Obesity in childhood is discussed to be associated with hypertension, dyslipidemia, impaired glucose metabolism, and chronic inflammation. It has not yet been studied in obese children which of these cardiovascular risk factors are related to intima media thickness (IMT), a noninvasive marker for early atherosclerotic changes. We collected the clinical data (age, sex, pubertal stage, percentage of body fat, SD score of body mass index [SDS-BMI]) and measured systolic blood pressure [SBP] and diastolic blood pressure [DBP], triglycerides [TGs], high- and low-density lipoprotein cholesterol, glucose, insulin, and high-sensitivity C-reactive protein [hsCRP]) in 96 obese children (median age, 11 years). The control group was composed of 25 nonobese children of the same age, sex, and pubertal stage. We determined the carotid IMT of all the patients by B-mode ultrasound with a 14-MHz linear transducer. Obese children demonstrated a significantly (P < .001) thicker intima media (median, 0.6 mm) as compared with the control group (median IMT, 0.4 mm). IMT was significantly correlated to the SDS-BMI (r = 0.38, P < .001), percentage of body fat (r = 0.39, P < .001), SBP (r = 0.39, P < .001) and DBP (r = 0.29, P = .002), glucose (r = 0.30, P = .001), and hsCRP levels (r = 0.29, P = .002). In stepwise backward multiple linear regression analysis, IMT correlated significantly to BMI (r2 = 0.05, P = .044), SBP (r2 = 0.15, P = .013), glucose (r2 = 0.05, P = .028), and hsCRP (r2 = 0.07, P = .005). Because IMT is increased in obese children, vascular changes in obesity seem to occur already in childhood. These changes are related to the cardiovascular risk factors of obesity, especially hypertension, chronic inflammation, and impaired glucose metabolism.

Intima media thickness in childhood obesity: Relations to inflammatory marker, glucose metabolism, and blood pressure

Although randomized controlled trials demonstrated the long-term efficacy of lifestyle interventions in overweight children, the effects of these interventions in clinical practice under real-life conditions are largely unknown. One hundred twenty-nine centers specialized in outpatient pediatric obesity care participated in this quality assessment. All patients presenting before the year 2006 for lifestyle intervention of at least 6 months duration in these institutions were analyzed in a 2-year follow-up. A total of 21,784 (45% male) overweight children and adolescents aged 2-20 years (mean BMI 30.4 kg/m2, mean SDS-BMI 2.51, mean age 12.6 years) were included in the analysis. Based on an intention-to-treat analysis with variables set back to baseline in lost of follow-up, 22% of the children reduced their SDS-BMI after 6 months, 15% after 12 months, and 7% after 24 months, but only in 24, 17, and 8% of children, respectively, complete data were available. In the five treatment centers with the best outcome (518 patients), 83% of the children reduced their overweight after 6 months, 67% after 12 months, and 51% after 24 months. Under real-life conditions, most treatment centers cannot prove the long-term efficacy of their interventions due to high drop-out rate or lack of documentation. Conversely, some institutions achieved a reduction of overweight in nearly the half of their patients 24 months after baseline demonstrating the great heterogeneity in outcome. To improve the effectiveness of lifestyle interventions in real-life studying, the process and structure quality as well as their long-term results is urgently needed.

https://onlinelibrary.wiley.com/doi/pdf/10.1038/oby.2009.17

Two-year Follow-up in 21,784 Overweight Children and Adolescents With Lifestyle Intervention

Aim: The prevalence of overweight and obesity in children is a public health problem because of future morbidity However, the prevalence of medical complications in overweight and obese primary school children in Australia is not well documented As part of the larger, prospective cohort Growth and Development Study, this report aimed to identify the medical complications of obesity in a population-based community sample of primary school-aged children

Methods:  Two groups of primary school children were studied: a random community sample of overweight/obese children (not seeking treatment) and a matched community sample of normal weight children Demographics, medical history, family history and symptoms of complications of overweight were collected Children had a physical examination, oral glucose tolerance tests with insulins, fasting lipid profiles and liver function tests

Results:  Data from 283 children are presented (61–134 years, mean 98 years) There were no differences in birth data, family composition, parental age or socio-economic status between groups Overweight and obese children were more likely to complain of musculoskeletal pain, depression, anxiety and bullying, and had more adverse examination findings than control children They also had more abnormal investigations: overweight children: impaired glucose tolerance (IGT) 13%, hyperinsulinism 195%, dyslipidaemia 638%, raised alanine transaminase (ALT) 90%; obese children: IGT 53%, hyperinsulinism 389%, dyslipidaemia 737%, raised ALT 316%

Conclusion:  Overweight and obese primary school-aged children have significant medical complications of their weight status Overweight children, in addition to obese children, should be screened for complications A secondary finding is a high proportion of normal weight children with lipid levels outside desirable healthy ranges

High incidence of obesity co‐morbidities in young children: A cross‐sectional study

Childhood obesity: concept, feasibility, and interim results of a local group-based, long-term treatment program.

