Obesity Degree and Cardiometabolic Risk among School Students. Egypt.

Transcription

1 Life Science Jounal 2012;9(3) Obesity Degee and Cadiometabolic Risk among School Students Nayea E Hassan 1, Saha A El-Masy 1, Manal A. Mohsen 2, Safaa T. Zaki 2, Eman Elashmawy 2, Muhammad Al- Tohamy Soliman 1, Mehevan M. Abd El-moniem 3 1 Biological Anthoology, 2 Child Health and 3 Medical Biochemisty Deatments, National Reseach Cente, Caio, Egyt. masysa@yahoo.com Abstact: Rationale: Childhood obesity is a isk facto fo develoing cadio metabolic diseases in adulthood. Objective: Studying the association of cadio metabolic isk factos in students (7-16 yeas) with diffeent degees of obesity. Methods: Coss-sectional study including 169 student: 72 obese [body mass index (BMI) > 95 th ecentile] and 97 extemely obese (BMI > 97 th ecentile) fo age and gende based on Egytian Gowth Refeence Chats. Inteelationshi between isk factos evalence: hyetension, high waist cicumfeence (WC), imaied fasting glucose, hyeinsulinieamia, insulin esistance, and dysliideamia (abnomal TC, LDL-C, HDL-C, and tiglyceide), accoding to age gous and degee of obesity wee assessed. A set of cadio metabolic isk factos wee defined fo each individual, anging fom 0 (no isk factos) to 9 (all isk factos). Results: In younge age gou (7-11 yeas), extemely obese students wee oven to have highe fequencies of cadio metabolic isk factos in comaison to obese gou, with highly significant diffeences egading fasting glucose level and WC. Olde students aged yeas ecoded insignificant diffeences in the fequency of cadio metabolic isk factos between obese and extemely obese ones. Fo both age gous, elevated total and LDL-Cholesteol wee significantly linked to distubances of cabohydate metabolism; indicated by fasting glucose level. Highly significant ositive inteelationshis between WC and tiglyceides fo childen, and diastolic blood essue fo adolescents wee detected. Among extemely obese students, 81% of younge and 60% of olde had a cluste of at least thee isk factos o moe in comaison to only 56.7% and 48.7% of obese. Conclusion: Cadio metabolic isk factos ae associated with degee of obesity in young age (7-11 yeas), but not in those aged yeas. Elevated tiglyceides ae the most common isk factos in both age gous. [Nayea E Hassan, Saha A El-Masy, Manal A. Mohsen, Safaa T. Zaki, Eman Elashmawy, Muhammad Al-Tohamy Soliman, Mehevan M. Abd El-moniem. Obesity Degee and Cadiometabolic Risk among School Students. Life Sci J 2012;9(3): ]. (ISSN: ).. 40 Key wods: Obesity; isk factos; childen, adolescents. 1. Intoduction: Oveweight and obesity ae an imotant isk facto fo cadiovascula diseases. Although the clinical manifestations of these diseases occu in adulthood, studies have demonstated that comobidities such as dysliidemias, hyetension and insulin esistance may be esent in childhood and adolescence ( Botton et al, 2007), and ae esonsible fo the inceased isk of mobidity and motality in adulthood (Bake et al, 2007; Bekowitz, 2010). In Egyt, as in othe ats of the wold, the obesity eidemic affects a gowing numbe of childen and adolescents (El-Masy, 2007, Shaaban et al, 2008). The study of Jackson et al (2003) among female adolescents showed that 35 % of the gils wee oveweight and 13 % wee obese. In the final eot of Diet, Nutition and Pevention of Chonic non communicable diseases in Egytian Adolescents (DNPCNCD, 2008), it was found that about 20.5% of the adolescents wee eithe oveweight o obese with highe evalence among uban than ual and females comaed to males. Few studies coelating obesity with cadiovascula isk factos have been conducted among adolescents in develoing counties, aticulaly in Egyt (Hassan et al, 2011a, b). Howeve, accoding to the Wold Health Oganization s eot (WHO 2006), childen and adolescents fom low socioeconomic levels ae as exosed to obesity and cadiovascula isk factos as thei ees fom high socioeconomic levels. Fo the develoment of moe efficient clinical evention and intevention ogams, studies tageted at this oulation ae necessay. In fact, obesity-elated diseases may deend on the ethnic o genetic backgound. Theefoe, studies including Egytian childen and adolescents with obesity of all degees ae necessay to examine the effects of adiosity on health in this age gou and its association with cadio metabolic isk factos. The aims of this study ae: 1). to detemine whethe the evalence of obesity-elated isk factos in Egyt is as high as eoted fo othe ats of the wold; 2) to examine whethe a clusteing of seveal isk factos occus; and 3) to exloe the ediction of single and multile comobidities by the degee of obesity as defined by BMI adjusting fo otential confoundes as age. 2. Subjects and methods: 293

