Increased waist circumference of children is associated with higher health risks

The bigger the waist circumference of an overweight child or adolescent, the higher is the risk for cardiometabolic diseases. This correlation is particularly relevant for boys in puberty.

Dr. Susann Blüher from the Integrated Research and Treatment Center (IFB) AdiposityDiseases in Leipzig has analyzed data of 1278 children and adolescents aged11 to 18 years within a multicentre data collection. It has been primarily examined how different body markers, such as waist circumference, body mass index (BMI) and waist-to-height ratio are associated with the risk of diseases associated with obesity (adiposity). For children and younger people a positive correlation could not yet been clarified so far. In June (2013) the study was published in the renowned Journal of Clinical Endocrinology and Metabolism.

The study¹ states that mainly pubescent boys with an increased waist circumference² have a higher prevalence of increased liver and uric acid levels or show a HDL-cholesterol deficiency. Increased liver values indicate a beginning liver disease. In addition, an increased BMI in pubertal development was associated with a higher risk for insulin resistance, which indicates an emerging dysfunction in glucose metabolism. The waist-to-height ration did not show additional predictive value compared to the BMI.

Dr. Blüher, head of the clinical trial therefore recommends for standard pediatric checkups to "always measure the waist circumference in obese children and adolescents, especially in puberty since an increased value can provide indications to existing comorbidities." Visceral fat depots located in the stomach area are as damaging in obese children as in adults; they are closely associated to obesity-related comorbidities. Since primarily boys and men are prone to develop abdominal fat depots they have an increased risk to suffer from diseases such as type 2 diabetes, atherosclerosis, or fatty liver disease.

The survey data of all children were made available by the APV register (Obesity Prospective Follow-up) directed by Prof. Reinhard Holl in Ulm. This data centre is a quality assurance program of all certified obesity centers in Germany, Austria and Switzerland. It currently contains data from 82,000 overweight and obese children and youths from all three countries. The current survey involves data from the University of Leipzig, the IFB, the University Medicine Berlin (Charité), the University of Ulm and other German, Austrian and Swiss hospitals.

In Germany, more than six percent of children and adolescents are obese. In addition, it is already known from analysis that around 70 percent of these young people have an increased risk to prospectively suffer from a cardiovascular disease. Over 30 percent of them already suffer from a beginning insulin resistance, which can result in type 2 diabetes. Since about 80 percent of overweight girls and boys remain fat as adults, it is expected that the number of obesity-related diseases such as type 2 diabetes, fatty liver, arteriosclerosis or high blood pressure will continue to increase. The indications for alarming diseases mainly occur in the pubertal development. Therefore appropriate prevention and treatment programs will be needed.

Doris Gabel

(1)  Study: Blüher S, Molz E, Wiegand S, Otto KP, Sergeyev E, Tuschy S, L'allemand-Jander D, Kiess W, Holl RW; for the APV Initiative and the German Competence Net Obesity. Body Mass Index, Waist Circumference, and Waist-to-Height-Ratio as Predictors of Cardiometabolic Risk in Childhood Obesity Depending on Pubertal Development. J Clin Endocrinol Metab. Published ahead of print June 17, 2013 as doi:10.1210/jc.2013-1389.

(2) The BMI is calculated as follows: weight in kilograms divided by the body size to the second.
The abdomen or waist circumference is measured with a flexible, non-elastic tape at the narrowest point between the lowest rib and the anterior superior iliac spine. As reference for the BMI values from the BMI percentiles Kromeyer-house sign (A) were used, as reference values for the waist circumference data from KIGGS were used (B).

A)  Kromeyer-Hauschild K, Wabitsch M, Kunze D, et al 2001: Percentiles of body mass index in children and adolescents evaluated from different regional German cohorts. Monatsschr Kinderheilkd 149:807-818.

B) Kromeyer-Hauschild K, Dortschy R, Stolzenberg H, Neuhauser H, Rosario A 201:  Nationally representative waist circumference percentiles in German adolescents aged 11.0-18.0 years. Int J Pediatr Obes 6:e129-137

Keywords: children & youths, fat tissue & BMI, associated diseases, IFB-research