Lambert N . Evaluation of Therapy for Overweight Children and Adolescents in Switzerland: Therapy in Multiprofessional Group Programs—Part 2: First Baseline Analysis. 2-2, 1-13. http://www.bag-admin.ch (accessed 15 November 2009) Eidgenössischeds Departement des Inneren, Bundesamt für Gesundheit: Bern, 2009.
Wille N, Ravens-Sieberer U, Bullinger M . Lebensqualität Psych Gesundheit von Kindern Jugendlichen mit Übergewicht Adipositas 2008. http://www.bzga-kinderuebergewicht.de/adipo_mtp/beobachtungsstudie/symposium171008/pdf/wille-bzga-symposium2008freiburg.pdf. Bundeszentrale für gesundheitliche Aufklärung: Köln.
Nederkoorn C, Braet C, Van EY, Tanghe A, Jansen A . Why obese children cannot resist food: the role of impulsivity. Eat Behav 2006; 7: 315–322.
Nederkoorn C, Jansen E, Mulkens S, Jansen A . Impulsivity predicts treatment outcome in obese children. Behav Res Ther 2007; 45: 1071–1075.
Farpour-Lambert NJ, Aggoun Y, Marchand LM, Martin XE, Herrmann FR, Beghetti M . Physical activity reduces systemic blood pressure and improves early markers of atherosclerosis in pre-pubertal obese children. J Am Coll Cardiol 2009; 54: 2396–2406.
Reinehr T, Kiess W, de Sousa G, Stoffel-Wagner B, Wunsch R . Intima media thickness in childhood obesity: relations to inflammatory marker, glucose metabolism, and blood pressure. Metabolism 2006; 55: 113–118.
Krebs A, Schmidt-Trucksäss A, Alt J, Doerfer J, Krebs K, Winkler K et al. Synergistic effects of elevated systolic blood pressure and hypercholesterolemia on carotid intima–media thickness in children and adolescents. Pediatr Cardiol 2009; 30: 1131–1136.
Raitakari OT, Juonala M, Viikari JS . Obesity in childhood and vascular changes in adulthood: insights into the cardiovascular risk in young finns study. Int J Obes (Lond) 2005; 29 (Suppl 2): S101–S104.
Baranowski T, Cooper DM, Harrell J, Hirst K, Kaufman FR, Goran M et al. Presence of diabetes risk factors in a large U.S. eighth-grade cohort. Diabetes Care 2006; 29: 212–217.
Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K et al. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med 2002; 346: 802–810.
Wiegand S, Maikowski U, Blankenstein O, Biebermann H, Tarnow P, Gruters A . Type 2 diabetes and impaired glucose tolerance in European children and adolescents with obesity—a problem that is no longer restricted to minority groups. Eur J Endocrinol 2004; 151: 199–206.
Alberti KG, Zimmet PZ . Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998; 15: 539–553.
European Diabetes Epidemiology Group. Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. The DECODE study group. Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe [see comments]. Lancet 1999; 354: 617–621.
Franks PW, Hanson RL, Knowler WC, Sievers ML, Bennett PH, Looker HC . Childhood obesity, other cardiovascular risk factors, and premature death. N Engl J Med 2010; 362: 485–493.
Baumann U . Obelix and the trouble of fatty liver disease in childhood. Pract Diab Int 2007; 24: 1–3.
Wiegand S, Keller K-M, Röbl M, l’Allemand D, Reinehr T, Holl RW, APV Study Group. Obese boys at increased risk for non-alcoholic liver disease. Evaluation of 16 390 overweight or obese children and adolescents. Int J Obes 2010; 34: 1468–1474.
Reinehr T, Toschke AM . Onset of puberty and cardiovascular risk factors in untreated obese children and adolescents: a 1-year follow-up study. Arch Pediatr Adolesc Med 2009; 163: 709–715.
Reinehr T, Schmidt C, Toschke AM, Andler W . Lifestyle intervention in obese children with non-alcoholic fatty liver disease: 2-year follow-up study. Arch Dis Child 2009; 94: 437–442.
Aeberli I, Zimmermann MB, Molinari L, Lehmann R, l’Allemand D, Spinas G et al. Fructose intake is a predictor of LDL particle size in overweight schoolchildren. Am J Clin Nutr 2007; 88: 1174–1178.