2 Between Octobe 2007 and Ail 2009, 5798 students (2655 boys and 3143 gils), with age ange 7-16 yeas, wee studied in a coss-sectional suvey fo evaluation of oveweight and obesity. These students wee ecuited fom 6 ublic schools (two Pimay Schools, two eaatoy and two seconday schools) situated in Giza govenoate. Pemission to efom the study was ganted by the Ministy of Education, and the diectos of the school included in the eseach. Paents wee infomed about the uose of the study and thei emission in the fom of witten consent was obtained. Anothe assent was taken fom the students to be involved in this eseach. The otocol was aoved by the Ethical Committee of the National Reseach Cente. The ageement efeence numbe is 07/091. Of the total samle, fou hunded and sixty-two students only (8.0%) comlaint of obesity; 174 boys and 288 gils; thei mean age was yeas, 26.4 % aged 7 11 yeas and 73.6% aged yeas. Obese students wee excluded if they had a io majo illness, including tye 1 o 2 diabetes, took medications o had a condition known to influence body comosition, insulin action o insulin secetion (e.g. glucocoticoid theay, hyothyoidism and Cushing s disease). All oveweight students efused to aticiate. Of the obese students eligible to the study, infomed consent and assent wee only obtained fom the aents of 169 students fo the laboatoy data; 72(45 boys and 27 gils), wee defined obese (with body mass index (BMI) equal to o geate than the 95 th - 97 th ecentile fo age and gende based on the Egytian Gowth Refeence Chats (Ghali et al, 2008) and 97 (28 boys and 69 gils) as extemely obese (with BMI highe than the 97 th ecentile). Data of BMI ecentiles, waist cicumfeence (WC), blood essue (BP), fasting liids and glucose wee collected. Each student subjected to a simle questione as ast histoy of chonic diseases, assessment of socioeconomic status; and a comlete hysical examination, including anthoometic measues. The height was measued to the neaest 0.5 cm using a Holtain otable anthoomete, and the weight was detemined to the neaest 0.1 kg using a Seca scale Balance with the subject dessed minimum clothes and no shoes. Body mass index (BMI) was calculated as weight (in kilogams) divided by height (in metes) squaed. Waist cicumfeence was measued at the level of the umbilicus with subject standing and beathing nomally, using non-stetchable lastic tae to the neaest 0.1 cm. Each measuement was taken as the mean of thee consecutive measuements, using standadized equiments and following the ecommendations of Intenational Biological ogammes (Hienaux and Tanne, 1969). Blood essue was measued with a standad mecuy shygmomanomete afte the subjects had ested at least 10 min. Systolic blood essue was ecoded at 294 the aeaance of sounds, and the diastolic blood essue was ecoded at the disaeaance of sounds. The blood essue measuement was eeated fo 3 consecutive days, if it was high to be sue fom the diagnosis of hyetension. Venous blood samles wee obtained to measue lasma glucose, lasma insulin levels and liid ofile in the moning by veniunctue afte ovenight fasting. Plasma glucose was detemined by the glucose oxidase method. Plasma insulin was measued using ELIZA immunoassay (DRG Diagnostic Poducts Cooation, Los Angeles, CA). Plasma concentations of total cholesteol and tiglyceides wee estimated in seum by using caloimetic assay kit oduced by P.Z. comay, Lublin, Poland. High-density liooteincholesteol (HDL-C) was detemined in seum by using caloimetic assay kits oduced by Stanbio laboatoy, Boene, Texas. Low-density liootein-cholesteol (LDL-cholesteol) was calculated as follows: LDL = Total cholesteol HDL = TG. 5 WC was consideed high if > 90 th ecentile fo age and sex. BP elated to age and sex was consideed elevated if systolic o diastolic blood essue above the 90 th ecentile of Egytian efeence anges (Zaki et al, 2006). Dysliideamia (abnomal liid levels) wee defined accoding to the Ameican Heat Association (Gundy et al, 2004) as follows: total cholesteol (TC) >210 mg/dl, high-density liootein (HDL-C)- cholesteol <40 mg/dl, low-density liootein (LDL- C)-cholesteol > 130 mg/dl, o tiglyceides (TG) >110 mg/dl. Any one elevated level out of the following was classified fo Imaied cabohydate metabolism accoding to modified WHO citeia adated fo childen (1999); imaied fasting glucose toleance>6.1 mmol/l, hyeinsulinieamia was defined fom noms fo age: 7-11 yeas> 15 mu/l; and yeas>30 mu/l; insulin esistance is defined as the levels of the HOMA-IR geate than 3.16, accoding to Keskin et al (2005). HOMA-IR (The homeostatic model assessment fo insulin esistance) was calculated as follow: HOMA-IR= fasting insulin (µu/ml) x fasting glucose (mmol/l)/22.5. Statistical analysis Statistical analyses wee caied out with calculations of the ootions of students exosed to diffeent isk factos: hyetension, high WC, imaied fasting glucose, hyeinsulinieamia, insulin esistance, and dysliideamia (abnomal TC, LDL-C, HDL-C, tiglyceide), in the obese and in the extemely obese gous, with the esective odds atios (OR) and 95% confidence intevals (CI).Inteelationshi between isk factos evalence accoding to the age gous wee assessed by chi-squae test. Data was examined by one

