US youth at high cardiovascular risk from excess weight
MedWire News: US adolescents are at significant risk for cardiovascular disease (CVD) from high blood pressure, diabetes, and other risk factors, and the risk is especially high among overweight and obese youth, according to a new report based on national surveillance data.
Analysis of 3383 12-19-year-old participants in the National Health and Nutrition Examination Survey (NHANES) from 1999 through 2008 shows that 14% had prehypertension or hypertension, 22% had low-density lipoprotein (LDL) cholesterol in the borderline high or high range, and 15% had prediabetes or diabetes, write Ashleigh May (Centers for Disease Control and Prevention) and colleagues.
In addition, the prevalence of LDL cholesterol levels in the borderline-high range was 22%, and 6% had low levels of high-density lipoprotein (HDL) cholesterol.
About half (49%) of overweight teens and three-fifths (61%) of those who were obese had one or more risk factors for CVD in addition to the elevated risk posed by their excess weight, May et al report in an article released early online in Pediatrics, the official journal of the American Academy of Pediatrics (AAP).
"The results of this national study indicate that US adolescents carry a substantial burden of CVD risk factors, especially those youth who are overweight or obese. Adolescence represents a window of opportunity for assessment of CVD risk factors and the promotion of lifestyles that will affect the development and progression of CVD," they write.
Although there were no significant changes from 1999-2000 to 2007-2008 in hypertension or elevated LDL cholesterol prevalence among US adolescents, the prevalence of diabetes increased by 14%, the authors noted.
NHANES is a continuous cross-sectional survey of the US civilian, non-institutionalized population. All NHANES participants complete a standardized household interview and undergo a physical exam that includes body and blood pressure measurements.
The investigators found that overall prevalence for each of the risk factors - overweight, high blood pressure, abnormal lipids, and diabetes status - was above 10%, with the exception of low HDL cholesterol.
They also observed a direct association between weight and LDL cholesterol levels. Specifically, 18% of normal weight youths (body mass index [BMI] <85th percentile) had elevated LDL cholesterol, compared with 28% of overweight adolescents (BMI percentile >85th to <95th), and 32% of those who were obese (>95th percentile).
The investigators note that while obese children are more likely than their normal-weight peers to be screened for some cardiovascular disease risk factors, hypertension if often overlooked.
"This is disconcerting, given the recommendation by the National High Blood Pressure Education Program and the AAP that children >3 years have their blood pressure measured as part of any health care visit," they write.
By Neil Osterweil