|Year : 2023 | Volume
| Issue : 1 | Page : 45-50
Relation between cardiometabolic risk factors and obesity differs in children and adults
Tahniyah Haq1, Tohfa-E-Ayub2, Md Fariduddin1, Palash Chandra Sutradhar3, Nishat Nayla Aurpa4, Md Abul Hasanat1
1 Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
2 Department of Biochemistry, Ibrahim Medical College, Dhaka, Bangladesh
3 Department of Medicine, Sir Salimullah Medical College, Dhaka, Bangladesh
4 Department of Neurology, Dhaka Medical College Hospital, Dhaka, Bangladesh
|Date of Submission||11-Dec-2022|
|Date of Acceptance||28-Dec-2022|
|Date of Web Publication||21-Feb-2023|
Room No. 1620, 15th Floor, Block D, Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka 1000
Source of Support: None, Conflict of Interest: None
Background: Obesity is a harbinger of cardiovascular disease. It is affecting individuals from an early age. Aim: The aim of the study was to compare cardiometabolic risk factors (CRFs) in obese children and adults; and to see their relationship with obesity. Materials and Methods: Two hundred and thirty-nine overweight and obese individuals (189 ≤20 and 50 >20 years) without secondary causes of obesity were included and data on their CRFs (blood pressure, plasma glucose, glycated hemoglobin, and lipid profile) were obtained from clinic records. Results: Mean age and body mass index (BMI) of ≤20 years of group were 13.77 ± 2.32 years and 33.29 ± 8.45 kg/m2, respectively. The mean age and BMI of >20-year group were 39 ± 1.41 years and 36.81 ± 2.40 kg/m2, respectively. Participants in the ≤20-year group had a lower rate of abnormal glucose tolerance (28.9% vs. 61.9%, P < 0.001) and hypertension (3.6% vs. 15.4%, P < 0.001), but a higher rate of dyslipidemia (98.8% vs. 97.5%, P < 0.001) than the ≤20 years of group. After adjusting for all cardiovascular risk factors, diastolic blood pressure was significantly related to obesity (BMI β = 0.380, P = 0.001; waist circumference β = 0.499, P < 0.001; fat mass index β = 0.407, P = 0.001; waist height ratio β = 0.356, P = 0.004) in the ≤20-year group, while fasting plasma glucose was related to BMI (β = 1.086, P = 0.001) in the >20-year group. Conclusion: There is a high rate of dyslipidemia in young obese individuals. Blood pressure is associated with obesity at a younger age, while dysglycemia is associated with increasing BMI in adults.
Keywords: Adults, cardiometabolic risk, children, obesity
|How to cite this article:|
Haq T, Tohfa-E-Ayub, Fariduddin M, Sutradhar PC, Aurpa NN, Hasanat MA. Relation between cardiometabolic risk factors and obesity differs in children and adults. Bangladesh J Endocrinol Metab 2023;2:45-50
|How to cite this URL:|
Haq T, Tohfa-E-Ayub, Fariduddin M, Sutradhar PC, Aurpa NN, Hasanat MA. Relation between cardiometabolic risk factors and obesity differs in children and adults. Bangladesh J Endocrinol Metab [serial online] 2023 [cited 2023 Mar 29];2:45-50. Available from: https://www.bjem.org/text.asp?2023/2/1/45/370145
| Introduction|| |
Cardiovascular disease (CVD) remains the number one cause of death and disability in the world. About 85% of CVD deaths are attributable to ischemic heart disease and stroke. There are multiple risk factors associated with CVD. The most common ones include general obesity (based on body mass index [BMI]), central obesity or abdominal obesity, hyperglycemia, dyslipidemia, and high-blood pressure. The prevalence of the cardiometabolic risk factors (CRFs) associated with noncommunicable diseases (NCDs) has increased and will continue to increase, as demonstrated by many studies and as predicted by projections and future estimates. Having one risk factor does not necessarily lead to developing CVD. Similar to other NCDs, people who develop ischemic heart disease typically have more than one risk factor. The clustering of cardiovascular risk factors begins in youth and continues during young adulthood and middle age., The presence of multiple risk factors simultaneously has been shown to increase the risk for atherosclerosis development in young- and middle-aged adults and the risk of CVD in middle age. For example, Wilson et al.'s study estimated that accumulating three or more risk factors was associated with around a 2.4-fold increase in men and 5.9-fold increase in women in the risk of coronary heart disease after 16 years of follow-up. In addition, they showed that having 3 or more risk factors in the general population, was attributable to about 20% of coronary