3 samle Kolmogoov-Sminov Z test fo nomal distibution, which evealed that the data was not nomally distibuted. So, bivaiate Seaman s coelation tests wee used to examine the association between contibuting isk factos. Vaiables with significant associations only ( < 0.05) in the bivaiate analysis wee included in the coelation tests. Finally, a set of cadiovascula isk factos was defined as the numbe of conditions esent in each individual, anging fom 0 (absence of all conditions) to 9 (esence of all the conditions mentioned).the evalence of combination of multile isk factos was examined also. Statistical significance was taken as < All statistical analyses wee efomed using the Statistical Package fo Social Sciences (SPSS/Windows Vesion 16.0, SPSS Inc., Chicago, IL, USA). 3. Results: Accoding to BMI, 42.6% wee obese, thei BMI >95 th u to 97 th ecentile, and 57.4 % wee extemely obese, thei BMI > 97 th ecentile. Gils esented somewhat moe fequently (56.8%) than boys (43.2%). In site of insignificant diffeences in the age of boys and gils (mean age of boys , while that fo gils ), gils had highe degee of obesity (71.9% of gils wee extemely obese) than boys (38.4%), while obesity; BMI between 95 th -97 th ecentile; was moe ominent in boys (61.6%) than gils (28.1%), namely that gils tended to be extemely obese than boys (table 1). Insignificant sex diffeences wee obseved in both age gous; 7-11 and fom 12 to 16 yeas; egading WC, BP and all the laboatoy data. So, the analysis was comleted without sex diffeentiation. The fequencies and odds atios(or) with esective 95% confidence intevals fo the vaiables of cadiovascula isk factos in elation to BMI degee in the two age gous ae esented in tables 2 and 3. In the younge age gou (7 to 11 yeas), extemely obese students wee oven to have highe fequencies of abnomal tiglyceides and fasting glucose levels, hyetension and high WC in comaison to the obese gou, with highly significant diffeences egading fasting glucose level and WC. Waist cicumfeence > 90 th ecentile was ecoded in 91.9% (cude OR = 7.16).The fequency of abnomal glucose levels was 35.1% (cude OR = 7.85). Hyetension was esent in 27.0% of extemely obese (cude OR=7.0). Aoximately 78% of the extemely obese students had high tiglyceide levels (cude OR = 1.99). Howeve, in the olde students aged yeas (table 3), insignificant diffeences in the fequency of diffeent vaiables of cadiovascula isk factos between the obese and extemely obese students wee ecoded. Table 1: Fequency distibution of the samle BMI>95 BMI >97 Boys Gils Boys Gils Total N (%) N (%) N (%) N (%) N (%) 7 11 yeas 20 (29.4) 11(16.2) 12(17.6) 25(36.8) 68(40.2) yeas 25(24.8) 16 (15.8) 16(15.8) 44(43.6) 101(59.8) Total 45(26.6) 27 (16.0) 28 (16.6) 69 (40.8) 169 (100.0) Table 2: Fequencies (%) and odds atio (OR) with thei esective 95% confidence intevals (CI) fo the vaiables elated to cadiovascula isk factos in childen aged 7-11 yeas using Chi- squae test Vaiables BMI>95 BMI >97 Cude OR (95% CI) P N yes N yes N % N % WC > 90th ecentile ( ) Glucose >6.1 mmol/l ( ) Insulin > 15 mu/l ( ) HOMA > ( ) Tiglycide>110 mg/dl ( ) TC > 210 mg/dl ( ) HDL-C<40 mg/dl ( ) LDL-C > 130 mg/dl ( ) Hyetension SBP> 90th ecentile ( ) DBP> 90th ecentile ( ) Cadiovascula isk factos 1 CV isk CV isk CV isk

4 Table 3: Fequencies (%) and odds atio (OR) with thei esective 95% confidence intevals (CI) fo the vaiables elated to cadiovascula isk factos in childen aged yeas using Chi- squae test Vaiables N BMI>95 N BMI >97 P yes yes Cude OR N % N % (95% CI) WC > 90th ecentile ( ) Glucose >6.1 mmol/l ( ) Insulin > 15 mu/l ( ) HOMA > ( ) Tiglycide> ( ) TC > 210 mg/dl ( ) HDL-C<40 mg/dl ( ) LDL-C > 130 mg/dl ( ) Hyetension SBP> 90th ecentile ( ) DBP> 90th ecentile ( ) Cadiovascula isk factos 1 CV isk CV isk CV isk Table 4: Inteelationshis between advese cadiovascula isk factos by Seaman coelation test. Risk factos Waist Cicumfeence Fasting glucose level 7-11 yeas yeas 7-11 yeas yeas SBP DBP Tiglyceides Total cholesteol HDL LDL Insulin level HOMA ** ** * * * * * ** ** Figue 1: Pevalence of cadiovascula isk factos 296

