BackgroundBody Mass Index (BMI) is widely used to assess the impact of obesity on cardiometabolic risk in children but it does not always relate to central obesity and varies with growth and maturation. Waist-to-Height Ratio (WHtR) is a relatively constant anthropometric index of abdominal obesity across different age, sex or racial groups. However, information is scant on the utility of WHtR in assessing the status of abdominal obesity and related cardiometabolic risk profile among normal weight and overweight/obese children, categorized according to the accepted BMI threshold values.MethodsCross-sectional cardiometabolic risk factor variables on 3091 black and white children (56% white, 50% male), 4-18 years of age were used. Based on the age-, race- and sex-specific percentiles of BMI, the children were classified as normal weight (5th - 85th percentiles) and overweight/obese (≥ 85th percentile). The risk profiles of each group based on the WHtR (<0.5, no central obesity versus ≥ 0.5, central obesity) were compared.Results9.2% of the children in the normal weight group were centrally obese (WHtR ≥0.5) and 19.8% among the overweight/obese were not (WHtR < 0.5). On multivariate analysis the normal weight centrally obese children were 1.66, 2.01, 1.47 and 2.05 times more likely to have significant adverse levels of LDL cholesterol, HDL cholesterol, triglycerides and insulin, respectively. In addition to having a higher prevalence of parental history of type 2 diabetes mellitus, the normal weight central obesity group showed a significantly higher prevalence of metabolic syndrome (p < 0.0001). In the overweight/obese group, those without central obesity were 0.53 and 0.27 times less likely to have significant adverse levels of HDL cholesterol and HOMA-IR, respectively (p < 0.05), as compared to those with central obesity. These overweight/obese children without central obesity also showed significantly lower prevalence of parental history of hypertension (p = 0.002), type 2 diabetes mellitus (p = 0.03) and metabolic syndrome (p < 0.0001).ConclusionWHtR not only detects central obesity and related adverse cardiometabolic risk among normal weight children, but also identifies those without such conditions among the overweight/obese children, which has implications for pediatric primary care practice.

Adverse levels of non-high-density lipoprotein cholesterol versus low-density lipoprotein cholesterol in childhood not only equally persist over time and better predict adult dyslipidemia but also are related to nonlipid cardiovascular risk factors in adulthood.

OBJECTIVE -Most epidemiologic studies have focused on the adverse impact of the metabolic syndrome on cardiovascular (CV) disease. However, information on the relationship between the clustering of metabolic syndrome variables at favorable levels in childhood and the measures of CV risk in adulthood is not known. RESEARCH DESIGN AND METHODS -The study cohort included 1,474 individuals (552 blacks and 922 whites) who were examined for CV risk factors in childhood (aged 4 -17 years) and again in adulthood (aged 19 -41 years) in Bogalusa, Louisiana, during 1982Louisiana, during -2003, with an average follow-up period of 15.8 years.RESULTS -In childhood, 9.0% of the cohort displayed clustering of three-or four-criterion risk variables at the bottom quartiles of BMI, homeostasis model assessment of insulin resistance, systolic blood pressure, and total-to-HDL cholesterol ratio. The clustering was significantly higher than expected by chance alone (P Ͻ 0.01). These children, compared with those having clustering of less than three risk variables at the bottom quartiles, had a lower prevalence of metabolic syndrome in adulthood (clustering at top quartiles) (3.8 vs. 14.6%, P Ͻ 0.001). A higher prevalence of clustering of risk variables at low levels in childhood was associated with negative parental histories of coronary heart disease (9.4 vs. 5.0%, P ϭ 0.024) and hypertension (10.5 vs. 6.6%, P ϭ 0.012). Mean values of carotid intima-media thickness in adulthood decreased with an increasing number of risk variables clustering at the bottom quartiles in childhood (P for trend ϭ 0.013).CONCLUSIONS -The constellation of metabolic syndrome variables at low levels in childhood is associated with lower measures of CV risk in adulthood. Diabetes Care 28:138 -143, 2005T he metabolic syndrome, a concurrence of obesity, disturbed glucose and insulin metabolism, dyslipidemia, and hypertension, is associated with an increased risk for developing cardiovascular (CV) diseases and type 2 diabetes and an increased mortality from all causes (1-3). Most epidemiologic studies (4) have focused on the predictive value of clustering of adverse levels of these major risk variables. On the other hand, it has been reported (5,6) that people without major risk factors are at lower risk of death from CV causes, non-CV causes, and all cancers and consequently have a greater life expectancy than others in the population. The merits of having a favorable risk factor profile are even extended to lower health care costs (7).The clustering of the metabolic syndrome variables often occurs in both children and adults (2,8 -10). Although the clustering of multiple risk variables related to the metabolic syndrome has been found to persist from childhood into adulthood (11), very little is known about the relationship between the clustering of these risk variables at favorable (low) levels in childhood and the measures of CV risk in adulthood. Longitudinal data from the Bogalusa Heart Study, a communitybased investigation of CV disease risk factors beginn...

Not all obese adults have cardiometabolic abnormalities. It is unknown whether this is true in children and, if true, whether children who have metabolically healthy overweight/obesity (MHO) will also have favorable cardiometabolic profiles in adulthood. These aspects were examined in 1,098 individuals who participated as both children (aged 5-17 years) and adults (aged 24-43 years) in the Bogalusa Heart Study between 1997 and 2002 in Bogalusa, Louisiana. MHO was defined as being in the top body mass index quartile, while low density lipoprotein cholesterol, triglycerides, mean arterial pressure, and glucose were in the bottom 3 quartiles, and high density lipoprotein cholesterol was in the top 3 quartiles. Forty-six children (4.2%) had MHO, and they were more likely to retain MHO status in adulthood compared with children in other categories (P < 0.0001). Despite markedly increased obesity in childhood and in adulthood, these same MHO children and adults showed a cardiometabolic profile generally comparable to that of nonoverweight/obese children (P > 0.05 in most cases). Moreover, there was no difference in carotid intima-media thickness in adulthood between MHO children and nonoverweight/obese children. Further, carotid intima-media thickness in adulthood was lower in MHO children than in metabolically abnormal, overweight/obese children (P = 0.003). In conclusion, the MHO phenotype starts in childhood and continues into adulthood.

Clustering of long-term rates of change in metabolic syndrome variables (body mass index, homeostasis model assessment of insulin resistance, ratio of triglycerides to high-density lipoprotein cholesterol, and mean arterial pressure) from childhood to adulthood was evaluated longitudinally (1982-2003) in a cohort of 389 Blacks and 631 Whites who were examined 3-6 times both as children (ages 4-17 years) and as adults (ages 18-38 years) over an average of 16 years (3,874 observations). The incremental area under the growth curve was used as a measure of long-term rates of change in risk variables since childhood. Intraclass correlations, a measure of the degree of clustering, among the four variables were significant (p< 0.001) for childhood, adulthood, and incremental area values and were higher in adulthood than in childhood. Blacks showed a higher degree of clustering of long-term rates of change in risk variables than did Whites. Adjustment for body mass index reduced the degree of clustering by approximately 50%. These results show that metabolic syndrome variables coexist in terms not only of their levels in childhood and adulthood but also of long-term rates of change. Obesity is of critical importance in the development of metabolic syndrome, and its prevention beginning in childhood needs to be addressed.