Severe Obesity, Obesity, and Cardiometabolic Risk in Children 0 to 6 Years of Age

Background: The prevalence of obesity in children has been shown to be plateauing or decreasing in some countries. However the burden of severe obesity is often not assessed. Children with severe obesity may be at increased risk for cardiovascular disease and diabetes. The objective is to determine the prevalence of severe obesity in young children and to examine the association with cardiometabolic risk factors. Methods: A longitudinal study was conducted through The Applied Research Group for Kids! (TARGet Kids!), a practice-based research network in Toronto, Canada. Healthy children from birth to 6 years of age were recruited and followed through middle childhood. The main outcomes of the study were; total cholesterol, HDL, LDL, and non-HDL cholesterol, triglycerides, glucose, systolic blood pressure (SBP) and diastolic blood pressure (DBP). BMI was age and sex-standardized based on the WHO growth standards. A BMI z score > 3 was used to define obesity for children under 5 years of age, and severe obesity for children ≥5 years of age. Results: Among 5738 children less than 5 years, 0.8% had a zBMI>3. In 626 children 5 and 6 years, 2.1% has a zBMI>3. In the multivariable analysis adjusted for age, sex, maternal ethnicity, and family history, using repeated measures, children with a zBMI>3 had significantly higher odds of having abnormal SBP (OR 6.4, 95% CI 1.5-27.9; p=0.01) and DBP (OR, 3.6 95% CI 1.2-10.6; p=0.02), respectively, as compared to healthy weight children. Trends demonstrating an association between zBMI>3 and abnormal lipid levels were also identified. Conclusion: Young children with zBMI greater than 3 have significantly higher blood pressure measures and trends towards worse lipid profiles than children at lower zBMIs

Severe Obesity, Obesity, and Cardiometabolic Risk in Children 0 to 6 Years of Age

Background: The prevalence of obesity in children has been shown to be plateauing or decreasing in some countries. However the burden of severe obesity is often not assessed. Children with severe obesity may be at increased risk for cardiovascular disease and diabetes. The objective is to determine the prevalence of severe obesity in young children and to examine the association with cardiometabolic risk factors. Methods: A longitudinal study was conducted through The Applied Research Group for Kids! (TARGet Kids!), a practice-based research network in Toronto, Canada. Healthy children from birth to 6 years of age were recruited and followed through middle childhood. The main outcomes of the study were; total cholesterol, HDL, LDL, and non-HDL cholesterol, triglycerides, glucose, systolic blood pressure (SBP) and diastolic blood pressure (DBP). BMI was age and sex-standardized based on the WHO growth standards. A BMI z score > 3 was used to define obesity for children under 5 years of age, and severe obesity for children ≥5 years of age. Results: Among 5738 children less than 5 years, 0.8% had a zBMI>3. In 626 children 5 and 6 years, 2.1% has a zBMI>3. In the multivariable analysis adjusted for age, sex, maternal ethnicity, and family history, using repeated measures, children with a zBMI>3 had significantly higher odds of having abnormal SBP (OR 6.4, 95% CI 1.5-27.9; p=0.01) and DBP (OR, 3.6 95% CI 1.2-10.6; p=0.02), respectively, as compared to healthy weight children. Trends demonstrating an association between zBMI>3 and abnormal lipid levels were also identified. Conclusion: Young children with zBMI greater than 3 have significantly higher blood pressure measures and trends towards worse lipid profiles than children at lower zBMIs

Longitudinal Analysis of Sleep Duration and Cardiometabolic Risk in Young Children

