Cardiovascular risk factors in overweight German children and adolescents: Relation to gender, age and degree of overweight

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Summary

Objective

So far in Europe, no large studies have been published on the frequencies of the cardiovascular risk factors hypertension and dyslipidaemia in overweight children.

Methods

Diagnosis of hypertension, decreased HDL-cholesterol, increased triglycerides, total and LDL-cholesterol were documented for 1004 overweight children and adolescents (aged 4–8 years, 52% girls, BMI-SDS in median 2.43) referred to four obesity centres. Hypertension and dyslipidaemia were defined by cut off points above the 95th percentile of healthy children. Multivariate linear regression was conducted for the dependent variables systolic and diastolic blood pressure, triglycerides, HDL-, LDL-, and total cholesterol, including gender, degree of overweight (SDS-BMI) and age as independent variables.

Results

Thirty-seven percent of the children studied suffered from hypertension, 27% displayed increased total cholesterol, 26% increased LDL-cholesterol, 20% increased triglycerides and 18% decreased HDL-cholesterol. Seventy percent of all children had at least one unfavourable cardiovascular risk factor. Hypertension and dyslipidaemia were observed in any age group and in any degree of overweight at least twofold above the suspected rate of 5%. SDS-BMI was significantly related to blood pressure (systolic: coefficient 7.26, p<0.001, diastolic: coefficient 3.21, p<0.001), weakly to triglycerides (coefficient 0.12, p=0.007), slightly negatively to HDL-cholesterol (coefficient −0.06, p=0.001) and not related to total and LDL-cholesterol. Age was positively related to blood pressure (systolic: coefficient 2.436, p<0.001, diastolic: coefficient 0.54, p<0.001) and negatively to HDL cholesterol (coefficient −0.02, p<0.001).

Conclusion

Cardiovascular risk factors were frequently present in a large collective of overweight European children and adolescents. They occurred mostly independently of age, gender and degree of overweight. Therefore, screening for cardiovascular risk factors seems meaningful at any age and degree of overweight in childhood.

Introduction

The worldwide increasing prevalence of obesity in childhood and adolescence poses an ever-increasing problem [1]. The relation between obesity and coronary artery disease is mediated by adverse changes of serum lipids and blood pressure levels [2], [3], [4], [5] rather than obesity being an independent cardiovascular disease risk factor variable [6].

Some obese subjects are characterised by hypertension, reduced high-density-lipoprotein (HDL) cholesterol, increased total cholesterol, low-density-lipoprotein (LDL) cholesterol and triglycerides [7]. Despite the prevalence of obesity in childhood, the atherogenic risk factors in paediatric obesity have been studied in only one large study from North America [8].

In order to (1) address the prevalence of hypertension and dyslipidaemia in a European country and (2) to assess the relationships between these cardiovascular risk factors and age, gender and degree of overweight, over 1000 overweight, obese and extreme obese German children were studied.

Section snippets

Study population

Clinical data (age, gender, degree of overweight) and cardiovascular risk factors of all non-syndromal overweight children and adolescents in four centres for obesity in Germany (Children's Hospital, Murnau; Insula Clinic, Berchtesgaden; Department of Pediatrics, University of Ulm; and Vestische Kinder- und Jugendklinik Datteln, University of Witten-Herdecke) were collected in the time period of 1999–2002. All these children and adolescents were referred to the centres because of their

Results

A total of 1004 overweight children and adolescents aged 4–18 years (52% girls, age in median 12.0 years, interquartile range 9.8–13.8 years) were studied. Fifteen percent of these children were overweight (BMI>90 percentile), 40% obese (BMI>97 percentile) and 45% extreme obese (BMI >99.5 percentile). The BMI was in median 28.2 kg/m2 (interquartile range 25.4–31.8 kg/m2) and SDS-BMI was in median 2.43 (interquartile range 2.07–2.79).

LDL-, HDL-cholesterol and triglyceride levels were

Discussion

This is the first study of a large cohort of predominantly Caucasian overweight and obese children and adolescents in Europe to address the frequencies of cardiovascular risk factors. The results of our study demonstrate that hypertension and dyslipidaemia are frequently present in overweight children. Seventy percent of all overweight children studied demonstrated at least one unfavourable cardiovascular risk factor.

The children of our study were referred to specialised obesity clinics. This

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