5 Fequency distibution of cadiovascula isk factos is shown in Tables 2, 3 and Figue 1. Six students only had no isk factos: 4 obese students aged 7-11 yeas, and 2 students aged yeas (1 obese and 1 extemely obese). Of the extemely obese students, 81% of younge students aged 7-11yeas and 60% of olde ones aged yeas had a cluste of at least thee isk factos o moe in comaison to only 56.7% and 48.7% of the obese students. The most common association of 2 isk factos in both age gous was elevated tiglyceides and deceased HDL-C. In case of existence of 3 isk factos o moe, high WC, elevated tiglyceides and LDL-C wee the common associations in the young age (7-11 yeas), while elevated tiglyceides, total cholesteol and deceased HDL- wee the common association in the olde students (12 16 yeas). Inteelations between CV isk factos using Seaman s coelation test evealed highly significant ositive inteelationshis between waist cicumfeence and tiglyceides in young age gou (7-11 ys), and diastolic BP fo olde age gou (12 16 ys). Elevated total cholesteol and LDL-cholesteol wee each significantly linked to distubances of cabohydate metabolism; indicated by fasting glucose level; in both age gous. Moeove, inceased tiglyceides deceased HDL-C and elevated insulin level wee also significantly associated with inceased fasting glucose level in olde students aged yeas (Table 4). 4. Discussion: Although the clinical symtoms of cadiovascula diseases occu in adulthood, the atheoscleotic ocess stats in childhood, and obesity is one of its main deteminants (McMahan et al, 2006). The esence of cadiovascula isk factos including dysliidemia, hyetension and abnomal baseline insulin levels chaacteizes the metabolic syndome (Agibasil et al, 2006; Lottenbeg et al, 2007; Sun et al, 2008). This study included 169 school students suffeing fom vaious degee of obesity. The association between the degee of obesity and cadio-metabolic isk factos was investigated. Desite the highe evalence of obesity among gils (56.8%) than boys (43.2%), yet the WC, BP and all the laboatoy data wee simila fo both sexes as thee wee insignificant sex diffeences. This coincided with evious studies (Jackson et al, 2003, El-Masy, 2007; Shaaban et al, 2008 Hassan et al, 2011) which ecoded highe evalence of obesity among gils comaed to boys. Results evealed that obese childen and adolescents had advese CV isk factos, which elated to degee of obesity in childen only and not in adolescents. Extemely obese childen wee oven to have highe fequencies of high waist cicumfeence (91.9%), abnomal tiglyceides (78.4%), high fasting glucose levels (35.1%) and hyetension (27.0%) 297 comaed with obese ones (61.3%, 64.5%, 6.5% and 3.2% esectively). Extemely obese childen wee found to have nealy 7 fold (times) isk fo having high WC and fasting glucose levels than obese ones, and the diffeences wee highly significant. Howeve, in adolescents, diffeences in the fequency of cadiovascula isk factos between the obese and extemely obese students wee minimal and insignificant. These esults coincide with the evious studies (Steinbege and Daniels, 2003; Wannamethee et al,. 2005; Kohli and Geenland 2006; Saland, 2007) which concluded that high levels of body mass index among childen and adolescents has been eoted to be associated with abnomal levels of liids, insulin, blood essue and all comonents of the metabolic syndome. Othe lage eidemiologic studies (Suk et al, 2003; Wang et al, 2005; Yusuf et al, 2005) stessed on the imotance of WC in edicting cadio metabolic isk factos and thei advese outcomes (e.g., diabetes, CHD, and death ate). They attibuted that to the finding that the body fat distibution; mainly excess abdominal fat (also known as cental o ue-body fat) is an imotant isk facto fo obesity-elated diseases. Howeve, ecise measuement of abdominal fat content equies the use of exensive adiological imaging techniques. Theefoe, waist cicumfeence (WC) is often used as a suogate make of abdominal fat mass, because WC coelates with abdominal subcutaneous and intaabdominal fat mass, and is associated with cadio metabolic disease isk (Pouliot et al, 1994)). Feedman et al (1999) in the Taiei Childen Heat Study, eoted a significant elation between obesity and high fasting glucose level. While Geiss et al (2001) in Koean childen and adolescents ecoded that fasting glucose concentations did not incease accoding to the incease in weight status. Liteatue eviews oved that adiosity leads