Research Shows BMI and Waist Size Signal Cardiovascular Risks in Preschoolers

A Miller School childhood obesity research team has published a landmark, population-based study showing that multiethnic children as young as 3 who have elevated body mass indexes and large waistlines are already at risk for cardiovascular disease and facing a potentially dire future.

Led by Sarah Messiah, Ph.D., M.P.H., research associate professor of pediatrics, the study, “BMI, Waist Circumference, and Selected Cardiovascular Disease Risk Factors Among Preschool-Age Children,” was published today in the online edition of Obesity. The first population-based study to examine cardiovascular disease risk factors in such young and ethnically diverse children, the study has the potential to significantly change how pediatricians and other child health care providers intervene to prevent or halt and reverse the disease process that’s already set in motion.

“Our study shows major implications for the health of the world’s future generations, in light of the global obesity epidemic which in turn will affect global economies and health care systems,” said Messiah, a well-known authority on obesity who was also lead author on a related study that drew national attention when it was published two years ago.

The new study’s findings should encourage pediatricians and other health care providers of very young children to discuss weight-related health issues with families when their patients are preschool age. “Our findings show that the weight-associated cardiovascular disease risk isn’t going to happen way down the road when they age into adulthood,” Messiah explained. “The wheel has already been set in motion if a preschool-age child is obese.”

Analyzing data from more than 3,600 children in the 1999-2008 National Health and Nutrition Examination Survey, the researchers examined the relationship between elevated body mass index and waist circumference and cardiovascular disease risk factors in 3- to 6-year-olds. Their findings suggest child health providers should consider using both body mass index and waist circumference to identify young children who may be at risk for elevated cardiovascular disease biomarkers.

The study is one of the first population-based analyses of non-Hispanic black, non-Hispanic white and Hispanic preschool-aged children and their cardiovascular disease risk factors associated with being overweight at such a young age.

The research showed that among non-Hispanic black boys and girls, Hispanic boys and non-Hispanic white girls, increased body mass index and waist circumference were associated with increased C-reactive protein levels, an indicator of inflammation, a hallmark for associated cardiometabolic health consequences.
Elevated triglyceride and non-HDL cholesterol and low HDL cholesterol also were generally associated with elevated body mass indexes and large waist circumferences in Hispanic children.

On the other hand, total cholesterol and LDL cholesterol were not significantly associated with elevated weight in 3- to 6-year-olds. Body mass index and waist circumference were similar in predicting the same risk factors.

Steven E. Lipshultz, M.D., professor and chairman of pediatrics and associate executive dean for child health at the Miller School and a co-author of the study, noted that the ability to individualize potentially preventive treatments to avoid heart disease is limited by an inadequate understanding of the risk-benefit ratios and long-term history of cardiac disease. He said devising targeted cardiovascular treatments and medication regimens for these patients has been difficult in part because they are children, and applying adult findings to them heightens the risk for complications and medical errors.

“Obese preschoolers are an important example of pediatric antecedents of adult cardiovascular disease,” said Lipshultz. “The study emphasizes the need for heightened awareness of this at-risk population for premature cardiovascular disease. The cardiac risk status of young children needs to be assessed intentionally and objectively and this new information may help care providers determine when and how to intervene, to improve not only mortality, but also morbidity. After all, the goal of treating at-risk children is not only to reduce the child’s risk, but to try to ensure that the child lives as long and as normal a life as possible.”

Four other Miller School researchers also served as co-authors: Kristopher Arheart, Ed.D., associate professor of epidemiology and public health; Ruby Natale, Ph.D., assistant professor of pediatrics; WayWay M. Hlaing, associate professor of epidemiology and public health; and Tracie Miller, M.D., professor of pediatrics and director of the Division of Pediatric Clinical Research.

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