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Abstract：
Severe obesity defined as BMI value corresponding to an adult > 40 kg/m2 affects 1-5% of children and adolescents in Europe. The purpose of this study was to assess the occurrence of cardiovascular risk factors in children and adolescents with severe obesity. The analysis included 140 patients (75 female) at the mean age of 14 ± 2.1 SD (range 10-18) years (all recruited in 4 regional reference centers in Poland). Severe obesity was defined as BMI > 35 kg/m2 (children 6-14 years), and BMI > 40 kg/m2 (> 14 years). Fasting plasma samples have been obtained in all patients, and OGTT was performed in all patients. The metabolic risk factors were defined as high blood pressure (BP > 90 percentile for height, age, and sex), HDL cholesterol < 1.03 mmol/L, TG ≥ 1.7 mmol/L, and hyperglycemic state (fasting blood glucose > 5.6 mmol/L, or blood glucose 120\' after oral glucose load > 7.8 mmol/L). Additionally, the MetS z-score was calculated using Metabolic Syndrome Severity Calculator. One hundred twenty-four (89%) participants presented with high BP, 117 (84%) with abnormal lipid profile, and 26 with the hyperglycemic. Only 12 (9%) were free of metabolic complications. More than 60% of patients had more than one cardiovascular risk factor. The high BP was significantly associated with the severity of obesity (F = 9.9, p = 0.002). Patients with at least one metabolic complication presented with significantly younger age of the onset of obesity (the mean age of the patients with no overt obesity complications was 10 years, while the mean age of those who presented at least one was 4.7 ± 3.5 SD years (p = 0.002)). A significant positive association between in the value of the Mets BMI z-score with age was observed (R = 0.2, p < 0.05). There were no differences between girls and boys regarding Mets BMI z-score (1.7 ± 0.8 vs 1.7 ± 0.7, p = 0.8).Conclusions: The most common metabolic risk factor in children and adolescents with severe obesity was high BP. The most important factor determining presence of obesity complications, and thus the total metabolic risk, seems to be younger (< 5 years) age of onset of obesity. What is Known? • It is estimated that 1-5% of children and adolescents in Europe suffer from severe obesity corresponding to an adult BMI > 40 kg/m2, and it is the fastest growing subcategory of childhood obesity. • Children with severe obesity face substantial health risk that may persist into adulthood, encompassing chronic conditions, psychological disorders and premature mortality. What is new: • The most common complication is high BP that is significantly associated with the severity of obesity (BMI z-score), contrary to dyslipidemia and hyperglycemic state, which do not depend on BMI z-score value. • The most important factor determining presence of obesity complications, and thus the total metabolic risk, seems to be younger (< 5 years) age of onset of obesity.
摘要：
定义为对应于成人>40kg/m2的BMI值的严重肥胖影响欧洲1-5%的儿童和青少年。这项研究的目的是评估患有严重肥胖的儿童和青少年的心血管危险因素的发生。分析包括140名患者（75名女性），平均年龄为14±2.1SD（范围10-18）岁（均在波兰的4个地区参考中心招募）。重度肥胖定义为BMI>35kg/m2（6-14岁儿童），BMI>40kg/m2（>14岁）。所有患者都获得了空腹血浆样本，所有患者均进行了OGTT。代谢危险因素定义为高血压（身高BP>90百分位数，年龄,和性别)，HDL胆固醇<1.03mmol/L，TG≥1.7mmol/L,和高血糖状态（空腹血糖>5.6mmol/L，或口服葡萄糖负荷>7.8mmol/L后的血糖120）。此外,使用代谢综合征严重程度计算器计算MetSz评分.一百二十四名（89％）参与者表现出高BP，117（84%）血脂异常，和26与高血糖。只有12例（9%）没有代谢并发症。超过60%的患者有一个以上的心血管危险因素。高血压与肥胖的严重程度显著相关(F=9.9,p=0.002)。至少有一种代谢并发症的患者出现肥胖的年龄明显较小（没有明显肥胖并发症的患者的平均年龄为10岁，而那些出现至少一个的人的平均年龄为4.7±3.5SD年（p=0.002））。观察到MetsBMIz评分值与年龄之间的显着正相关（R=0.2，p<0.05）。男孩和女孩在MetsBMIz评分方面没有差异（1.7±0.8vs1.7±0.7，p=0.8）。结论：重度肥胖儿童和青少年最常见的代谢危险因素是高BP。决定肥胖并发症存在的最重要因素，因此总的代谢风险，似乎较年轻（<5岁）的肥胖发病年龄。什么是已知的？•据估计，欧洲有1-5％的儿童和青少年患有严重的肥胖症，相当于成人BMI>40kg/m2，这是儿童肥胖症增长最快的子类别。•严重肥胖的儿童面临巨大的健康风险，可能会持续到成年期，包括慢性病，心理障碍和过早死亡。最常见的并发症是与肥胖严重程度（BMIz评分）显著相关的高血压，与血脂异常和高血糖状态相反，这不取决于BMIz分数值。•决定肥胖并发症存在的最重要因素，因此总的代谢风险，似乎较年轻（<5岁）的肥胖发病年龄。