to inceased tiglyceides in obese childen (Baanowski et al, 2006; Weiss et al, 2004). Chu et al (1998) have shown a stong elationshi between tiglyceides and obesity (OR 7.1 ( )) among US childen. The same was ecoded by Weiss et al (2004) and Kim et al (2006) among the obese childen of Cental Euoean studies. Reineh et al (2005a, b) demonstated in a longitudinal study that hyeinsulineamia may be the cental abnomality in obese childen and adolescents, and this contibutes to dysliideamia. The hysiological mechanism suggested fo this ocess is that the intaabdominal fat has a high and intense metabolic activity, emitting the tiglyceide deots concentated in this egion to be moe easily mobilized to the blood steam, thus leading to an inceased oduction of fee-fatty acids and LDL-c in the live (Bjönto 1997). The esent study showed that extemely obese adolescents aged yeas (69.6%) had maked

6 loweing of the HDL-cholesteol concentation comaed to obese ones (48.7%). They wee found to have a 2 times isk fo having low concentations of HDL-C than obese ones. On the othe hand, the fequency of having low HDL-C was nealy simila concening the younge age gou aged 7 to 11 yeas (56.7% of obese childen and 54% of extemely obese ones). Howeve, the diffeences wee insignificant fo both age gous. Pevious studies of Weiss et al (2004) and Baanowski et al (2006) oved that adiosity leads to makedly loweed HDL-cholesteol concentations. As obseved in the geneal oulation, HDL-cholesteol concentations ae loweed by ubety o age >12 yeas, most obably caused by inceasing andogens (Bao et al, 1996; Williams et al, 2002) o educed hysical inactivity (Akeblom et al, 1999) Results of this study ecoded that obese (50%) and extemely obese childen (40.5%) had high fequency of elevated LDL- C than obese (32.5%) and extemely obese (31%) adolescents. This coincided with Moison et al (2003) who concluded that ubetal obese adolescents had a lowe obability of elevated LDL-cholesteol concentations, which was exlained by the incease of estadiol concentations both with ubety and adiosity, even in male subjects. Insite of that, the esent study detected that LDLcholesteol level was vey weakly elated with the degee of obesity fo both studied childen (OR 0.68( )) and adolescents (OR 0.94( )). This finding suots evious obsevations that LDLcholesteol is not elated to BMI o to the metabolic syndome (Baanowski et al, 2006; Kim et al, 2006; Weiss et al, 2004). Howeve, Feedman et al (1999) in oulation based studies; and aticulaly in younge childen; ecoded the effect of BMI on LDLcholesteol. Ove the ast decade, BP in childen inceased substantially (Fod et al, 2004; Muntne et al, 2004) and was associated with the concuent incease of body weight (Couch and Daniels 2005), even as ealy as in 2- to 5-yea-old childen in a study of Falkne et al ( 2006) in a imay cae setting. Iesective of the effects of obesity, elevated BP in childhood is edictive of sustained hyetension and taget-ogan damage in young adulthood ( Soof et al, 2003; Vos et al, 2003; Lande et al, 2006). The National Health and Nutition Examination Suvey (NHANES) on childen and adolescents, inceased obesity; esecially abdominal obesity indicated by WC; was obseved to exlain at of the tendency to elevated blood essue levels, because thee is an association between hyetension and hyeinsulinism (WHO 2006). The evalence of elevated BP in the esent study was oughly simila in both extemely obese childen (27%) and adolescents (28%), but highe comaed with obese childen (3%) and adolescents (16%). Shae et al 298 (2006) found that diastolic hyetension was moe often elevated than systolic. Anothe imotant obsevation in this study was the clusteing of 2 o moe CV isk factos, being closely associated with the degee of excess weight. The most common association of 2 isk factos in both age gous was elevated tiglyceides and deceased HDL-C. In case of clusteing of 3 isk factos o moe, the most evalent was elevated tiglyceides level fo both obese and extemely obese students which wee associated with high WC and LDL-C in young childen, and imaied total cholesteol and HDL-C, in adolescents (12-16 yeas). Simila esults wee eoted in evious studies (Weiss et al, 2004; Baanowski et al, 2006). A clusteing of thee o moe advese CV isk factos has been shown to be the most sevee obesityelated health hazad. This is suoted by the obsevation that thee is a close inteaction between inceased tiglyceides, BP, and imaied cabohydate metabolism. Tiglyceide-induced insulin esistance and hyeinsulinemia may be the common athohysiological link between these aametes, but the exact natue