Background: To determine if sleep duration in early childhood is associated with cardiometabolic risk in later childhood as assessed by a cardiometabolic risk (CMR) cluster score (sum of age and sex-standardized z-scores of waist circumference (WC), systolic blood pressure (SBP), triglycerides, glucose, and (inverse) high density lipoprotein (HDL)). Secondary objectives included examining sleep duration and the individual cardiometabolic risk factors and BMI z-score. Methods: A prospective cohort study was conducted using data from the TARGet Kids! practice-based research network in Toronto, Canada. Children (n=597) with parent reported 24-hour sleep duration in early childhood (12-36 months) and a follow-up visit (36-96 months) with all five CMR factors were included in the analysis. Multivariable linear regression was used to assess the relationship between early childhood sleep duration and later childhood cardiometabolic risk, adjusting for relevant covariates. Results: Average 24-hour sleep duration in early childhood [mean age: 28.1 (6.6) months] was 11.8 (1.4) hours, with 87% meeting or exceeding total sleep recommendations for their age. Sleep duration in early childhood was not associated with the CMR cluster score in later childhood. Shorter sleep duration was associated with higher HDL concentrations [adjusted Beta = -0.028 (95% CI: -0.049, -0.007), p=0.009]. Conclusions: Further research is needed to determine if early childhood sleep duration is associated with HDL in later childhood. Future studies, which investigate sleep quality in addition to sleep duration, may be helpful.We thank all of the participating families for their time and involvement in TARGet Kids! and are grateful to all practitioners who are currently involved in the TARGet Kids! practice-based research network. Advisory Committee: Eddy Lau, Andreas Laupacis, Patricia C. Parkin, Michael Salter, Peter Szatmari, Shannon Weir. Research Team: Charmaine Camacho, Arthana Chandraraj, Dharma Dalwadi, Ayesha Islam, Thivia Jegathesan, Tarandeep Malhi, Megan Smith, Laurie Thompson. Applied Health Research Centre: Christopher Allen, Bryan Boodhoo, Judith Hall, Peter Juni, Gerald Lebovic, Karen Pope, Jodi Shim, Kevin Thorpe; Mount Sinai Services Laboratory: Azar Azad

Longitudinal Analysis of Sleep Duration and Cardiometabolic Risk in Young Children

Background: To determine if sleep duration in early childhood is associated with cardiometabolic risk in later childhood as assessed by a cardiometabolic risk (CMR) cluster score (sum of age and sex-standardized z-scores of waist circumference (WC), systolic blood pressure (SBP), triglycerides, glucose, and (inverse) high density lipoprotein (HDL)). Secondary objectives included examining sleep duration and the individual cardiometabolic risk factors and BMI z-score. Methods: A prospective cohort study was conducted using data from the TARGet Kids! practice-based research network in Toronto, Canada. Children (n=597) with parent reported 24-hour sleep duration in early childhood (12-36 months) and a follow-up visit (36-96 months) with all five CMR factors were included in the analysis. Multivariable linear regression was used to assess the relationship between early childhood sleep duration and later childhood cardiometabolic risk, adjusting for relevant covariates. Results: Average 24-hour sleep duration in early childhood [mean age: 28.1 (6.6) months] was 11.8 (1.4) hours, with 87% meeting or exceeding total sleep recommendations for their age. Sleep duration in early childhood was not associated with the CMR cluster score in later childhood. Shorter sleep duration was associated with higher HDL concentrations [adjusted Beta = -0.028 (95% CI: -0.049, -0.007), p=0.009]. Conclusions: Further research is needed to determine if early childhood sleep duration is associated with HDL in later childhood. Future studies, which investigate sleep quality in addition to sleep duration, may be helpful.We thank all of the participating families for their time and involvement in TARGet Kids! and are grateful to all practitioners who are currently involved in the TARGet Kids! practice-based research network. Advisory Committee: Eddy Lau, Andreas Laupacis, Patricia C. Parkin, Michael Salter, Peter Szatmari, Shannon Weir. Research Team: Charmaine Camacho, Arthana Chandraraj, Dharma Dalwadi, Ayesha Islam, Thivia Jegathesan, Tarandeep Malhi, Megan Smith, Laurie Thompson. Applied Health Research Centre: Christopher Allen, Bryan Boodhoo, Judith Hall, Peter Juni, Gerald Lebovic, Karen Pope, Jodi Shim, Kevin Thorpe; Mount Sinai Services Laboratory: Azar Azad