The utility of the international child and adolescent overweight guidelines for predicting coronary heart disease risk factors

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Abstract

The purpose of this study was to assess the association between the international overweight cutoffs for children and youth and coronary heart disease risk factors. The sample included 410 boys and 337 girls 9–18 years of age from the Québec Family Study. Participants were classified as normal weight or overweight using the international BMI cutoffs, and into normal and elevated risk groups based on the 90th percentile of sex-specific age-adjusted risk factors [blood pressure, fasting total cholesterol (CHOL), LDL-C, HDL-C, CHOL/HDL-C, triglycerides, glucose, and physical work capacity]. Overweight participants had between 1.6 and 9.1 times the risk of elevated risk factors compared to normal-weight participants. Further, boys and girls with four or more risk factors were 19 and 43 times more likely to be overweight, respectively, compared to participants with no risk factors. The results add evidence that the international cutoffs are related to health risks in youth, supporting the adoption of the guidelines.

Introduction

Adulthood obesity is associated with an increased risk of premature mortality and a host of chronic metabolic disorders and diseases [1]. The health risks associated with childhood obesity have received less attention; however, obese children have an elevated risk of developing dyslipidemia, high blood pressure, hyperinsulinemia, gall bladder disease, orthopedic problems, sleep apnea, and several social and psychologic problems [2], [3]. A recent study has estimated that the economic burden of treating obesity-related disorders in youth was approximately $125 million/year in the United States during 1997–1999, a figure that has more than tripled over the last 20 years [4]. Obese children also have an elevated risk of remaining obese as an adult [5] and suffering from metabolic disorders in adulthood [3], [6], making the prevention of childhood obesity a public health priority.

In many studies, obesity is defined using the body mass index (BMI, kg/m2). The most recent guidelines for the classification of adulthood overweight and obesity were devel-oped by the World Health Organization (WHO) [7] and U.S. National Institutes of Health (NIH) [1]. Among adults, overweight is defined as having a BMI between 25 and 29.9 kg/m2, and obesity is defined as having a BMI⩾30 kg/m2. These guidelines are health related and were established from the relationships between BMI and various health outcomes [1], [7].

Among children and youth, several criteria have been used in the past for the classification of overweight and obesity. Until recently, the recommended approach was to use the smoothed BMI percentiles from the first U.S. National Health and Nutritional Examination Survey (NHANES I, 1971–1974) published by Must et al. [8]. Using this strategy, children and youth between the 85th and 95th percentiles were classified as being “at risk of overweight” and those ⩾95th percentile were “overweight” [9]. However, different investigators have used different cutoffs from local or national reference data from around the world for the classification of overweight and obesity among children and youth [10].

The use of different childhood BMI cutoffs by different investigators can lead to confusion in the literature, a topic that has been recently addressed [11], [12], [13]. It was recently recommended that an international classification system be established for the identification of overweight and obese children and youth [14]. These reference data have been published by Cole and colleagues [15], and several investigators have subsequently published prevalence studies using them [16], [17], [18], [19], [20]. The new childhood BMI cutoffs are statistically linked to the adult health-related cutoffs of 25 and 30 kg/m2; however, there is currently no evidence that the childhood guidelines are associated with an increased health risk in childhood. Thus, the purpose of this study was to evaluate the utility of the new childhood guidelines for the classification of overweight in the prediction of coronary heart disease (CHD) risk factors.

Section snippets

Design and participants

The design of the Québec Family Study (QFS) has been described in detail elsewhere [21]. The original design of the QFS was a population-based family study of French-Canadians, which assures a certain degree of genetic homogeneity. The present sample includes 410 boys and 337 girls 9–18 years of age from Phase I of QFS (1980), who were recruited from the greater Québec City area through the local media (radio, television, flyers). Given that the participants are from a family study, some of the

Results

The descriptive characteristics of the sample are presented in Table 1. The mean ages of the boys and girls were 13.6 y and 13.8 years, respectively, and ranged from 9 to 18 years in both boys and girls. Table 2 presents the results of the ANCOVAs, controlling for age, comparing risk factors among normal weight and overweight children and youth. In boys, HDL-C and PWC150 were significantly lower and CHOL/HDL-C, GLY, SBP, and DBP were significantly higher in the overweight group compared to the

Discussion

The results indicate that the new international overweight guidelines are useful in predicting CHD risk factors in chil-dren and youth. Overweight boys have between 1.6 and 5.7 times the risk of having elevated risk factors compared to normal weight boys, and overweight girls have between 1.6 and 9.1 times the risk of having elevated risk factors compared to normal weight girls, as defined in this study. This is the first study, to our knowledge, that has explicitly tested the utility of the

Acknowledgements

This research was supported by the Heart and Stroke Foundation of Ontario (#T 4946). The Québec Family Study was supported over the years by the Fonds pour la Recherche en Santé du Québec (FRSQ), Fonds pour la Formation de Chercheurs et l'Aide à la Recherche du Québec (FCAR), Health Canada, and the Medical Research Council of Canada. It is currently supported by the Canadian Institutes for Health Research. Claude Bouchard was funded, in part, by the George A. Bray Chair in Nutrition, and

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