of the elation between inceased fat mass, insulin esistance, and ateial hyetension in childen emains unclea (Sinaiko et al. 2002). The esent study demonstated that distubances of cabohydate metabolism; indicated by fasting glucose level; was significantly associated with the deceased HDL-cholesteol and insulin level in adolescents aged yeas, and with elevated total cholesteol and LDL-cholesteol in both childen and adolescents. These esults ae consistent with many othe studies as dysliidemia is well documented in olde childen and adults who ae obese (Boyd et al, 2005; Reineh et al, 2005), and associations have been found between seum fasting insulin concentations and seum liids in 2 3-y-old Hisanic childen (Shea et al, 2003). A significant ositive coelation between waist cicumfeence and diastolic BP fo adolescents only was detected also in the esent study. This comes in ageement with the Geman study of Reineh et al (2005), who found that the degee of body mass index coelates ositively with diastolic hyetension. Obesity tacks fom childhood to adulthood, and childhood adiosity is a stong edicto of obesity, insulin esistance (Steinbege et al, 2001), and abnomal liids in adulthood (Sinivasan et al, 1996). Moeove, the ate of incease in adiosity duing childhood was significantly elated to the develoment of cadiovascula isk in young adults (Sinaiko et al, 1999). Howeve, BMI only accounts fo 60% of the vaiance of insulin esistance in adults (Abbasi et al, 2002), which suggests that othe factos ae imotant. It has been eoted that a tansient insulin-esistant state occus in childen duing nomal ubetal

7 develoment (Caio et al, 1989; Moan et al, 1999). Studies with euglycemic insulin clams have shown that insulin esistance inceases at the beginning of ubety, eaks at mid ubety, and etuns to neaeubetal levels by the end of ubety (Moan et al, 1999). The incease in gowth homone, sex homone, and insulin-like gowth facto-1 levels that occus duing ubety is thought to be the cause of this fom of insulin esistance (Moan et al, 2002). Thus the insulin level in childen and adolescents is influenced not only by the obesity degee but also by the nomal incease in gowth homone, sex homone, and insulinlike gowth facto-1 levels that occus duing nomal ubetal develoment. In summay: This study evealed that obese childen and adolescents did show advese cadio metabolic isk factos. The most evalent isk facto was elevated tiglyceides level which wee associated with imaied cabohydate metabolism, as well as with insulin esistance, hyetension and high waist cicumfeence. Conclusion: Cadio metabolic isk factos tend to cluste, being closely associated with the degee of excess weight,; aticulaly in young childen. Thus a comehensive sceening is cucial fo all obese childen and adolescents to identify cadio metabolic isk factos as ealy as ossible aimed at educing mobidity and motality in adulthood. Fo the develoment of moe efficient clinical evention and intevention ogams, studies tageted at this oulation ae necessay. Evaluation of the nutitional status is, theefoe, essential in the clinical actice, aiming at detecting and eventing obesity and the associated cadio metabolic isk factos. Changes in lifestyle by encouaging hysical activities and an adequate balanced diet ae key stategies fo maintaining healthy weight. Coesonding autho Saha A El-Masy Biological Anthoology Deatments, National Reseach Cente, Caio, Egyt masysa@yahoo.com Refeences 1. Abbasi F, Bown BW J, Lamendola C, McLaughlin T, Reaven GM. Relationshi between obesity, insulin esistance, and coonay heat disease isk. J Am Coll Cadiol 2002; 40: Agibasil M, Caki S, Ozme S, Ciliv G. Metabolic syndome in Tukish childen and adolescents. Metabolism 2006; 55 (8): Akeblom HK, Viikai J, Raitakai OT, et al. Cadiovascula isk in Young Finns Study: geneal 299 outline and ecent develoments. Ann Med 1999; 31(sul 1): Bake JL, Olsen LW, Soensen TI. Childhood body-mass index and the isk of coonay heat disease in adulthood. N Engl J Med 2007; 357 (23): Bao W, Sinivasan SR, Beenson GS. Pesistent elevation of lasma insulin levels is associated with inceased cadiovascula isk in childen and young adults. The Bogalusa Heat Study. Ciculation 1996; 93: Baanowski T, Cooe DM, Haell J et al. Pesence of diabetes isk factos in a lage U.S. eighth-gade cohot. Diabetes Cae 2006; 29: Bekowitz I. Cadiovascula Diseases ae killing us. The Official Bulletin of the intenational academy of cadiovascula science 2010; 9 (1): Bjönto P. Body fat distibution, insulin esistance, and metabolic diseases. Nutition 1997; 13 (9): Botton J, Heude B, Kettaneh A, Boys JM, Lommez