Severe obesity and cardiometabolic risk in children: comparison from two international classification systems.

<h4>Objectives</h4>There is no agreed-upon definition for severe obesity (Sev-OB) in children. We compared estimates of Sev-OB as defined by different cut-points of body mass index (BMI) from the Centers for Disease Control and Prevention (CDC) or the World Health Organization (WHO) curv...

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Autores principales:	Giuliana Valerio, Claudio Maffeis, Antonio Balsamo, Emanuele Miraglia Del Giudice, Claudia Brufani, Graziano Grugni, Maria Rosaria Licenziati, Paolo Brambilla, Melania Manco, Childhood Obesity Group of the Italian Society of Pediatric Endocrinology and Diabetology
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/3d094178d1c342fb97d3c92a3fe81955
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spelling	oai:doaj.org-article:3d094178d1c342fb97d3c92a3fe819552021-11-18T08:40:08ZSevere obesity and cardiometabolic risk in children: comparison from two international classification systems.1932-620310.1371/journal.pone.0083793https://doaj.org/article/3d094178d1c342fb97d3c92a3fe819552013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24386280/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Objectives</h4>There is no agreed-upon definition for severe obesity (Sev-OB) in children. We compared estimates of Sev-OB as defined by different cut-points of body mass index (BMI) from the Centers for Disease Control and Prevention (CDC) or the World Health Organization (WHO) curves and the ability of each set of cut-points to screen for the presence of cardiometabolic risk factors.<h4>Research design and methods</h4>Cross-sectional, multicenter study involving 3,340 overweight/obese young subjects. Sev-OB was defined as BMI ≥ 99(th) percentile or ≥ 1.2 times the 95(th) percentile of the CDC or the WHO curves. High blood pressure, hypertriglyceridemia, low High Density Lipoprotein -cholesterol and impaired fasting glucose were considered as cardiometabolic risk factors.<h4>Results</h4>The estimated prevalence of Sev-OB varied widely between the two reference systems. Either using the cut-point ≥ 99(th) percentile or ≥ 1.2 times the 95(th) percentile, less children were defined as Sev-OB by CDC than WHO (46.8 vs. 89.5%, and 63.3 vs. 80.4%, respectively p<0.001). The CDC 99(th) percentile had lower sensitivity (58.5 vs 94.2), higher specificity (57.6 vs 12.3) and higher positive predictive value (34.4 vs 28.9) than WHO in identifying obese children with ≥ 2 cardiometabolic risk factors. These differences were mitigated using the 1.2 times the 95(th) percentile (sensitivity 73.9 vs. 88.1; specificity 40.7 vs. 22.5; positive predictive value 32.1 vs. 30.1). Substantial agreement between growth curves was found using the 1.2 times the 95(th) percentile, in particular in children ≤ 10 years.<h4>Conclusions</h4>Estimates of Sev-OB and cardiometabolic risk as defined by different cut-points of BMI are influenced from the reference systems used. The 1.2 times the 95(th) percentile of BMI of either CDC or WHO standard has a discriminatory advantage over the 99(th) percentile for identifying severely obese children at increased cardiometabolic risk, particularly under 10 years of age.Giuliana ValerioClaudio MaffeisAntonio BalsamoEmanuele Miraglia Del GiudiceClaudia BrufaniGraziano GrugniMaria Rosaria LicenziatiPaolo BrambillaMelania MancoChildhood Obesity Group of the Italian Society of Pediatric Endocrinology and DiabetologyPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 12, p e83793 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Giuliana Valerio Claudio Maffeis Antonio Balsamo Emanuele Miraglia Del Giudice Claudia Brufani Graziano Grugni Maria Rosaria Licenziati Paolo Brambilla Melania Manco Childhood Obesity Group of the Italian Society of Pediatric Endocrinology and Diabetology Severe obesity and cardiometabolic risk in children: comparison from two international classification systems.
description	<h4>Objectives</h4>There is no agreed-upon definition for severe obesity (Sev-OB) in children. We compared estimates of Sev-OB as defined by different cut-points of body mass index (BMI) from the Centers for Disease Control and Prevention (CDC) or the World Health Organization (WHO) curves and the ability of each set of cut-points to screen for the presence of cardiometabolic risk factors.<h4>Research design and methods</h4>Cross-sectional, multicenter study involving 3,340 overweight/obese young subjects. Sev-OB was defined as BMI ≥ 99(th) percentile or ≥ 1.2 times the 95(th) percentile of the CDC or the WHO curves. High blood pressure, hypertriglyceridemia, low High Density Lipoprotein -cholesterol and impaired fasting glucose were considered as cardiometabolic risk factors.<h4>Results</h4>The estimated prevalence of Sev-OB varied widely between the two reference systems. Either using the cut-point ≥ 99(th) percentile or ≥ 1.2 times the 95(th) percentile, less children were defined as Sev-OB by CDC than WHO (46.8 vs. 89.5%, and 63.3 vs. 80.4%, respectively p<0.001). The CDC 99(th) percentile had lower sensitivity (58.5 vs 94.2), higher specificity (57.6 vs 12.3) and higher positive predictive value (34.4 vs 28.9) than WHO in identifying obese children with ≥ 2 cardiometabolic risk factors. These differences were mitigated using the 1.2 times the 95(th) percentile (sensitivity 73.9 vs. 88.1; specificity 40.7 vs. 22.5; positive predictive value 32.1 vs. 30.1). Substantial agreement between growth curves was found using the 1.2 times the 95(th) percentile, in particular in children ≤ 10 years.<h4>Conclusions</h4>Estimates of Sev-OB and cardiometabolic risk as defined by different cut-points of BMI are influenced from the reference systems used. The 1.2 times the 95(th) percentile of BMI of either CDC or WHO standard has a discriminatory advantage over the 99(th) percentile for identifying severely obese children at increased cardiometabolic risk, particularly under 10 years of age.
format	article
author	Giuliana Valerio Claudio Maffeis Antonio Balsamo Emanuele Miraglia Del Giudice Claudia Brufani Graziano Grugni Maria Rosaria Licenziati Paolo Brambilla Melania Manco Childhood Obesity Group of the Italian Society of Pediatric Endocrinology and Diabetology
author_facet	Giuliana Valerio Claudio Maffeis Antonio Balsamo Emanuele Miraglia Del Giudice Claudia Brufani Graziano Grugni Maria Rosaria Licenziati Paolo Brambilla Melania Manco Childhood Obesity Group of the Italian Society of Pediatric Endocrinology and Diabetology
author_sort	Giuliana Valerio
title	Severe obesity and cardiometabolic risk in children: comparison from two international classification systems.
title_short	Severe obesity and cardiometabolic risk in children: comparison from two international classification systems.
title_full	Severe obesity and cardiometabolic risk in children: comparison from two international classification systems.
title_fullStr	Severe obesity and cardiometabolic risk in children: comparison from two international classification systems.
title_full_unstemmed	Severe obesity and cardiometabolic risk in children: comparison from two international classification systems.
title_sort	severe obesity and cardiometabolic risk in children: comparison from two international classification systems.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/3d094178d1c342fb97d3c92a3fe81955
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Severe obesity and cardiometabolic risk in children: comparison from two international classification systems.

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