Knowing the changes of cardiovascular risk factors (CRF) in relation to weight loss would be helpful to advise overweight children and their parents and to decide whether drugs should be prescribed in addition to lifestyle intervention.
To determine the BMI-SDS reduction to improve CRFs in overweight children.
Prospective observation study.
Specialized outpatient obesity clinic.
1388 overweight children (mean BMI 27.9±0.1, mean age 11.4±0.1years, 43.8% male, 45.5% prepubertal).
1-year lifestyle intervention.
Main outcome measures:
We studied changes of blood pressure (BP), fasting HDL-, LDL-cholesterol, triglycerides, glucose, and insulin resistance index HOMA. Change of weight status was determined by delta BMI-SDS based on the recommended percentiles of the International Task Force of Obesity.
BMI-SDS change was associated with a significant improvement of all CRFs except fasting glucose and LDL-cholesterol after adjusting for multiple confounders such as baseline CRF, age, gender, BMI, pubertal stage and its changes. BMI-SDS reduction ≥0.25-0.5 was related to a decrease of systolic BP (-3.2±1.4mmHg), diastolic BP (-2.2±1.1mmHg), triglycerides (-6.9±5.8mg/dl), HOMA (-0.5±0.3), and triglyceride/HDL-cholesterol (-0.3±0.2), while HDL-cholesterol increased (+1.3±1.2mg/dl). A reduction of >0.5 BMI-SDS led to more pronounced improvement (systolic BP -6.0±1.3mmHg, diastolic BP -5.1±1.3mmHg, triglycerides -16.4±7.1mg/dl, HDL-cholesterol +1.6±1.5mg/dl, HOMA -0.9±0.3). Per 0.1 BMI-SDS reduction systolic BP (-1.0mmHg), diastolic BP (-0.8mmHg), triglycerides (-2.3mg/dl), HOMA (-0.2), and triglyceride/HDL-cholesterol (-0.5), decreased significantly, while HDL-cholesterol (0.2mg/dl) increased significantly in linear regression analyses accounted for multiple confounders.
A BMI-SDS reduction ≥0.25 improved significantly hypertension, hypertriglyceridemia and low HDL-cholesterol, while a BMI-SDS >0.5 doubled the effect.