1389 (54 )1 - *** *** *** ** *** * * ** *** ( ) : /8/26 : 88/2/1 : (WC) (BMI) :.. (CVD) - : :

Transcription

1 JQUMS, Vol.14, No.1, Spring Predicting risk factors of cardiovascular disease according to anthropometric measures in children and adolescents R Kelishadi* M Hashemipour** Z Faghihimani*** E Nazemi*** S Ghatreh-Samani*** N Khavarian*** *Associate professor of Pediatrics, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran **Professor of Pediatric Endocrinology, Endocrine & Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran ***Research Assistant, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran Abstract Background: Regarding the higher risk of abdominal obesity versus generalized obesity, nowadays the combined measurement of body mass index (BMI) and waist circumference (WC) is used for prediction of obesity health hazards among adults however; such information is limited among children and adolescents. Objective: In this study, the individualized and combined influence of BMI and WC on risk factors of cardiovascular disease (CVD) in overweight children and adolescents was assessed. Methods: This study included 3432 overweight/obese children and adolescents referred to the Pediatric Preventive Cardiology Department (Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences) in whom six CVD risk factors were measured and registered. At the first step of analysis, BMI and WC were considered as continuous variables in predicting CVD risk factors. At the second step, the participants were initially categorized into overweight and obese, and later, the risk factors in each group were compared among those with WC lower and or higher than 75 th percentile. Findings: When the BMI and WC in a regression model for predicting CVD risk factors were used, the increase in variance was found to have insignificant difference compared to those obtained for BMI and WC, individually. When the aforementioned categories were applied, WC was shown to be more informative about risk factors than that of BMI alone. Conclusion: The findings of present study emphasize on the role of abdominal obesity in increasing the risk of chronic diseases, notably CVD in children and adolescents hence, similar to adults, measurement of WC as well as BMI should be routinely considered among children and adolescents. Keywords: Body Mass Index, Waist Circumference, Obesity, Metabolic Syndrome, Children and Adolescents Corresponding address: Jomhouri Eslami Square, Khorram Street, Sedigheh Tahereh Treatment & Research Complex, Cardiovascular Research Center, Isfahan University of Medical Sciences. Isfahan, Iran Kelishadi@med.mui.ac.ir Tel: Received: 2009/04/21 Accepted: 2009/11/17

2 1389 (54 )1 - *** *** *** ** *** * * ** *** ( ) : kelishadi@med.mui.ac.ir /8/26 : 88/2/1 : (WC) (BMI) :.. (CVD) - : :. CVD.. CVD BMI WC 75 WC. CVD BMI WC : BMI WC. WC BMI BMI CVD WC WC 111/3±8/5 WC (BMI ).(p=0/04) 113/1±8/5. : BMI WC. : 13/ (2). (4 3). : (1).

3 /.... ( HDL LDL ).. 0/1 0/1 BMI. BMI ( ) ( ). BMI. (IOTF) BMI BMI 29/ (12). (12). () 75 (19 18)... ( ) ALPK2 - : 95 LDL 5 HDL - (5). (6-11). (BMI) (12). - (WC) - (14 13).. (15). (16). - (17) :

4 1389 (54 )1 BMI -. ) 100.(95 : - HDL. (19).. SPSS : (1 ) ).(2 BMI - 2 R. BMI. BMI. - (OR). BMI BMI /9±2/7 22/2±2/6* 75/1±9/1 114/2±31/6 46/1±12/6 119/7±54/7 85/4±11/6 113±8/1 64/7±5/6 9/4±2/9* 26/6±4/5* 82/20±12/6* 116/9±31/8 45±12/2 126/1±73/8 84/8±12/3 112/4±7/3 64/4±5/5 10/1±2/9* 21/3±2/9 71/4±8/7 111/4±30/5 45/7±13/3 122/8±60/2 84/6±10/9 111/9±8/8 64/3±5/4 8/9±3/3* 25/9±5/5 78/1±11/9* 113/5±33/6 46/4±20/4 115/4±56/5 83/7±13/2 111/2±10/3 64/5±5/3 () ( / ) () ( / )LDL ( / ) HDL ( / ) ( / ) ( ) ( ) p<0/05*

5 /... BMI. BMI LDL.(3 ) BMI BMI. 0/055 0/004 BMI LDL. - BMI HDL BMI BMI BMI. LDL /5 10/2±3/1 21/3±3 65/7±7/8 112/3±29/5 46±12/8 119±55/1 83/6±11/4 111/3±8/5 64/3±5/3 37/6 10/6±2/6* 21/9±2/7* 75/3±8/1 112/5±31/9 12/8±45/68 123/8 ± 60/7 85/9±10/9* 113/1±8/5* 64/5±5/6 41/6 8/4±3/3 25/8±4/4 72/6±11/9* 114/2±33/6 20/8±47/34 115/2±72/1 83±12 110/2±7/4 64/1±6/2 49/4 9/8±2/9* 26/7±5/5* 81/9±11/9 115/9±32/2 13/2±44/40 124/6±85/5* 85/2±13/3 113/2±10/1 64/8±6/3 () ( / ) ( ) ( / ) LDL ( / ) HDL ( / ) ( / ) ( ) ( ) p<0/05* /99(0/98 1/02) 1 /05(1 1/99) 0 /01(1/03 0/99) 1/03(1/006 1/063) HDL 0 /99(0/98 1/01) 1 /02(1/06 0/09) 0 /001(0/01 0/99) 0/02(0/99 1/04) LDL 1 /05(1/02 1/08) 1 /96(1/04 0/89) 1 /04(1/06 1/02) 1/04(1/01 1/08) 1 /03(1 1/05) 1 /03(1/07 0/98) 1 /03(1/05 1/01) 1 /05(1/02 1/09) 1 /17(0/71 1/93) 0 /93(1/12 0/79) 0 /94(1/12 0/79) 0/94(0/67 1/33) 1 /04(0/966 1/13) 1 /07(1/15 0/99) 1 /07(0/99 1/15) 1/08(1/02 1/15)

