Cardiovascular risk factors between children and adolescents with classes III and IV obesity

Obesity is associated with many cardiovascular risk factors (CVRF) such as hypertension, dyslipidemia, and impaired glucose metabolism in childhood. These CVRFs are expected to lead to premature death later in life. It has been demonstrated in a large longitudinal study over 40 years that mortality due to cardiovascular events rose with increase of body mass index (BMI) in adolescents. Many studies reported a significant relationship between degree of overweight and CVRFs in children and adolescents. This relationship is mediated by sex and age since CVRFs deteriorated during puberty and improved at the end of puberty.

There is an ongoing discussion whether a linear dose-response relationship of increasing degree of overweight on the presence of CVRFs plateaus above a certain threshold. It has been demonstrated in one previous study that children and adolescents with class III obesity as defined by 140–160% of the 95th percentile of their BMI did not differ in their CVRFs from children and adolescents with class IV obesity as defined by >160% of the 95th percentile of their BMI. This finding may have practical relevance, because indications for different treatment approaches for obesity such as medications or bariatric surgery are usually based on defined cut-off points of degree of overweight. However, large confirmatory studies are still lacking.

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