The metabolic syndrome and cardiometabolic risk factors in children and adolescents: Associations between different anthropometric measurements and cardiometabolic risk factors
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Introduction: The prevalence of pediatric obesity has increased worldwide during the last decades, and is currently a serious health challenge, as it causes extensive health problems in terms of cardiovascular comorbidities and premature mortality. Early detection and treatment of childhood obesity is therefore of major importance. The Body Mass Index (BMI) is most commonly used to assess adiposity. Although the BMI also is considered to be a good predictor for various adverse effects of adiposity, indicators of central obesity may have a closer link with cardiometabolic risk as the BMI does not describe fat distribution, and visceral fat causes metabolic alterations through multiple pathways. Objective: This thesis aims to determine the prevalence of the metabolic syndrome (MetS) as defined by Cook et al., and to explore the associations between anthropometric measurements (AM) and cardiometabolic risk factors in a group of severely obese children and adolescents at Haukeland University Hospital. Materials and methods: Ninety-six obese patients with BMI >IOTF 35kg/m2 or BMI>30 kg/m2 with comorbidities, aged 5-18 years were recruited from the Obesity outpatient clinic at Haukeland University Hospital in Bergen. Information was retrieved from the medical records of the participants. Prevalence of the MetS and associations between SD-scores for BMI, waist circumference (WC), waist-to-height-ratio (WHtR), and waist-to-sitting height-ratio (WSHR), and systolic/diastolic blood pressure (SBP/DBP), HDL, LDL, total cholesterol, HbA1c, ALAT, gGT and the MetS were assessed. For correlations and linear regression, blood pressure measurements were categorized according to percentiles adjusted for age, gender and height. AIC was used to compare the different regression models. All models were run with and without adjustment for age and gender. Results: The prevalence of the MetS in this group of obese children and adolescents was 36.9%. Significant moderate to weak correlations were found between all AM and SBP/DBP; and between BMI and WSHR, and markers of insulin resistance. Logistic regression models adjusted for age and gender showed that BMI, WHtR and WSHR were also significantly associated with a SBP >90th percentile, and WC with DBP. BMI was the only measurement significantly related to the MetS, and had the lowest AIC when investigating both SBP and the MetS. For DBP, WC had the lowest AIC. No significant relations were found with the other biomarkers using linear regression adjusted for age and gender. Conclusions: A relatively high prevalence of the MetS underlines the importance of screening for cardiometabolic risk factors and providing good treatment for this group of severely obese patients. Due to weak associations, AM are probably not the main factor affecting the presence of cardiometabolic risk in this group of severely obese children and adolescents except for SBP, which showed significant associations with all AM. Among the investigated AM, BMI was the best to predict cardiometabolic risk.
PublisherThe University of Bergen
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