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Two-thirds of severely obese children already have at least one heart disease risk factor, Dutch researchers found.
Of the 255 children between the ages of 2 and 18 whose cardiovascular risk factors were available, 56% had hypertension, 14% had high blood glucose, and 54% had low HDL cholesterol, according to Joana E. Kist-van Holthe, MD, PhD, from VU University Medical Center in Amsterdam, and colleagues.
"Remarkably," they said, 62% of those severely obese children ages 12 and younger already had one or more of these risk factors, they reported online in Archives of Disease in Childhood.
They defined severe obesity as a body mass index (BMI) of 20.5 kg/m2 for a 2-year-old, 31 for a 12-year-old, and 35 for an 18-year-old.
Although there is a global awareness of the increasing prevalence of obesity in children and of the cardiovascular risks associated with it, data on various categories and consequences of severe childhood obesity are lacking, the researchers noted.
But such data are important for healthcare providers and in forming public health policy "as they give an indication of the need for early detection, timely treatment, and the development of interventions for this specific group."
To that end, Kist-van Holthe and colleagues gathered data on newly diagnosed cases of severe obesity from 2005 to 2007 supplied by pediatricians in general hospitals in the Netherlands.
Of the 307 newly diagnosed cases of severe obesity, 52% were boys, and boys 12 and under tended to be heavier than their adolescent counterparts. With girls it was the opposite, as the adolescents tended to be more obese than the younger girls.
Interestingly, 40% of this severely obese cohort were of non-ethnic Dutch origin, included those of Turkish, Moroccan, and Surinamese backgrounds. The researchers said this finding is in line with other studies that showed an increased risk for obesity in these ethnic groups compared with Dutch children.
Overall, the investigators found that 67% of the children had at least one cardiovascular risk factor; 17% had at least two; 8% at least three, and 2.5% at least four.
High blood pressure was the most prevalent risk factor, occurring in more than half of all the children and in more than half of children 12 and younger.
However, boys older than 12 tended to have more risk factors than the other age and sex categories. Specifically, more older boys tended to have high triglycerides and low HDL cholesterol.
More older girls as well were reported to have low HDL cholesterol compared with those 12 and younger.
Although 14% of the entire cohort exhibited impaired fasting glucose, only two children had type 2 diabetes, the researchers reported.
"The prevalence of impaired fasting glucose in this population is worrying, considering the increasing prevalence worldwide of type 2 diabetes in children and adolescents," the authors wrote. "Likewise, the high prevalence of hypertension and abnormal lipids in these children may lead to cardiovascular disease in (young) adulthood."
Kist-van Holthe and colleagues also reported that nearly one in three of these severely obese children came from one-parent families.
The study was limited because it included only children diagnosed by a pediatrician and not those diagnosed by an internist. Another limitation is the lack of an agreed-upon definition for severe obesity, "which might explain why very few studies have reported on severely obese children."
The researchers called for "specialized pediatric obesity centers for the intensive treatment of severely obese children."
They also called for "internationally accepted criteria for defining severe obesity and guidelines for the early detection and treatment of severe obesity and comorbidity."
From the American Heart Association:
- Childhood Obesity Research Summit
- Progress and Challenges in Metabolic Syndrome in Children and Adolescents
The researchers declared they have no conflicts of interest.
- Reviewed by Dori F. Zaleznik, MD Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, BSN, RN, Nurse Planner
Archives of Disease in ChildhoodSource Reference: van Emmerik NM, et al "High cardiovascular risk in severely obese young children and adolescents" Arch Dis Child 2012; DOI: 10.1136/archdischild-2012-301877.