Background Adiposity in childhood has been associated with increased cardiovascular risk which may be established in childhood and adolescence. Also centrally distributed fat (waist circumference) has been suggested to be a better marker of cardiometabolic risk compared to body mass index (BMI). We aimed to assess the association of adiposity measures with cardiometabolic outcomes in children and consider if the magnitude of these associations differ by adiposity measurement.
Methods European cohorts with data available on BMI and waist circumference and cardiometabolic outcomes (at least blood pressure) were invited to participate in the collaborative project. Cross-sectional associations between adiposity measures (age- and gender-standardised z scores) and cardiometabolic outcomes and prospective associations (cardiometabolic outcomes measured at least 12 months after adiposity measurement) were examined. Results from individual cohorts were pooled using a random-effect meta-analysis and heterogeneity between them explored.
Results A total of 13 cohorts (n=3644–17186 for different outcomes) were included in the cross-sectional analysis. BMI and waist circumference were both positively associated with diastolic and systolic blood pressure (DBP, SBP) and with total cholesterol, LDLc, triglycerides, insulin and CRP, with the magnitudes of association with each outcome being similar for BMI and waist. For example, the mean difference in DBP per standard deviation (SD) increase in BMI was 0.90 mmHg (95% confidence intervals (CI) 0.55, 1.24) and per SD waist was 0.73 mmHg (95%CI 0.33, 1.12); similar results for SBP were 1.73 mmHg (95%CI 1.28, 2.18) and 1.33 mmHg (95%CI 0.83, 1.81). In prospective analysis (6 cohorts, n=3708–7073 for different outcomes) BMI and waist circumference were positively associated with SBP and total cholesterol and inversely with HDLc associations were similar for the two adiposity measurements or were stronger for BMI. For example a 1SD greater BMI was associated with 1.36 mmHg higher SBP (95%CI 0.67, 2.05) compared with 0.96 mmHg (95% CI 0.35, 1.57) for waist. Direct measurements of fat mass, such as DXA or bioelectrical impedance, did not exhibit stronger associations with risk factors than did BMI. Age at adiposity measurement did not consistently influence the heterogeneity of association between studies.
Conclusion Adiposity in childhood and adolescence is associated with adverse cardiometabolic outcomes. This suggests that interventions should be considered earlier before adverse effects become established. The magnitude of the association is similar between BMI, waist circumference and direct measures of adipostiy. Therefore BMI alone could be considered an adequate measure in public health and health surveillance systems.
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