Obesity and the Metabolic Syndrome in Children and Adolescents

Weiss, Ram; Dziura, James; Burgert, Tania S.; Tamborlane, William V.; Taksali, Sara E.; Yeckel, Catherine W.; Allen, K. Eileen; Lopes, Melinda; Savoye, Mary; Morrison, John A.; Sherwin, Robert S.; Caprio, Sonia

doi:10.1056/nejmoa031049

Cited by 2,886 publications

(2,377 citation statements)

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“…Widespread and extreme obesity are more common now (1) , combined with an obesogenic environment (9) ; so current estimates may underestimate the strength of tracking of obesity between childhood and adulthood in contemporary populations. Additionally, research has demonstrated that many obese children already manifest some metabolic complications, including impaired glucose tolerance, dyslipidaemia, hypertension, fatty liver disease and systemic low-grade inflammation (59)(60)(61) .…”

Section: Methodological Considerations: Sampling and Assessmentmentioning

confidence: 99%

Childhood obesity: the impact on long-term risk of metabolic and CVD is not necessarily inevitable

McMullen

2014

Proc. Nutr. Soc.

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The worldwide prevalence of overweight and obesity in the adult population is estimated to be 35 %. These trends are reflected in childhood obesity prevalence, and the potential impact of early-onset obesity is of great concern. The aim of this review was to investigate the long-term implications of childhood obesity for metabolic and cardiovascular health, focusing on the independent contribution of childhood obesity to adult disease risk, as distinct from associations mediated by tracking of obesity across the lifespan. The data systematically reviewed provide little evidence to suggest that childhood overweight and obesity are independent risk factors for metabolic and cardiovascular risk during adulthood. Instead, the data demonstrate that the relationships observed are dependent on tracking of BMI between childhood and adulthood, alongside persistence of dietary patterns and physical activity. Adjustment for adult BMI uncovers unexpected negative associations between childhood BMI and adult disease, suggesting a protective effect of childhood obesity at any given level of adult BMI. Further work is required to explain these findings, both in terms of pathways and statistical artefacts. To conclude, it must be stressed that it is not suggested that childhood obesity is without negative consequence. Childhood obesity is clearly associated with a range of adverse physical and psychological outcomes. However, the data are important in supporting a positive message that the long-term consequences of childhood obesity are avoidable; and that there remains opportunity for intervention across the lifespan. This nuance in understanding long-term risk is important when considering the effectiveness of interventions at different stages of the lifespan. Childhood: Obesity: Metabolic syndrome: Cardiovascular disease: Blood pressureThe worldwide prevalence of overweight and obesity in the adult population is currently estimated to be 35 %, rising to over 70 % in some population groups, with rates of obesity nearly doubling between 1980 and 2008 (1) . This is a global phenomenon, with the prevalence of overweight and obesity in low-and middleincome countries on the rise, mirroring their transition to the obesogenic environments more commonly associated with 'Western' living. The relationship between obesity and risk of non-communicable disease in adulthood has long been established, with a wealth of evidence demonstrating the considerable impact of excess adiposity on the health and wellbeing of populations (2) . The trends in adult overweight and obesity are reflected in childhood obesity prevalence, and the potential impact of early-onset obesity is of great concern. It has been estimated that 200 million school-aged children were overweight or obese in 2010 worldwide, with a prevalence of >20 % in European states and >30 % in regions of North America (3) . In the UK, the 2007 Foresight report showed that about 8-10 % of girls and boys were obese in 2004, and this was projected to rise to an estimated 25 % by 2050 (4)...

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Section: Methodological Considerations: Sampling and Assessmentmentioning

confidence: 99%

Childhood obesity: the impact on long-term risk of metabolic and CVD is not necessarily inevitable

McMullen

2014

Proc. Nutr. Soc.

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“…Search protocol Systematic database searches for abstracts and full-length manuscripts were performed on Ovid MEDLINE s (MEDL) 10,2004. Firstly, four categorical searches were conducted using the following 'keywords': (1) 'weight training,' 'strength training,' 'exercise,' 'exercise therapy,' 'weightlifting,' 'physical fitness,' or 'physical activity' (yielded 293 106 studies), (2) 'child', 'adolescent', or 'pediatrics' (yielded 1 795 359 studies), (3) 'body fat,' 'body weight,' or 'body composition' (yielded 325 759 studies) and (4) 'overweight,' 'obese' or 'obesity' (yielded 53 875 studies).…”

