Increasing Body Mass Index z-Score Is Continuously Associated with Complications of Overweight in Children, Even in the Healthy Weight Range

Telethon Institute for Child Health Research, Center for Child Health Research, University of Western Australia, Australia.
Journal of Clinical Endocrinology & Metabolism (Impact Factor: 6.21). 03/2007; 92(2):517-22. DOI: 10.1210/jc.2006-1714
Source: PubMed


Overweight/obesity in children is increasing. Incidence data for medical complications use arbitrary cutoff values for categories of overweight and obesity. Continuous relationships are seldom reported.
The objective of this study is to report relationships of child body mass index (BMI) z-score as a continuous variable with the medical complications of overweight.
This study is a part of the larger, prospective cohort Growth and Development Study.
Children were recruited from the community through randomly selected primary schools. Overweight children seeking treatment were recruited through tertiary centers.
Children aged 6-13 yr were community-recruited normal weight (n = 73), community-recruited overweight (n = 53), and overweight treatment-seeking (n = 51). Medical history, family history, and symptoms of complications of overweight were collected by interview, and physical examination was performed. Investigations included oral glucose tolerance tests, fasting lipids, and liver function tests.
Adjusted regression was used to model each complication of obesity with age- and sex-specific child BMI z-scores entered as a continuous dependent variable.
Adjusted logistic regression showed the proportion of children with musculoskeletal pain, obstructive sleep apnea symptoms, headaches, depression, anxiety, bullying, and acanthosis nigricans increased with child BMI z-score. Adjusted linear regression showed BMI z-score was significantly related to systolic and diastolic blood pressure, insulin during oral glucose tolerance test, total cholesterol, high-density lipoprotein, triglycerides, and alanine aminotransferase.
Child's BMI z-score is independently related to complications of overweight and obesity in a linear or curvilinear fashion. Children's risks of most complications increase across the entire range of BMI values and are not defined by thresholds.

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    • "Not only overweight/obesity but also increased body mass index (BMI) has been found to increase the risk of mental health problems. For example, research has found that increased BMI is continuously associated with complications of overweight in children, including depression, anxiety, bullying, musculoskeletal pain, headaches, and obstructive sleep apnea symptoms, even in the healthy weight range (Bell et al., 2007). These results indicate that early prevention and intervention programs for mental health problems are needed among adolescents with overweight/obesity or increased BMI. "
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    ABSTRACT: The aims of this study were to examine the mediating effect of bullying involvement on the relationships between body mass index (BMI) and mental health problems, including social phobia, depression, suicidality, and low self-esteem among adolescents in Taiwan. The moderation effect of sex on the mediating role of bullying involvement was also examined. Five thousand two hundred and fifty-two students of high schools completed the questionnaires. Victimization and perpetration of passive and active bullying were assessed using the Chinese version of the School Bullying Experience Questionnaire. BMI was calculated from self-reported weight and height measurements. The Social Phobia Inventory, the Mandarin Chinese version of the Center for Epidemiological Studies-Depression Scale, the suicidality-related questionnaire from the epidemiological version of the Kiddie-Schedule for Affective Disorders and Schizophrenia, and the Rosenberg Self-Esteem Scale were applied to assess social phobia, depression, suicidality, and low self-esteem, respectively. The mediating effect of bullying involvement on the associations between increased BMI and mental health problems was examined by the Sobel test. The moderation effect of sex on the mediating role of bullying involvement was tested by the multiple-group structural equation model. Victimization of passive and active bullying and perpetration of passive bullying, but not perpetration of active bullying, had a mediating effect on the relationships between increased BMI and all four mental health problems. Sex did not have a significant moderation effect on the mediating role of bullying involvement. Bullying involvement should be a target of prevention and intervention in developing a strategy to improve mental health among adolescents with increased BMI.
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    • "In the present study the correlation with and sensitivity of WHtR were maximal for IR and hypertension. This leads us to believe that IR is one of the earliest metabolic disturbances to arise and contributes to hypertension, stimulating sodium and water renal retention , the sympathetic nervous system and vasoconstric- tion [14]. Through IR the lypolysis is intensified in adipose tissue, creating atherogenic dyslipidemia which together with the production of cytokines by visceral adipose tissue promote inflammatory reactions and hepatic CRP synthesis [24,25]. "
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    ABSTRACT: Background Childhood obesity is a public health problem worldwide. Visceral obesity, particularly associated with cardio-metabolic risk, has been assessed by body mass index (BMI) and waist circumference, but both methods use sex-and age-specific percentile tables and are influenced by sexual maturity. Waist-to-height ratio (WHtR) is easier to obtain, does not involve tables and can be used to diagnose visceral obesity, even in normal-weight individuals. This study aims to compare the WHtR to the 2007 World Health Organization (WHO) reference for BMI in screening for the presence of cardio-metabolic and inflammatory risk factors in 6–10-year-old children. Methods A cross-sectional study was undertaken with 175 subjects selected from the Reference Center for the Treatment of Children and Adolescents in Campos, Rio de Janeiro, Brazil. The subjects were classified according to the 2007 WHO standard as normal-weight (BMI z score > −1 and < 1) or overweight/obese (BMI z score ≥ 1). Systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting glycemia, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG), Homeostatic Model Assessment – Insulin Resistance (HOMA-IR), leukocyte count and ultrasensitive C-reactive protein (CRP) were also analyzed. Results There were significant correlations between WHtR and BMI z score (r = 0.88, p < 0.0001), SBP (r = 0.51, p < 0.0001), DBP (r = 0.49, p < 0.0001), LDL (r = 0.25, p < 0.0008, HDL (r = −0.28, p < 0.0002), TG (r = 0.26, p < 0.0006), HOMA-IR (r = 0.83, p < 0.0001) and CRP (r = 0.51, p < 0.0001). WHtR and BMI areas under the curve were similar for all the cardio-metabolic parameters. A WHtR cut-off value of > 0.47 was sensitive for screening insulin resistance and any one of the cardio-metabolic parameters. Conclusions The WHtR was as sensitive as the 2007 WHO BMI in screening for metabolic risk factors in 6-10-year-old children. The public health message “keep your waist to less than half your height” can be effective in reducing cardio-metabolic risk because most of these risk factors are already present at a cut point of WHtR ≥ 0.5. However, as this is the first study to correlate the WHtR with inflammatory markers, we recommend further exploration of the use of WHtR in this age group and other population-based samples.
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    • "The association between parent and child BMI is well documented (Bell et al., 2007; Burke et al., 2001; Huus et al., 2007; Kleiser, Schaffrath Rosario, Mensink, Prinz-Langenohl , & Kurth, 2009) and concurs with our study's cross-sectional results. To our knowledge, we are the first to use longitudinal modelling to show that parent birth weight is also a significant predictor of their child's future obesity. "
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