Received on July 12, 2007
Accepted on November 26, 2007

Endocrinology and Metabolism

Prevalence and Cluster of Cardiometabolic Biomarkers in Overweight and Obese Schoolchildren: Results from a Large Survey in Southwest Germany

¹ Institute of Epidemiology, Ulm University, Ulm, Germany
² Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Ulm University Medical Center, Ulm, Germany
³ Department of Nutrition, Food and Consumer Sciences, University of Applied Sciences Fulda, Fulda, Germany
⁴ Department of Epidemiology and Health Reporting Baden-Württemberg, State Health Office, Stuttgart, Germany
⁵ Department of Internal Medicine II–Cardiology, Ulm University Medical Center, Ulm, Germany

^* To whom correspondence should be addressed. E-mail: gabriele.nagel{at}uni-ulm.de.

BACKGROUND: Obesity is associated with substantial metabolic changes and subclinical inflammation. We explored associations between body mass index (BMI) and cardiometabolic biomarkers and their clustering in overweight and obese schoolchildren.

METHODS: In this population-based, cross-sectional study among 450 children 10 years old, we measured adiponectin, leptin, inflammatory markers, apolipoprotein (apo) AI and B, and lipoprotein-associated phospholipase A₂ (Lp-PLA₂). Except for adiponectin and apoAI (10th percentile) the 90th percentile was used as cutoff point. Body weight was categorized in age- and sex-specific BMI percentiles and overweight and obesity according to International Obesity Task Force definitions.

RESULTS: In linear regression models, all cardiometabolic markers except apoB were statistically significantly associated with overweight. In logistic regression models, compared with the reference category (25th–75th percentile of BMI), overweight was associated with increased concentrations of leptin [odds ratio (OR) 59.88; 95% CI 16.68–214.39], C-reactive protein (6.30; 2.95–13.45), fibrinogen (2.82; 1.33–6.01), and low apoAI (2.62; 1.19–5.75). Overweight was positively associated with interleukin-6, Lp-PLA₂, and apoB concentrations and inversely with adiponectin concentrations. Most importantly, in obese children 35% showed one, 20% two, 10% three, and 15% four or more abnormal cardiometabolic biomarkers. The number of abnormal cardiometabolic markers increased in overweight (p_trend <0.001) and obese (p_trend <0.001) children.

CONCLUSIONS: Overweight and obesity in children are associated with complex metabolic changes and a low-grade inflammatory response, and thus might not only accelerate cardiovascular disease later on, but may also be associated with the initiation of atherosclerosis in early life.