events in men and 48% in women. Another study on hypertensive individuals without CVD showed that accumulating three or more risk factors increased the relative risk of developing cardiovascular events from 2.07 (95% confidence interval [CI] 1.86–2.30) to 2.80 (95% CI 2.48–3.17) when compared to having only one risk factor, in a 6-year follow-up. Interrelationships between pairs of risk factors have been studied previously. Weight increase was reported to be associated with hyperlipidemia, glycemia, and hypertension in young adults. Hypertension was reported to be associated with type 2 diabetes. In addition, insulin resistance was associated with hypertension. Other studies reported an increase in incident diabetes and hypertension following dyslipidemia.,
Since NCDs are caused by the interplay of risk factors and their accumulation, it is important to study how these risk factors are linked and how they accumulate before a chronic disease is established. The aim of the study was to compare CRFs and see their relationship with obesity in obese children and adults.
| Materials and Methods|| |
Overweight and obese children and adults without secondary causes of obesity or chronic illness were included in this study, and secondary data of their CRFs were obtained. This retrospective study was conducted at Bangabandhu Sheikh Mujib Medical University (BSMMU) from January 2017 to February 2022. This study was approved by Institutional Research Board, BSMMU (Registration No. 651).
Overweight and obesity were determined by calculating BMI which was plotted on the Centers for Disease Control chart. Indices of obesity (BMI, waist circumference [WC], fat mass index [FMI], and waist height ratio [WHtR]) and CRFs (hypertension, abnormal glucose tolerance, and dyslipidemia) were determined from records of clinical examination and laboratory investigations. The cutoffs used to demarcate abnormal levels are shown in [Table 1].
|Table 1: Cardiometabolic risk factors and their cut offs in children and adult|
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Weight was measured using an electronic digital weighing machine to the nearest 0.1 kg, with the participant wearing light clothes and without shoes. Height was measured by a portable wall-mounted stadiometer to the nearest 0.1 cm with the participant without shoes in the erect position, back against the wall with his/her head held in Frankfurt horizontal plane with a right-angled triangle resting on the scalp and against the wall. WC was measured midway between the lowest rib and the superior border of the iliac crest using a nonextensible and nonelastic measuring tape in mid respiration and inferences were drawn in percentiles WHtR was calculated by the formula WC in centimeters divided by body height in centimeters. Blood pressure was measured three times by the same individual with an aneroid sphygmomanometer (Yamasu) after calibration and standardization and mean value was recorded. Glucose was measured by hexokinase/ Glucose-6-Phosphate Dehydrogenase (G-6-PDH) method. Glycated hemoglobin (HbA1c) was measured using the NGSP certified method (Bio-Rad D-10™ HbA1c Program 220-0101, USA). Triglyceride and high-density lipoprotein-cholesterol (HDL-C) were measured by automated analyzer (Architect Plus ci8200). Low-density lipoprotein cholesterol (LDL-C) was calculated with the use of the Friedewald formula: LDL-C = TC– HDL-C– (TG/5).
All values were expressed as means ± standard deviation or frequencies. The Chi-square test was used to compare cardio-metabolic risk between children and adults. Pearson's correlation and multiple linear regression (enter method) were used to evaluate the association between CRFs and different indices of obesity. The SPSS version 23.0 (SPSS 22) was used for the statistical analyses.
| Results|| |
The total population was divided into two groups according to their ages: group I aged ≤20 years and Group II aged >20 years. Adults >20 years were found more obese than the younger adults (≤20 years). The rest of the parameters of obesity index was also higher in >20 years of group [Table 2]. HbA1c, total cholesterol (TC), LDL-C, alanine aminotransferase (ALT) was found higher in ≤20 years of participants than the above 20 years adults among all the CRFs [Table 3]. In both groups, almost all the participants had dyslipidemia. On the contrary participants, >20 years had a higher rate of abnormal glucose tolerance and hypertension than the ≤20 years of group [Table 4].