A, Besson JL, et al. Cadiovascula isk facto levels and thei elationshis with oveweight and fat distibution in childen: the Fleubaix Laventie Ville Santé II study. Metabolism 2007; 56 (5): Boyd GS, Koeinigsbeg J, Falkne B, Gidding S, Hassink S. Effect of obesity and high blood essue on lasma liid levels in childen and adolescents. Pediatics 2005; 116: Caio S, Plewe G, Diamond M, Simonson DC, Boulwae SD, Shewin RS, Tambolane WV. Inceased insulin secetion in ubety: a comensatoy esonse to eductions in insulin sensitivity. J Pediat 1989; 114: Chu NF, Rimm EB, Wang DJ, et al. Clusteing of cadiovascula disease isk factos among obese schoolchilden: the Taiei Childen Heat Study. Am J Clin Nut 1998; 67: Couch SC, Daniels SR. Diet and blood essue in childen. Cu Oin Pediat 2005; 17: DNPCNCD. Diet, nutition and evention of chonic non communicable diseases in Egytian adolescents. Final Reot El-Masy SA. Nutitional assessment of Egytian childen. Egyt Med J NRC, 2007; 6(2): Falkne B, Gidding SS, Ramiez-Ganica G et al. The elationshi of body mass index and blood essue in imay cae ediatic atients. J Pediat 2006; 148: Fod ES, Mokdad AH, Ajani UA. Tends in isk factos fo cadiovascula disease among childen and adolescents in the United States. Pediatics 2004; 114:

8 18. Feedman DS, Dietz WH, Sinivasan SR, Beenson GS. The elation of oveweight to cadiovascula isk factos among childen and adolescents: the Bogalusa Heat Study. Pediatics 1999; 103: Geiss HC, Pahofe KG, Schwandt P. Paametes of childhood obesity and thei elationshi to cadiovascula isk factos in healthy eubescent childen. Int J Obes Relat Metab Disod 2001; 25: Ghalli I, Salah N, Hussien F, et al. Egytian gowth cuves fo infants, childen and adolescents. In: Satoio A, Buckle JMH, Maazzi N, Cecee nel mondo. Feing Publishe, Italy, Gundy SM, Bewe J HB, Cleeman JI, Smith J SC, Lenfant C, Ameican heat Association, National Heat, lung, And Blood Institute. Definition of metabolic syndome: eot of the national heat, lung, and blood institute/ameican heat Association confeence on scientific issues elated to definition. Ciculation 2004;109: Hassan NE, Sheif L, El-Masy SA, Fouad WA, Elwakkad A, Anwa M and Zaki ST : Pevalence of metabolic syndome among obese childen and adolescents. e-spen, the Euoean e-jounal of Clinical Nutition and Metabolism, 2011a; 6: e248- e Hassan NE, Zaki ST, El-Masy SA, Mohsen MA and Elashmawy E: Imact of balanced caloic diet and hysical activity on body comosition and fat distibution of obese Egytian adolescent gils. Maced J Med Scie, 2011b, Mas 15, 4 (1): Hienaux J, Tanne JM. Gowth and hysical studies. In: Human Biology: A guide to field methods. Weine JS, Louie SA, editos. Oxfod. U.K: IBP. London, Blackwell Scientific Publications; Jackson RT, Rashed M, Saad-Eldin R. Rual uban diffeences in weight, body image, and dieting behavio among adolescent Egytian schoolgils. Int J Food Sci Nut 2003; 54: Keskin M, Kutoglu S, Kendici M, Atabek ME, Yazici C. Homeostasis model assessment is moe eliable than the fasting glucose/insulin atio and quantitative insulin sensitivity check index fo assessing insulin esistance among obese childen and adolescents. Pediatics 2005;115: Kim HM, Pak J, Kim HS, Kim DH, and Pak SH. Obesity and Cadiovascula Risk Factos in Koean Childen and Adolescents Aged Yeas fom the Koean National Health and Nutition Examination Suvey, 1998 and Am J Eidemiol 2006; 164: Kohli P, Geenland P. Role of the metabolic syndome in isk assessment fo coonay heat disease. JAMA 2006; 295: Lande MB, Cason NL, Roy J, Meaghe CC. Effects of childhood imay hyetension on caotid intima media thickness: a matched contolled study. Hyetension 2006; 48: Lottenbeg SA, Gleze A, Tuatii LA. Metabolic syndome: identifying the isk factos. J Pediat (Rio J) 2007; 83 (5 Sul): S McMahan CA, Gidding SS, Malcom GT, Tacy RE, Stong JP, McGill HC J, et al. Pathobiological deteminants of atheoscleosis in youth isk scoes ae associated with ealy and advanced atheoscleosis. Pediatics 2006; 118 (4): Moan A, Jacobs DR J, Steinbege J, Cohen P, Hong CP, Pineas R, Sinaiko AR. Association between the insulin esistance of ubety and the insulin-like gowth facto-1/gowth homone axis. J Clin Endocinol Metab 2002; 87: Moan A, Jacobs DR J, Steinbege J, Hong CP, Pineas R, Lueke R, Sinaiko AR. Insulin esistance duing ubety: esults fom clam studies in 357 childen. Diabetes 1999; 48: Moison JA, Baton BA, Bio FM, Seche DL. Sex homones and the changes in adolescent male liids: longitudinal studies in a biacial cohot. J Pediat 2003; 142: Muntne P, He J, Cutle JA, Wildman RP, Whelton PK. Tends in blood essue among childen and