6 1389 (54 )1 : BMI - BMI BMI. -. BMI 2597 BMI. 7/3 BMI 7/7 8/1 BMI. BMI - (20) BMI (21). BMI I 102 ). ( 88 (20). (22) (2 1 ) -1 R 2 =0/91-2 R 2 =0/87

7 /... hyperandrogenemia in pre- and early pubertal obese girls. J Clin Endocrinol Metab 2007; 92(2): Hanevold C, Waller J, Daniels S, et al. International Pediatric. The effects of obesity, gender, and ethnic group on left ventricular hypertrophy and geometry in hypertensive children: a collaborative study of the International Pediatric Hypertension Association. Pediatrics 2004; 113(2): Weiss R, Dziura J, Burget et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004; 350: Mandato C, Lucariello S, Licenziati MR, et al. Metabolic, hormonal, oxidative, and inflammatory factors in pediatric obesityrelated liver disease. J Pediatr 2005; 147(1): Friesen CA, Roberts CC. Cholelithiasis. Clinical characteristics in children. Case analysis and literature review. Clin Pediatr (Phila) 1989; 28(7): Barlow SE, Dietz WH. Obesity evaluation and treatment: Expert Committee recommendations. The Maternal and Child Health Bureau, Health Resources and Services Administration and the Department of Health and Human Services. Pediatrics 1998; 102(3): E Sousa G, Baatz H, Aksu F, et al. Headache and diplopia in an extremely obese adolescent. Klin Padiatr 2008; 220(5): Lawlor DA, Mamun AA, O'Callaghan MJ, et al. Is being overweight associated with behavioural problems in childhood and adolescence? Findings from the Mater- University study of pregnancy and its outcomes. Arch Dis Child 2005; 90(7): Berenson GS. Combined influence of body mass index and waist circumference on BMI (23) BMI (24) BMI BMI BMI.. : 1. Hedley AA, Ogden CL, Johnson CL, et al. Prevalence of overweight and obesity among US children, adolescents, and adults. JAMA 2004; 291 (23): Kelishadi R, Ardalan G, Gheiratmand R, et al. Association of physical activity and dietary behaviours in relation to the body mass index in a national sample of Iranian children and adolescents: CASPIAN Study. Bull World Health Organ 2007; 85(1): McGill HC, McMahan CA, Gidding SS. Are pediatricians responsible for prevention of adult cardiovascular disease? Nat Clin Pract Cardiovasc Med 2009; 6(1): McCartney CR, Blank SK, Prendergast KA, et al. Obesity and sex steroid changes across puberty: evidence for marked

8 1389 (54 )1 Waist circumference for the screening of the metabolic syndrome in children. Acta Paediatr 2002; 91(12): Sung RY, Yu CC, Choi KC, et al. Waist circumference and body mass index in Chinese children: cut-off values for predicting cardiovascular risk factors. Int J Obes (Lond) 2007; 31(3): Savva SC, Tornaritis M, Savva ME, et al. Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index. Int J Obes Relat Metab Disord 2000; 24(11): Fernández JR, Redden DT, Pietrobelli A, et al. Waist circumference percentiles in nationally representative samples of African- American, European-American, and Mexican-American children and adolescents. J Pediatr 2004; 145(4): Kelishadi R, Gouya MM, Ardalan G, et al. CASPIAN Study Group. First reference curves of waist and hip circumferences in an Asian population of youths: CASPIAN study. J Trop Pediatr 2007; 53(3): Kelishadi R, Cook SR, Motlagh ME, et al. Metabolically obese normal weight and phenotypically obese metabolically normal youths: the CASPIAN Study. J Am Diet Assoc 2008; 108(1): Moreno LA, Pineda I, Rodríguez G, et al. Waist circumference for the screening of the metabolic syndrome in children. Acta Paediatr 2002; 91(12): Weiss R, Dziura J, Burgert TS, et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004; 350(23): Janssen I, Katzmarzyk PT, Ross R. Body mass index, waist circumference, and health risk: evidence in support of current National Institutes of Health guidelines. Arch Intern Med 2002; 162(18): Wildman RP, Gu D, Reynolds K, et al. Are waist circumference and body mass index independently associated with cardiovascular disease risk in Chinese adults. Am J Clin Nutr 2005; 82(6): Ardern CI, Katzmarzyk PT, Janssen I, et al. Discrimination of health risk by combined body mass index and waist circumference. Obes Res 2003; 11(1): Kelishadi R, Gheiratmand R, Ardalan G, et al. CASPIAN Study Group. Association of anthropometric indices with cardio-vascular disease risk factors among children and adolescents: CASPIAN Study. Int J Cardiol 2007; 117(3): Messiah SE, Arheart KL, Lipshultz SE, et al. Body mass index, waist circumference, and cardiovascular risk factors in adolescents. J Pediatr 2008; 153(6): coronary artery disease risk factors among children and adolescents. Pediatrics 2005; 115(6):