Identifying Children at Risk for Obesity, Type 2 Diabetes, and Cardiovascular Disease

Abstract

In 1998, the World Health Organization (WHO) designated obesity as a global epidemic affecting adults and children. In general, obesity is defined as the degree of somatic overweight that affords detrimental health consequences. This definition does not contemplate a specific cutoff point, but it allows health care providers to consider individual predisposition when assessing at-risk children, including underlying conditions, family history, medications, and lifestyle. Within the scientific community, the discovery of leptin and the elucidation of disorders affecting various neuroendocrine pathways and the genetic linkages of obesity have promulgated the notion that obesity is a disease. BMI is the accepted measure of obesity in children and adolescents. In childhood, comparison of BMI to normal curves for age and sex allows for categorization of BMI above the 85th percentile as overweight and above the 95th percentile as obese. In the United States, the most recent estimates of obesity prevalence are based on data from the 1999-2000 National Health and Nutrition Examination Survey (NHANES IV). 1 NHANES IV demonstrated that 20.6% of 2-to 5-year-old children in the United States were overweight. In older children, this prevalence was even higher, with 30.3% of 6-to 11-year-old children and 30.4% of adolescents (12-19 years of age) being overweight. The prevalence of obesity among children aged 0-23 months, 2-5 years, 6-11 years, and adolescents was 11.4, 10.4, 15.3, and 15.5%, respectively. This epidemic equally affects both sexes, and its prevalence has increased compared to data from the previous NHANES reports in all age ranges and racial groups. However, minorities are over-represented in this epidemic. 1 For instance, the prevalence of obesity among African-American (23.6%) and Hispanic (23.4%) adolescents is twice that among white adolescents (12.7%), and the rate of increase in the prevalence of obesity among African-American and Hispanic adolescents almost doubled between the periods 1988-1994 and 1999-2000, from 13.4 to 23.6% in African Americans and from 13.8 to 23.4% in Hispanics. Obesity has overtaken AIDS and malnutrition as the top health problem in the world. 2 Obesity markedly reduces life expectancy, especially among younger individuals. Severely obese (BMI > 45 kg/m 2) young adults have a reduced life expectancy of 5-20 years. Childhood obesity often persists into adulthood and has been independently associated with subsequent morbidity and mortality in adulthood. However, the sequelae of obesity are not limited to adulthood,

Racial Disparity in Glucagon-Like Peptide 1 and Inflammation Markers Among Severely Obese Adolescents

“…We chose AUC to estimate as a single value both magnitude and duration of the response for insulin, glucose, GLP-1 active , and GLP-1 total to glucose load over time, and only absolute concentrations were used to report fasting insulin, glucose, and GLP-1 at baseline and at 15 min. The insulinogenic index (⌬I30/⌬G30) and composite insulin sensitivity index (CISI) ϭ 10,000/ square root [(fasting insulin ϫ fasting blood glucose) ϫ (mean insulin (0 -120 min) ϫ mean glucose (0 -120 min)] were used as surrogate markers of ␤-cell function and insulin sensitivity, respectively (1). A subject's glucose tolerance status was defined on the basis of the 2007 American Diabetes Association criteria (11).…”

“…The prevalence of obesity and the rate of increase among African-American adolescents are twice as great as those among Caucasian adolescents. Type 2 diabetes in children also has increased alarmingly and is emerging as a critical health issue (1). Consequently, African-American adolescents have the highest incidence and prevalence of type 2 diabetes (2).…”

The relationship between BMI and blood pressure in children aged 7–12 years in Ankara, Turkey

“…High childhood BP predicts CVD in adulthood, and HT plus high BMI predicts even worse CVD in adulthood (15) . The risk of obesity is related to factors in the antenatal environment, the early postnatal years, the adiposity rebound (at 5-6 years of age) and puberty (16) .The relationship between HT and BMI in children has not been studied in Ankara, which is the second largest and the capital city in Turkey. We measured height, weight and BP in 2826 students, aged 7-12 years, in Ankara, Turkey.…”

The Effects of Glucose Tolerance, Hypertension, and Race on Heart Rate Variability, QT Interval Duration, and Left Ventricular Hypertrophy in Overweight-Obese Adolescents

“…Normative values for BMI vary by age and gender, making comparisons across groups difficult. However, RBMI is a continuous variable derived from BMI which provides a measure of obesity severity and is useful for tracking obesity progression and which facilitates comparison across age and sex groups (Velasquez-Mieyer, Perez-Faustinelli, & Cowan, 2005;Wang et al, 2000). Relative body mass index could prove to be beneficial for clinicians monitoring obesity in the aging child (Velasquez-Mieyer et al, 2005).…”

“…However, RBMI is a continuous variable derived from BMI which provides a measure of obesity severity and is useful for tracking obesity progression and which facilitates comparison across age and sex groups (Velasquez-Mieyer, Perez-Faustinelli, & Cowan, 2005;Wang et al, 2000). Relative body mass index could prove to be beneficial for clinicians monitoring obesity in the aging child (Velasquez-Mieyer et al, 2005). As a child ages, the amount of expected body fat changes; however, RBMI remains relatively stable as age increases (Wang et al, 2000).…”