Section: Methodsmentioning

confidence: 99%

“…98 As in adults, excessive visceral fat (central obesity) is associated with an increased disease risk in children and adolescents, particularly for components of the 'metabolic syndrome.' [9][10][11][12][13][14] The waist circumference measure, a proxy of visceral fat, is uniformly included in the diagnosis of the 'metabolic syndrome' in both children and adults. 99 Safe and effective treatments for central obesity in youth are urgently needed, given the increasing prevalence of overweight in youth, [1][2][3][4][5] and that the prevalence of 'metabolic syndrome' in overweight children and adolescents has been reported to be as high as 29-50%, 10,13 and rising.…”

Section: Central Obesitymentioning

confidence: 99%

“…Of major concern is the growing body of evidence reporting overweight-related morbidity in childhood and adolescence, both in the psychosocial [6][7][8] and physiological domain. [9][10][11][12][13][14] Recently, the prevalence of 'metabolic syndrome' was reported to be 39 and 50% in moderate and severely obese children and adolescents, respectively, indicating higher morbidity burden with greater obesity severity. 10 Unless this trend is curtailed, obesity-related disease, disability and death worldwide is projected to increase well into the 21st century, 15 whereas life expectancy at birth and at older ages may begin to decline by the middle of the 21st century.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12][13][14] Recently, the prevalence of 'metabolic syndrome' was reported to be 39 and 50% in moderate and severely obese children and adolescents, respectively, indicating higher morbidity burden with greater obesity severity. 10 Unless this trend is curtailed, obesity-related disease, disability and death worldwide is projected to increase well into the 21st century, 15 whereas life expectancy at birth and at older ages may begin to decline by the middle of the 21st century. 16 Fundamentally, the etiology of overweight in children and adolescents, as in adults, is attributable to energy (caloric) intake in excess of energy expenditure.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of exercise for treating overweight in children and adolescents: a systematic review

2006

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Background: Overweight prevalence among children/adolescents is increasing, while adult obesity may potentially cause a decline in life expectancy. More exercise is uniformly recommended, although treatment efficacy remains unclear. Objective: To determine the efficacy of exercise alone for treating overweight in children/adolescents. Design: A systematic review and meta-analysis of randomized trials published in English were completed following multiple database searches performed on December 10, 2004. Studies of isolated or adjunctive exercise/physical activity treatment in overweight/obese children or adolescents which reported any overweight outcome were included. Literature searches identified 645 papers which were manually searched, of which 45 were considered for inclusion, of which 13 papers which reported 14 studies were included (N ¼ 481 overweight boys and girls, aged B12 years). Two reviewers independently identified relevant papers for potential inclusion and assessed methodological quality. Principal measures of effects included the mean difference (MD) (between treatment and control groups), the weighted MD (WMD), and the standardized MD (SMD). Results: Few studies were of robust design. The pooled SMD was À0.4 (À0.7, À0.1, P ¼ 0.006) for percent body fat, and À0.2 (À0.6, 0.1, P ¼ 0.07) for central obesity outcomes, whereas the pooled WMD was À2.7 kg (À6.1 kg, 0.8 kg, P ¼ 0.07) for body weight, all of which favored exercise. Pooled effects on body weight were significant and larger for studies of higher doses, whereas nonsignificant and smaller effects were seen for studies of lower doses of exercise (155-180 min/weeks vs 120-150 min/ weeks). Conclusions: Based on the small number of short-term randomized trials currently available, an aerobic exercise prescription of 155-180 min/weeks at moderate-to-high intensity is effective for reducing body fat in overweight children/adolescents, but effects on body weight and central obesity are inconclusive. Recommendations for future study designs are discussed.

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Fasting Triglyceride and the Triglyceride–HDL Cholesterol Ratio Are Not Markers of Insulin Resistance in African Americans

Sumner

Finley²,

Genovese³

et al. 2005

Arch Intern Med

196

144

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Obesity and the Metabolic Syndrome in Children and Adolescents

Abstract: The prevalence of the metabolic syndrome is high among obese children and adolescents, and it increases with worsening obesity. Biomarkers of an increased risk of adverse cardiovascular outcomes are already present in these youngsters.

Cited by 2,886 publications

References 29 publications

Childhood obesity: the impact on long-term risk of metabolic and CVD is not necessarily inevitable

Childhood obesity: the impact on long-term risk of metabolic and CVD is not necessarily inevitable

Efficacy of exercise for treating overweight in children and adolescents: a systematic review

Fasting Triglyceride and the Triglyceride–HDL Cholesterol Ratio Are Not Markers of Insulin Resistance in African Americans

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