|Table 3: Descriptive characteristics of cardio metabolic risk factors among participants (n=239)|
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In the ≤20 years of group, systolic blood pressure (SBP) and diastolic blood pressures (DBPs) were positively correlated with all the indices of obesity [Table 5]. When controlling for all the other CRFs, systolic and diastolic were still related with obesity [Table 6]. In the >20 years of age group, fasting and 2 h plasma glucose had positive correlation with indices of obesity [Table 7], but only fasting plasma glucose and BMI were related when adjusting for other cardiometabolic factors [Table 8].
|Table 5: Correlations of obesity index with cardio metabolic risk factors among participants aged ≤20 years (n=189)|
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|Table 6: Regression analysis of cardio metabolic risk factors with obesity indices of participants aged ≤20 years (n=189)|
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|Table 7: Correlations of obesity index with cardio metabolic risk factors among participants aged >20 years (n=50)|
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|Table 8: Regression analysis of cardio metabolic risk factors with anthropometric status of participants aged >20 years (n=50)|
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| Discussion|| |
Cardiometabolic risk (CMR) between two age groups was compared. The frequency of hypertension and abnormal glucose tolerance was higher in individuals aged >20 years, but the rate of dyslipidemia was higher in those ≤20 years. SBP and DBP were related with BMI, WC, FMI, and WHtR, even after adjusting for all other CRFs in the ≤20 years' group. However, in the >20 years' group, only fasting plasma glucose was linearly related to BMI after controlling for other risk factors.
Individuals ≥20 years were observed to be more hypertensive, hyperglycemic, though almost all the participants had dyslipidemia irrespective of their age. It may be due to the rise of insulin resistance with age. Participants below 20 years had higher HbA1c, TC, LDL-C, and ALT than those of above 20 participants. The HbA1c was higher in ≤20 years of group despite a lower plasma glucose, as HbA1c has poor accuracy and agreement with oral glucose tolerance test in children, and is erroneously higher in obesity.
Kim et al. in their study included BMI and WC for measuring obesity to show the relationship with CRFs but in our study, we also included FMI and WHtR to get accuracy in the obesity index. We observed that obesity in >20 years adults was associated only with hyperglycemia (both in fasting blood sugar [FBS] and AG [2 hours after glucose intake]), whereas being obese in ≤20 years had strong association with higher SBP and DBP. The mechanisms that may increase cardiovascular risk in diabetic hypertensive patients are not completely understood. Endothelial dysfunction and hypertension are intimately related. Endothelial cells, situated at the blood-tissue interface, react swiftly to local trauma or inflammation. Nitric oxide is less bioavailable to blood arteries when the endothelium is altered, which is known as endothelial dysfunction. Vasomotor responses and anti-inflammatory capabilities are thus compromised by endothelium-mediated mechanisms. This is regarded as the first stage of vascular remodeling, atherosclerosis, CVD, or cerebrovascular disease. A study on the South African under 18 years population found hypertension as one of the major CMR factors associated with obesity.
We observed a stronger correlation of SBP, DBP (for ≤20 years' old group), and FBS, AG (for >20 years aged group) with BMI and WC than other indices of obesity, which was consistent with another study done in our country. Hypertension was found to be positively associated with all the indices of obesity (indicating general and central obesity) in ≤20-year diabetic population from the regression analysis. However, in case of people aged >20 years, this association was seen only between hyperglycemia and general obesity (BMI). This finding is suggestive for considering younger population at high risk of CVD from diabetes and further studies should be conducted on this group of people aged ≤20 years.
| Conclusion|| |
There is a high rate of dyslipidemia in young obese individuals. Blood pressure is associated with obesity at a younger age, while dyslipidemia is associated with increasing BMI in adults.
We would like to acknowledge the obesity team of the Department of Endocrinology, BSMMU.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]