Children's Hospital of Eastern Switzerland, St Gallen, Switzerland.
Int J Obes (Lond). 2010 Dec;34 Suppl 2:S32-6. doi: 10.1038/ijo.2010.237.
Childhood overweight (body mass index (BMI)>90th centile) poses a major public health problem in so far as adult diseases manifest themselves already during childhood. In this review, after examining the prevalence of metabolic and cardiovascular diseases, the issue of whether BMI or other clinical parameters are valid tools to predict co-morbidities in children is discussed. Data of 2001-2008 are reviewed, including several studies conducted on more than 260,000 overweight and obese children in Germany and Switzerland. Apart from non-metabolic co-morbidities, namely musculoskeletal complications and attention deficit/hyperactivity disorders in up to 74% and up to 58% of overweight children, respectively, at least one cardiovascular and metabolic risk factor was seen in 52% of the overweight children, mostly high blood pressure (35%) with increased left ventricular mass or arterial stiffness. Signs of fatty liver disease or dyslipidemia were found in up to 29 and 32% of the children, respectively. Type 2 diabetes was found in less than 0.7% of the children, and an elevated fasting glucose or glucose intolerance in 3%. Irrespective of BMI, the quality of fat and protein intake predicted hypertension or insulin resistance, and fructose predicted lower (and more atherogenic) particle size of low-density lipoprotein-cholesterol. Out of the adiposity markers, waist circumference was closely correlated with insulin resistance and the components of the metabolic syndrome. In conclusion, risk factors are found in more than half of the overweight children, most frequently high blood pressure or dyslipidemia, and were mainly related to waist circumference, but also to BMI and fat mass. Even in the presence of normal BMI, screening for cardiovascular risk factors is advocated in each child with elevated waist circumference, but its cut-off points still remain to be validated. The increased occurrence of orthopedic and psychiatric complaints may detrimentally influence health-related lifestyle and obesity therapy.
儿童超重（身体质量指数（BMI）>第 90 百分位数）是一个主要的公共卫生问题，因为成年疾病已经在儿童时期表现出来。在这篇综述中，在检查了代谢和心血管疾病的流行情况之后，讨论了 BMI 或其他临床参数是否是预测儿童合并症的有效工具的问题。审查了 2001-2008 年的数据，包括在德国和瑞士进行的几项研究，涉及超过 260,000 名超重和肥胖儿童。除了非代谢合并症，即肌肉骨骼并发症和注意力缺陷/多动障碍，分别在多达 74%和 58%的超重儿童中，至少有一个心血管和代谢危险因素见于 52%的超重儿童中，主要是高血压（35%）、左心室质量增加或动脉僵硬。高达 29%和 32%的儿童分别出现脂肪肝或血脂异常的迹象。儿童中不到 0.7%患有 2 型糖尿病，3%患有空腹血糖升高或葡萄糖耐量降低。无论 BMI 如何，脂肪和蛋白质摄入的质量都可以预测高血压或胰岛素抵抗，而果糖则可以预测 LDL-胆固醇的粒径降低（更具动脉粥样硬化性）。在肥胖标志物中，腰围与胰岛素抵抗和代谢综合征的成分密切相关。总之，超过一半的超重儿童存在危险因素，最常见的是高血压或血脂异常，这些主要与腰围有关，但也与 BMI 和脂肪量有关。即使 BMI 正常，也提倡对每个腰围升高的儿童进行心血管危险因素筛查，但仍需验证其切点。骨科和精神科投诉的增加可能会对健康相关的生活方式和肥胖治疗产生不利影响。