The aim of this study was to determine the prevalence of hypertension in overweight or obese pediatric subjects using different national or international references, which are based either on the entire population or on normal weight children only: 188 centers from Germany, Austria, and Switzerland participated in the Adipositas Patienten Verlaufsbeobachtung initiative. Data from 57,915 children aged 6 to 18 years who are overweight or obese were used to determine the prevalence of prehypertension and hypertension based on Second Task Force, European pooled data, Fourth Report all and Fourth Report nonoverweight, or German Health Interview and Examination Survey for Children and Adolescents (KiGGS) references. Three references included overweight children, whereas 2 (Fourth Report nonoverweight and KiGGS) were based on nonoverweight children only. Based on KiGGS, Fourth Report nonoverweight, Fourth Report all, European pooled data, or Second Task Force, the prevalence of hypertension was 47%, 42%, 36%, 32%, and 27%, respectively. Recent references classified more children as hypertensive, whereas fewer children fell into the prehypertensive group. Only 22% of children were classified as hypertensive by each of the 5 references (8% as prehypertensive). The prevalence of normal blood pressure was independent of the reference applied. Hypertension as defined by the different reference systems was significantly correlated, and all methods were significantly associated with impaired glucose metabolism or dyslipidemia, without significant differences in methods. In conclusion, the diagnosis of elevated blood pressure depends on the reference population used. A nonoverweight reference population substantially increases the prevalence of hypertension in children and adolescents who are overweight or obese. The choice of the reference has significant implications for risk stratification and treatment decisions.

Blood Pressure in 57,915 Pediatric Patients Who Are Overweight or Obese Based on Five Reference Systems

So far in Europe, no studies have been pub- lished on the structuring of medical care for obese chil- dren and adolescents. Besides anthropometric parameters, evaluations of the cardiovascular risk factors hypertension, dyslipidaemia, impaired glucose metabolism and treatment modalities were documented in a standardised multicentre evaluation survey (APV) of 18 primarily outpatient and nine rehabilitation insti- tutions. In total, 3837 children (aged 2-20 years) took part in the years 2000 up to March 2003, of whom 1985 were treated in outpatient institutions and 1852 in rehabilitation institutions. Of these children, 10% were overweight, 37% obese, 49% extremely obese and 4% of normal weight at initial presentation. The frequencies of diagnostic procedures performed and documented were low (measurement of blood pressure 43%, lipids 40%, glucose metabolism 21%). In the subgroup of obese children who were screened for cardiovascular risk factors, 23% suffered from hypertension, 11% displayed increased cholesterol, 9% increased low-density lipo- protein-cholesterol, 29% increased triglycerides, 11% decreased high-density lipoprotein-cholesterol and 6% had impaired glucose metabolism. Conclusion: Despite the high prevalence of cardiovascular risk factors in obese children and adolescents confirmed in this report, diagnostic procedures failed in a considerable percentage even in specialised treatment centres for obese children and adolescents. In future, the feedback based on stan- dardised evaluation of diagnostic and treatment proce- dures should aim to improve the quality of medical care.

APV: a standardised multicentre documentation derived to study initial presentation and cardiovascular risk factors in patients transferred to specialised treatment institutions

So far in Europe, no studies have been published on the structuring of medical care for obese children and adolescents Besides anthropometric parameters, evaluations of the cardiovascular risk factors hypertension, dyslipidaemia, impaired glucose metabolism and treatment modalities were documented in a standardised multicentre evaluation survey (APV) of 18 primarily outpatient and nine rehabilitation institutions In total, 3837 children (aged 2–20 years) took part in the years 2000 up to March 2003, of whom 1985 were treated in outpatient institutions and 1852 in rehabilitation institutions Of these children, 10% were overweight, 37% obese, 49% extremely obese and 4% of normal weight at initial presentation The frequencies of diagnostic procedures performed and documented were low (measurement of blood pressure 43%, lipids 40%, glucose metabolism 21%) In the subgroup of obese children who were screened for cardiovascular risk factors, 23% suffered from hypertension, 11% displayed increased cholesterol, 9% increased low-density lipoprotein-cholesterol, 29% increased triglycerides, 11% decreased high-density lipoprotein-cholesterol and 6% had impaired glucose metabolism Conclusion: despite the high prevalence of cardiovascular risk factors in obese children and adolescents confirmed in this report, diagnostic procedures failed in a considerable percentage even in specialised treatment centres for obese children and adolescents In future, the feedback based on standardised evaluation of diagnostic and treatment procedures should aim to improve the quality of medical care

Medical care of obese children and adolescents. APV: a standardised multicentre documentation derived to study initial presentation and cardiovascular risk factors in patients transferred to specialised treatment institutions.

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APV: a standardised multicentre documentation derived to study initial presentation and cardiovascular risk factors in patients transferred to specialised treatment institutions

Medical care of obese children and adolescents. APV: a standardised multicentre documentation derived to study initial presentation and cardiovascular risk factors in patients transferred to specialised treatment institutions.