Cardiovascular morbidity, diabetes and cancer risk among children and adolescents with severe obesity

Abstract

Severe obesity among children and adolescents is a significant global public health concern. The prevalence has markedly increased over the last decades, becoming common in many countries. Overwhelming rates of obesity among youth have prompted efforts to identify an evidence-based immediate- and long-term cardiometabolic risk factor profile in childhood-onset severe obesity, and to highlight gaps that require further investigation. The PubMed database was systematically searched in accordance with PRISMA guidelines. The search yielded 831 results, of which 60 fulfilled stringent criteria and were summarized in this review. The definition of severe obesity was variable, with only one half the publications using the definition BMI > 120% of the 95th percentile. Point estimates of the prevalence of at least one cardiometabolic risk factor in children with severe obesity reportedly range from 67 to 86%. Cross-sectional studies indicate that children and adolescents with severe obesity are at greater risk than those with mild obesity for type 2 diabetes, hypertension, fatty liver disease and dyslipidemia, already at childhood and adolescence. Robust epidemiological data on the long-term risk and actual point estimates in adulthood are lacking for these diseases as well as for other diseases (coronary heart disease, stroke, chronic kidney disease and cancer). Recent longitudinal studies indicate an increased risk for cardiomyopathy, heart failure, cardiovascular mortality and all-cause mortality in adulthood for adolescents with severe obesity compared to those with mild obesity. Given the alarming increase in the prevalence of severe obesity, the persistence of adiposity from childhood to adulthood and the precarious course of young adults with chronic comorbidities, the economic and clinical services burden on the healthcare system is expected to rise.

COVID-19 and obesity in childhood and adolescence: a clinical review

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History of lower-limb complications and risk of cancer death in people with type 2 diabetes

“…The risk of cancer increased in people with cardiovascular disease as did the risk of cardiovascular disease in cancer patients [20]. Only few studies have evaluated the risk for cancer death according to vascular complications in people with diabetes, and have reported inconsistent findings [21][22][23]. As far as we are aware, the relationship between lower-limb complications and cancer death has not been investigated in patients with diabetes.…”

Adolescent BMI and early-onset type 2 diabetes among Ethiopian immigrants and their descendants: a nationwide study

“…Severe obesity in childhood is a risk factor for cardiovascular morbidity [ 6 ], and among children in the US, BMI at baseline preceded higher insulin levels at follow-up during childhood, with blacks and whites showing similar patterns of this one-directional relationship [ 7 ]. Immigrants from low- and middle-income countries including those of African and other ancestries have been shown to have a disproportionately high risk for type 2 diabetes, which may be evident at a lower body-mass index (BMI) [ 8 ].…”