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Original Investigation |

Origin of Cardiovascular Risk in Overweight Preschool Children:  A Cohort Study of Cardiometabolic Risk Factors at the Onset of Obesity

Blegina Shashaj, MD, PhD1; Giorgio Bedogni, MD2; Maria P. Graziani, MD3; Alberto E. Tozzi, MD1; Maria L. DiCorpo, MD3; Donatella Morano, MD3; Ludovica Tacconi, MD3; Patrizio Veronelli, MD3; Benedetta Contoli, PhD1; Melania Manco, MD, PhD1
[+] Author Affiliations
1Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
2Clinical Epidemiology Unit, Liver Research Center, Area Science Park, Trieste, Italy
3Federazione Italiana Medici Pediatri, Rome, Italy
JAMA Pediatr. 2014;168(10):917-924. doi:10.1001/jamapediatrics.2014.900.
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Importance  To date, the relationship among adiposity, insulin resistance, and cardiovascular risk factors at the onset of overweight or obesity has been unexplored.

Objectives  To assess whether insulin resistance and metabolic abnormalities are detectable at the onset of obesity and to unravel the interplay among adiposity, insulin resistance, and other such abnormalities.

Design, Setting, and Participants  The Origin of Cardiovascular Risk in Overweight Preschool Children cohort study aimed to evaluate at the onset of obesity in preschool children the prevalence of metabolic abnormalities, including hypertension, dyslipidemia, impaired carbohydrate metabolism, and nonalcoholic fatty liver disease. Between July 1, 2011, and July 30, 2012, in the Rome municipality, 13 family pediatricians enrolled healthy children (age range, 2.0-5.8 years) in the study during their routine practice of growth monitoring. Clinical medical records of 5729 children were reviewed; 597 children manifested new-onset overweight or obesity as their body mass index changed from normal weight to overweight or obesity in the previous 12 months according to the International Obesity Task Force classification. Of them, 219 were studied.

Main Outcomes and Measures  Patients with new-onset overweight or obesity underwent clinical laboratory testing, including oral glucose tolerance test, and ultrasonographic investigations of fatty liver and intimal medial thickness of the common carotid arteries, subcutaneous adipose tissue, and visceral adipose tissue. The homeostatic assessment model algorithm–insulin resistance was calculated.

Results  Among the entire population (n = 5729), overweight increased from 7.0% at 2.0 years to 16.9% at 5.8 years, with corresponding figures of 1.1% to 2.9% for obesity. In total, 597 overweight or obese children (10.4%) were identified, and 219 of them (36.7%) were studied. Among the latter, 86 patients (39.3%) had at least 1 metabolic abnormality. Hypertension was diagnosed in 29 patients (13.2%), dyslipidemia in 55 patients (25.1%), impaired fasting glucose level in 7 patients (3.2%), and glucose intolerance in 6 patients (2.7%). Nonalcoholic fatty liver disease was diagnosed in 68 patients (31.1%).

Conclusions and Relevance  Cardiometabolic risk factors, including fatty liver, are detectable in preschoolers at the onset of overweight or obesity, despite short-term exposure to excess weight and reduced insulin sensitivity. Our findings suggest the need to screen for cardiometabolic abnormalities at an earlier age than is now recommended.

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Figure.
Age-Adjusted Probability of Body Mass Index According to the International Obesity Task Force Classification

Values are point estimates (95% CIs) obtained from a proportional odds logistic regression with cluster CIs.

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