Lo Joan C, Chandra Malini, Sinaiko Alan, Daniels Stephen R, Prineas Ronald J, Maring Benjamin, Parker Emily D, Sherwood Nancy E, Daley Matthew F, Kharbanda Elyse O, Adams Kenneth F, Magid David J, O'Connor Patrick J, Greenspan Louise C
Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
Int J Pediatr Endocrinol. 2014 Mar 3;2014(1):3. doi: 10.1186/1687-9856-2014-3.
Newer approaches for classifying gradations of pediatric obesity by level of body mass index (BMI) percentage above the 95th percentile have recently been recommended in the management and tracking of obese children. Examining the prevalence and persistence of severe obesity using such methods along with the associations with other cardiovascular risk factors such as hypertension is important for characterizing the clinical significance of severe obesity classification methods.
This retrospective study was conducted in an integrated healthcare delivery system to characterize obesity and obesity severity in children and adolescents by level of body mass index (BMI) percentage above the 95th BMI percentile, to examine tracking of obesity status over 2-3 years, and to examine associations with blood pressure. Moderate obesity was defined by BMI 100-119% of the 95th percentile and severe obesity by BMI ≥120% × 95th percentile. Hypertension was defined by 3 consecutive blood pressures ≥95th percentile (for age, sex and height) on separate days and was examined in association with obesity severity.
Among 117,618 children aged 6-17 years with measured blood pressure and BMI at a well-child visit during 2007-2010, the prevalence of obesity was 17.9% overall and was highest among Hispanics (28.9%) and blacks (20.5%) for boys, and blacks (23.3%) and Hispanics (21.5%) for girls. Severe obesity prevalence was 5.6% overall and was highest in 12-17 year old Hispanic boys (10.6%) and black girls (9.5%). Subsequent BMI obtained 2-3 years later also demonstrated strong tracking of severe obesity. Stratification of BMI by percentage above the 95th BMI percentile was associated with a graded increase in the risk of hypertension, with severe obesity contributing to a 2.7-fold greater odds of hypertension compared to moderate obesity.
Severe obesity was found in 5.6% of this community-based pediatric population, varied by gender and race/ethnicity (highest among Hispanics and blacks) and showed strong evidence for persistence over several years. Increasing gradation of obesity was associated with higher risk for hypertension, with a nearly three-fold increased risk when comparing severe to moderate obesity, underscoring the heightened health risk associated with severe obesity in children and adolescents.
最近在肥胖儿童的管理和跟踪中，推荐了根据体重指数（BMI）高于第95百分位数的百分比来对儿童肥胖等级进行分类的新方法。使用这些方法检查重度肥胖的患病率和持续性，以及与高血压等其他心血管危险因素的关联，对于确定重度肥胖分类方法的临床意义至关重要。
这项回顾性研究在一个综合医疗保健服务系统中进行，以根据BMI高于第95百分位数的百分比来确定儿童和青少年的肥胖及肥胖严重程度，检查2至3年内肥胖状况的跟踪情况，并检查与血压的关联。中度肥胖定义为BMI为第95百分位数的100 - 119%，重度肥胖定义为BMI≥第95百分位数的120%。高血压定义为在不同日期连续3次血压≥第95百分位数（根据年龄、性别和身高），并与肥胖严重程度相关联进行检查。
在2007 - 2010年一次健康儿童检查中测量了血压和BMI的117,618名6至17岁儿童中，总体肥胖患病率为17.9%，在男孩中，西班牙裔（28.9%）和黑人（20.5%）的患病率最高；在女孩中，黑人（23.3%）和西班牙裔（21.5%）的患病率最高。重度肥胖总体患病率为5.6%，在12至17岁的西班牙裔男孩（10.6%）和黑人女孩（9.5%）中最高。2至3年后获得的后续BMI也显示出重度肥胖有很强的持续性。按BMI高于第95百分位数的百分比分层与高血压风险的分级增加相关，与中度肥胖相比，重度肥胖导致高血压的几率高2.7倍。
在这个以社区为基础的儿童人群中，发现5.6%患有重度肥胖，因性别和种族/族裔而异（西班牙裔和黑人中最高），并有充分证据表明其在几年内持续存在。肥胖程度的增加与高血压风险升高相关，重度肥胖与中度肥胖相比，风险增加近三倍，突出了儿童和青少年中重度肥胖相关的更高健康风险。
