Ebrahim Nia, Khadegi Apruva, Deng Shuliang, Qian Kun, Yao Zonghui, Thaker Shaleen, May Benjamin, Patibandala Nandan, Lopez-Pintado Sara, Thaker Vidhu V
Institute of Human Nutrition, Columbia University, New York, NY, 10032, USA.
Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA.
Int J Obes (Lond). 2025 Jul 17. doi: 10.1038/s41366-025-01836-z.
Persistence of childhood adiposity is known to be associated with long-term adverse cardiometabolic risks. Yet, cross-sectional body mass index (BMI) is often used to classify obesity in clinical care and research. This study aimed to develop and validate a childhood BMI classification system using real life longitudinal clinical data.
This observational study used electronic health record data from a tertiary care hospital, with replication in an independent cohort. For individuals with ≥ 3 BMI measurements, the median BMI percentile and persistence in the obesity class were used for longitudinal classification. The association between longitudinal BMI class and early onset obesity, socioeconomic status (SES), and adverse cardiometabolic risk was analyzed.
Height, weight, and cardiometabolic risk measures were obtained for 22,352 children from 2014-18 in the primary cohort and 24,444 children in the replication cohort. Obesity (BMI ≥ 95 percentile [BMI]) was observed in 24.1% and severe obesity (BMI ≥ 120% of BMI) in 10.6%. Individuals with early onset obesity (age ≤ 6 years) remained in the same or higher obesity class; those in the high-SES group had lower odds of obesity. The proportion of individuals with cardiometabolic risk increased with obesity severity (p-value 0.01 - < 0.001). The AUC for cardiometabolic risk by longitudinal BMI class was higher compared to that for cross-sectional BMI (80.0% vs. 75.8%, p < 0.001).
The Longitudinal BMI classification may better reflect long-term cardiometabolic risk in children. This classification can be useful for focused intervention strategies and for profiling of individuals for genetic testing.
已知儿童肥胖的持续存在与长期不良心脏代谢风险相关。然而，在临床护理和研究中，横断面体重指数（BMI）常被用于肥胖分类。本研究旨在利用真实生活中的纵向临床数据开发并验证一种儿童BMI分类系统。
这项观察性研究使用了一家三级医疗医院的电子健康记录数据，并在一个独立队列中进行了重复验证。对于有≥3次BMI测量值的个体，使用BMI百分位数中位数和肥胖类别中的持续性进行纵向分类。分析了纵向BMI类别与早发性肥胖、社会经济地位（SES）和不良心脏代谢风险之间的关联。
在主要队列中，2014 - 2018年期间为22352名儿童获取了身高、体重和心脏代谢风险指标，在重复队列中为24444名儿童获取了相关指标。观察到肥胖（BMI≥第95百分位数[BMI]）的发生率为24.1%，重度肥胖（BMI≥BMI的120%）的发生率为10.6%。早发性肥胖（年龄≤6岁）的个体仍处于相同或更高的肥胖类别；高SES组的个体肥胖几率较低。心脏代谢风险个体的比例随肥胖严重程度增加（p值为0.01 - <0.001）。纵向BMI类别预测心脏代谢风险的曲线下面积（AUC）高于横断面BMI（80.0%对75.8%，p<0.001）。
纵向BMI分类可能更好地反映儿童的长期心脏代谢风险。这种分类对于有针对性的干预策略以及对个体进行基因检测的特征分析可能有用。