Freedman DS, Dietz WH, Srinivasan SR, Berenson GS . The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics 1999; 103: 1175–1182.
Katzmarzyk PT, Tremblay A, Perusse L, Despres JP, Bouchard C . The utility of the international child and adolescent overweight guidelines for predicting coronary heart disease risk factors. J Clin Epidemiol 2003; 56: 456–462.
Bell LM, Byrne S, Thompson A, Ratnam N, Blair E, Bulsara M et al. Increasing BMI z-score is continuously associated with complications of overweight in children, even in the healthy weight range. J Clin Endocrinol Metab 2007; 92: 517–522.
Voss LD, Metcalf BS, Jeffery AN, Wilkin TJ . IOTF thresholds for overweight and obesity and their relation to metabolic risk in children (EarlyBird 20). Int J Obes (Lond) 2006; 30: 606–609.
Lee S, Bacha F, Arslanian SA . Waist circumference, blood pressure, and lipid components of the metabolic syndrome. J Pediatr 2006; 149: 809–816.
Lee S, Bacha F, Gungor N, Arslanian SA . Waist circumference is an independent predictor of insulin resistance in black and white youths. J Pediatr 2006; 148: 188–194.
Ouyang F, Christoffel KK, Brickman WJ, Zimmerman D, Wang B, Xing H et al. Adiposity is inversely related to insulin sensitivity in relatively lean Chinese adolescents: a population-based twin study. Am J Clin Nutr 2010; 91: 662–671.
Yusuf S, Hawken S, Ounpuu S, Bautista L, Franzosi MG, Commerford P et al. Obesity and the risk of myocardial infarction in 27 000 participants from 52 countries: a case-control study. Lancet 2005; 366: 1640–1649.
Kromeyer-Hauschild K, Gläßer N, Zellner K . Waist circumference percentile in Jena Children (Germany) 6- to 18-years of age. Aktuel Ernaehr Med 2008; 33: 116–122.
Fredriks AM, van Buuren S, Fekkes M, Verloove-Vanhorick SP, Wit JM . Are age references for waist circumference, hip circumference and waist-hip ratio in Dutch children useful in clinical practice? Eur J Pediatr 2005; 164: 216–222.
Maffeis C, Banzato C, Talamini G . Waist-to-height ratio, a useful index to identify high metabolic risk in overweight children. J Pediatr 2008; 152: 207–213.
Sempach R, Farpour-Lambert N, l’Allemand D, Laimbacher J . Therapie des adipösen Kindes und Jugendlichen: Vorschläge für multiprofessionelle Therapieprogramme. Paediatrica 2007; 18: 33–39.
Somu S, Sundaram B, Kamalanathan AN . Early detection of hypertension in general practice. Arch Dis Child 2003; 88: 302.
National Institutes of Health (US). The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114 (Suppl): 555–576.
American Academy of Pediatrics. Committee on Nutrition. Cholesterol in childhood. Pediatrics 1998; 101: 141–147.
Fischbach F . Age-dependant reference limits of several enzymes in plasma at different measuring temperatures. Klin Lab 1998; 38: 555–569.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The author has received consulting fees from Pfizer.
Rights and permissions
About this article
Cite this article
l'Allemand-Jander, D. Clinical diagnosis of metabolic and cardiovascular risks in overweight children: early development of chronic diseases in the obese child. Int J Obes 34 (Suppl 2), S32–S36 (2010). https://doi.org/10.1038/ijo.2010.237
Published:
Issue Date:
DOI: https://doi.org/10.1038/ijo.2010.237
Keywords
This article is cited by
-
Effects of an antenatal dietary intervention in women with obesity or overweight on child outcomes at 8–10 years of age: LIMIT randomised trial follow-up
BMC Pediatrics (2023)
-
BMI trajectory and inflammatory effects on metabolic syndrome in adolescents
Pediatric Research (2023)
-
Emergence of the adolescent obesity epidemic in the United States: five-decade visualization with humanoid avatars
International Journal of Obesity (2022)
-
Fibroblast growth factor 23—Klotho and hypertension: experimental and clinical mechanisms
Pediatric Nephrology (2021)
-
Association between dietary sodium, calcium, saturated fat and blood pressure in obese Egyptian adolescents
Egyptian Pediatric Association Gazette (2019)