Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Witten, Germany.
German Center for Diabetes Research, Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.
Int J Obes (Lond). 2021 May;45(5):1061-1073. doi: 10.1038/s41366-021-00773-x. Epub 2021 Apr 7.
Obesity is associated with many cardiovascular risk factors (CVRF) in childhood. There is an ongoing discussion whether there is a linear relationship between degree of overweight and deterioration of CVRFs justifying body mass index (BMI) cut-offs for treatment decisions.
We studied the impact of BMI-SDS on blood pressure, lipids, and glucose metabolism in 76,660 children (aged 5-25 years) subdivided in five groups: overweight (BMI-SDS 1.3 to <1.8), obesity class I (BMI-SDS 1.8 to <2.3), class II (BMI-SDS 2.3-2.8), class III (BMI-SDS > 2.8-3.3), and class IV (BMI-SDS > 3.3). Analyses were stratified by age and sex.
We found a relationship between BMI-SDS and blood pressure, triglycerides, HDL cholesterol, liver enzymes, and the triglycerides-HDL-cholesterol ratio at any age and sex. Many of these associations lost significance when comparing children with obesity classes III and IV: In females < 14 years and males < 12 years triglycerides and glucose parameters did not differ significantly between classes IV and III obesity. Prevalence of dyslipidemia was significantly higher in class IV compared to class III obesity only in females ≥ 14 years and males ≥ 12 years but not in younger children. In girls < 14 years and in boys of any age, the prevalences of type 2 diabetes mellitus did not differ between classes III and IV obesity.
Since a BMI above the highest BMI cut-off was not associated consistently with dyslipidemia and disturbed glucose metabolism in every age group both in boys and girls, measurements of CVRFs instead of BMI cut-off seem preferable to guide different treatment approaches in obesity such as medications or bariatric surgery.
肥胖与儿童时期的许多心血管危险因素（CVRF）有关。目前正在讨论超重程度与 CVRF 恶化之间是否存在线性关系，从而证明体重指数（BMI）切点用于治疗决策是合理的。
我们研究了 BMI-SDS 对 76660 名儿童（年龄 5-25 岁）的血压、血脂和葡萄糖代谢的影响，这些儿童被分为五组：超重（BMI-SDS 1.3 至<1.8）、肥胖 I 级（BMI-SDS 1.8 至<2.3）、肥胖 II 级（BMI-SDS 2.3-2.8）、肥胖 III 级（BMI-SDS>2.8-3.3）和肥胖 IV 级（BMI-SDS>3.3）。分析按年龄和性别分层。
我们发现，在任何年龄和性别中，BMI-SDS 与血压、甘油三酯、高密度脂蛋白胆固醇、肝酶以及甘油三酯-高密度脂蛋白胆固醇比值之间均存在关系。当比较肥胖 III 级和 IV 级的儿童时，许多这些关联失去了意义：在女性<14 岁和男性<12 岁时，III 级和 IV 级肥胖之间的甘油三酯和葡萄糖参数没有显著差异。只有在女性≥14 岁和男性≥12 岁时，IV 级肥胖的血脂异常患病率显著高于 III 级肥胖，但在年龄较小的儿童中并非如此。在女性<14 岁和任何年龄的男孩中，III 级和 IV 级肥胖之间的 2 型糖尿病患病率没有差异。
由于在每个年龄组的男孩和女孩中，BMI 超过最高 BMI 切点并不总是与血脂异常和葡萄糖代谢紊乱相关，因此，测量 CVRF 而不是 BMI 切点似乎更适合指导肥胖的不同治疗方法，如药物治疗或减肥手术。
