Predictors of Metabolic Risk in Childhood Obesity

Abstract

Most of the complications of juvenile obesity are due to metabolic disturbances induced by an excessive accumulation of fat which leads to chronic diseases like type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Finding effective ways of identifying obese paediatric patients who are at increased risk of developing cardiovascular and metabolic complications has been recognised to be a promising strategy to improve prevention of complications of early obesity. Moreover, correctly identifying obese children who are already affected by metabolic co-morbidities should be a clinical priority. According to the state of the art summarised in this review, traditional metabolic variables included in the definitions of metabolic syndrome (MS), pre-diabetes, non-alcoholic fatty liver disease (NAFLD)/non-alcoholic steato-hepatitis and, in obese girls, the presence of polycystic ovary syndrome are the best available longitudinal predictors of CVD and T2DM among obese children and adolescents. In clinical practice, traditional metabolic variables included in the definitions of MS should be assessed in all obese children and adolescents; fasting metabolic variables have been proposed to identify obese patients likely to be affected by impaired glucose tolerance or T2DM, and ultrasound has proved to be a valid surrogate for biopsy in the diagnosis of NAFLD. Further large longitudinal and cross-sectional studies are needed to improve our chances of identifying obese youth at the highest metabolic risk.

A weighty matter: Identification and management of overweight and obesity in adolescents

“…[1] However, obese adolescents who revert to normal adiposity have the same risk of developing diabetes, hypertension and dyslipidaemia in adulthood as those who were never obese. [11] Therefore, it is essential that this condition be diagnosed early and managed holistically to ensure a successful outcome. This is particularly relevant in view of the increasing prevalence of adolescent obesity in SA.…”

“…[10] There are other measures of overweight and obesity that do not use weight and height in adolescents, which may add value in defining visceral fat and body composition; however, few have paediatric norms while others are expensive or impractical in clin ical practice. [4,8] Although BMI and waist circumference are highly correlated and the associations with visceral adiposity are of similar magni tudes, [11] reference cut points for waist circumference in adolescents that identify risk beyond that provided by BMI category are not available. [5] The cheapest but least reproducible is the measurement of skinfold thickness using calipers; this is therefore not recommended in routine clinical care.…”

“…[4,11] Cardiometabolic abnormalities and the metabolic syndrome are common with overweight and obesity, even during adolescence, and the appropriate cut points for diagnosis in the adolescent population are presented in Table 4.…”

Acantosis nigricans is associated with risk factors related to cardiovascular disease in Mexican children with obesity

“…This phenomenon affects children as well as adults and is associated with the premature onset of chronic uninfectious diseases. In fact, some diseases before found only in adults, such as diabetes mellitus type 2 (DM-2) and high blood pressure, in some cases now appear very early in life (1,2).…”

“…Indeed, 50% of children who are obese at 6 years of age and 80% of obese adolescents remain obese in adulthood (4,5). These children and adolescents also have a greater probability of early onset metabolic disorders (e.g., dyslipidemia, insulin resistance, glucose intolerance and DM-2), some types of cancer, degenerative cardiovascular disease, dermatological/neurological/endocrine disorders, as well as alterations in the respiratory system, gastrointestinal tract and locomotor apparatus (6,7). All of these disorders involve, to a greater or lesser extent, a shorter life expectancy and a lower quality of life, and all are for the most part preventable (8).…”