adolescents. JAMA 2004; 291: Pouliot MC, Deses JP, Lemieux S, et al. Waist cicumfeence and abdominal sagittal diamete: best simle anthoometic indices of abdominal visceal adiose tissue accumulation and elated cadiovascula isk in men and women. Am J Cadiol 1994; 73: Reineh T, Andle W, Denze C, Siegied W, Maye H, Wabitsch M. Cadiovascula isk factos in oveweight Geman childen and adolescents: elation to gende, age and degee of oveweight. Nut Metab Cadiovasc Dis 2005a; 15: Reineh T, de Sousa G, Andle W. Longitudinal analyses among oveweight, insulin esistance, and cadiovascula isk factos in childen. Obes Res 2005b; 13 (10): Saland JM. Udate on the metabolic syndome in childen. Cu Oin Pediat 2007; 2: Shaaban SY, El-Masy SA, Younis NT and Mohamed HH : Malnutition Among Peschool Childen In Caio. The Egyt. Paed. Assoc. Gaz. 2008; 56 (3):

9 41. Shae JA, Naylo LH, Jones TW et al. Imact of obesity on diastolic function in subjects < o = 16 yeas of age. Am J Cadiol 2006; 98: Shea S, Aymong E, Zybet P, Beglund L, et al. Fasting lasma insulin modulates liid levels and aticle size in 2- to 3-yea-old childen. Obes Res 2003; 11: Sinaiko AR, Donahue RP, Jacobs DR, Pineas RJ. Relation of weight and ate of incease in weight duing childhood and adolescence to body size, blood essue, fasting insulin, and liids in young adults: the Minneaolis Childen s Blood Pessue Study. Ciculation 1999; 99: Sinaiko AR, Steinbege J, Moan A, Pineas RJ, Jacobs DR J. Relation of insulin esistance to blood essue in childhood. J Hyetens 2002; 20: Soof JM, Alexandov AV, Cadwell G, Potman RJ. Caotid atey intimalmedial thickness and left venticula hyetohy in childen with elevated blood essue. Pediatics 2003; 111: Sinivasan SR, Bao W, Wattigney WA, Beenson GS. Adolescents oveweight is associated with adult oveweight and elated multile cadiovascula isk factos: the Bogalusa Heat Study. Metabolism 1996; 45: Steinbege J, Daniels SR. Obesity, insulin esistance, diabetes, and cadiovascula isk in childen: an Ameican Heat Association scientific statement fom the Atheoscleosis, Hyetension, and Obesity in the Young Committee (Council on Cadiovascula Disease in the Young) and the Diabetes Committee (Council on Nutition, Physical Activity, and Metabolism). Ciculation 2003; 107: Steinbege J, Moan A, Hong CP, Jacobs DR J, Sinaiko AR. Adiosity in childhood edicts obesity and insulin esistance in young adulthood. J Pediat 2001;138: Suk SH, Sacco RL, Boden-Albala B, et al. Nothen Manhattan Stoke Study. Abdominal obesity and isk of ischemic stoke: the Nothen Manhattan Stoke Study. Stoke 2003; 34(7): Sun SS, Liang R, Huang TT, Daniels SR, Aslanian S, Liu K, et al. Childhood obesity edicts adult metabolic syndome: the Fels Longitudinal Study. J Pediat. 2008; 152 (2): Vos LE, Oen A, Uitewaal C et al. Adolescent blood essue and blood essue tacking into young adulthood ae elated to subclinical atheoscleosis: the Atheoscleosis Risk in Young Adults (ARYA) study. Am J Hyetens 2003; 16: Wang Y, Rimm EB, Stamfe MJ, Willett WC, Hu FB. Comaison of abdominal adiosity and oveall obesity in edicting isk of tye 2 diabetes among men. Am J Clin Nut 2005; 81(3): Wannamethee SG, Shae AG, Lennon L, Mois RW. Metabolic syndome vs Famingham Risk Scoe fo ediction of coonay heat disease, stoke, and tye 2 diabetes mellitus. Ach Inten Med 2005, 165: Weiss R, Dziua J, Buget TS et al. Obesity and the metabolic syndome in childen and adolescents. N Engl J Med 2004; 350: WHO citeia adated fo childen. Diabetes Eidemiology Collaboative analysis of diagnostic citeia in Euoe study gou, Will new diagnostic citeia fo diabetes mellitus change henotye of diabetes Eidemiology Collaboative analysis of diagnostic citeia in Euoe study gou: glucose toleance and motality: comaison of WHO and ameican diabetes association diagnostic citeia. Lancet 1999; 354: Williams CL, Hayman LL, Daniels SR, et al. Cadiovascula health in childhood: a statement fo health ofessionals fom the Committee on Atheoscleosis, Hyetension, and Obesity in the Young (AHOY) of the Council on Cadiovascula Disease in the Young, Ameican Health Association. Ciculation 2002; 106: Wold Health Oganization. Peventing chonic diseases: a vital investment. [Accessed on 2006 Oct 30]. Available fom: htt:// ntents/en/index.html 58. Yusuf S, Hawken S, Ounuu S, et al. INTERHEART Study Investigatos. Obesity and the isk of myocadial infaction in 27,000 aticiants fom 52 counties: a case-contol study. Lancet 2005; 366: Zaki ME, Ismail S, Ibahim NA, Kandeel WA and Bassiouni R. Pecentiles of blood essue of Egytian childen and adolescents ( 3-17 yeas). Med. J. Caio Univesity, 2006; 74 (3)sul.: /12/