Users Online: 683
Home Print this page Email this page
Home About us Editorial board Search Browse articles Submit article Ahead of Print Instructions Subscribe Contacts Login 


 
Previous article Browse articles Next article 
ORIGINAL ARTICLE
Adv Biomed Res 2016,  5:56

Childhood cardiovascular risk factors, a predictor of late adolescent overweight


Department of Endocrinology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran

Date of Submission28-Dec-2014
Date of Acceptance31-Jan-2015
Date of Web Publication16-Mar-2016

Correspondence Address:
Dr. Saeed Kalantari
Department of Endocrinology, School of Medicine, Guilan University of Medical Sciences, Rasht
Iran
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-9175.178802

Rights and Permissions
  Abstract 

Background: We conducted a prospective study to elucidate the effects of increased cardiovascular risk factors on future weight gain and also the relation between body mass index (BMI) and other cardiovascular risk factors in children and adolescents.
Materials and Methods: This study was conducted on 1525 nonobese children and adolescents with an age range of 3-16 years old, participating in the 1st phase and follow-up phases of Tehran Lipid and Glucose Study. The subjects were evaluated 4 times with a 3-year time interval regarding lipid profile status and BMI, and other cardiovascular disease (CVD) risk factors. All the cases had a BMI <85% and had been appraised in at least two evaluation points.
Results: Cardiovascular risk factors, high-density lipoprotein (HDL) (P = 0.019), low-density lipoprotein (P = 0.016), triglyceride (TG) (P < 0.001), and blood pressure (BP) (P = 0.001); had significant effects on weight gain. There was also no difference between boys and girls and no age trend for increasing weight in both groups. The associations between BMI with cardiovascular risk factors were assessed cross-sectionally. For both sexes, BMI was significantly correlated to systolic and diastolic BP and TG (P = 0.05). For girls, BMI was significantly related to HDL (P = 0.05) regardless to age, but in boys, the relation of BMI with HDL only increased with age (P = 0.05).
Conclusion: Increased CVD risk factors are predictors of future overweight in childhood and adolescent and increased weight is linked significantly with dyslipidemia and hypertension in this age group.

Keywords: Cardiovascular risk factors, children, dyslipidemia, obesity


How to cite this article:
Kalantari S. Childhood cardiovascular risk factors, a predictor of late adolescent overweight. Adv Biomed Res 2016;5:56

How to cite this URL:
Kalantari S. Childhood cardiovascular risk factors, a predictor of late adolescent overweight. Adv Biomed Res [serial online] 2016 [cited 2019 Nov 18];5:56. Available from: http://www.advbiores.net/text.asp?2016/5/1/56/178802


  Introduction Top


Childhood and adolescent obesity is an important factor and is strongly associated with other cardiovascular disease (CVD) risk factors.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22] The incidence of hyperlipidemia, hypertension, and insulin resistance is more in obese children.[4], 5, [23],[24],[25],[26],[27],[28] There are a few reports regarding childhood hypertriglyceridemia [29] and hypercholesterolemia,[30],[31],[32] and other cardiovascular risk factors as a predictor of adolescent obesity and in the literature.

To elucidate this issue and also the relation between body mass index (BMI) and other cardiovascular risk factors, we conducted a community-based prospective study on children and adolescents age 3-16 years and followed them for increasing weight and other CVD risk factors.


  Materials and Methods Top


Subjects

The Tehran Lipid and Glucose Study (TLGS) is a long-term (at least 20 years) large scale community-based prospective study, for prevention of noncommunicable disease by implementation of a healthy lifestyle modification and reduction of coronary artery disease (CAD) risk factors. A total of 15,005, residents of district 13 of Tehran, aged 3 years and over were selected by multistage cluster random sampling method. Age distribution and socioeconomic status of the population in the district no. 13 are delegate of the overall population of Tehran.[33]

This study was conducted on 1525 nonobese children and adolescents (723 boys and 802 girls) with an age range of 3–16 years old (mean 10.65 ± 3.75), participating in the 1st phase and follow-up of TLGS. The subjects were evaluated 4 times with a 3-year time interval regarding lipid profile status and BMI and other CVD risk factors. All the cases had a BMI <85% and had been appraised in at least two evaluation points. The data was gathered for age, weight, height, blood pressure (BP), lipid profile (total cholesterol, low-density lipoprotein [LDL], high-density lipoprotein-cholesterol [HDL-C], triglyceride [TG], and non-HDL-C), and glucose concentrations. To evaluate the relation between BMI and cardiovascular risk factors, hypercholesterolemia was used as a predefined risk factor and subjects were categorized into hypercholesterolemic and nonhypercholesterolemic groups.

Baseline characteristics of subjects are shown in [Table 1].
Table 1: Baseline characteristics of subjects

Click here to view


According to National Heart, Lung, and Blood Institute (NHLBI) panel report,[34] subjects with age and sex-specific elevations in LDL-C concentration >75th percentile at all 4 evaluation points were classified as hypercholesterolemic. Subjects with LDL-C persistently less than the 75th percentile were considered nonhypercholesterolemic. Serum TG, non-HDL-C <75%, and serum HDL-C >20% were considered normal. Fasting blood sugar (FBS) >100 mg/dl was reported as abnormal.

The informed written consent from the parents of guardians of all children and adolescents participating in the study was obtained.

Anthropometric assessment

Trained medical doctors and personnel collected the information and samples according to the standard methods. Height and weight were measured to ± 0.1 cm and ± 0.1 kg, respectively. BMI was calculated by dividing weight in kilograms to the square of height in meters. Waist circumference was assessed by measuring the waist girth at the level of the umbilicus. Obesity and overweight in children and adolescents were defined according to international cut-off points for BMI.[35]

On the basis of the circumference of the participant's arm, a pediatric, regular adult of a large cuff was used on the right arm at the heart level. BP was measured in 2 replicates with at least a 30-s interval while they were in a relaxed sitting position. The systolic BP was recorded at the 1st Korotkoff phase (appearance of the 1st sound) and diastolic BP was measured at the 5th Korotkoff phase (disappearance of the sound). According to NHLBI panel report, age, sex, and height matched systolic and diastolic BP <90% were taken into accounted as normal.[36].

Laboratory analysis

A blood sample was drawn between 7:00 and 9:00 am. After 12–14 h overnight fast. Samples were centrifuged within 30-45 min of collection and sent to TLGS Research Laboratory (RL) on the day of blood collection.

Total cholesterol and TG were measured by enzymatic colorimetric method (Iran Pars Azmun) on Selectra II auto analyzer. The coefficient of variations was calculated 2.2 and 1.6%, respectively. HDL was measured after precipitation of non-HDL lipoproteins with an enzymatic method of CHOD-PAP. HDL-C concentration was deduced from total cholesterol for non-HDL-C calculation. LDL-C was calculated with Friedwall formula in samples with TG >400 mg/dl. Blood glucose concentrations were measured by a glucose analyzer with standard chemical procedures in TLGS RL.

Baseline characteristics, lipid profile, and other CVD risk factors of the subjects were compared, using one-way analysis of variance [Table 1] and [Table 2]. To assess the changes in weight in subjects with abnormal lipid profiles and cardiovascular risk factors (FBS and BP) repeated-measures analysis of variance was used with BMI as the dependent variable and age, sex [Figure 1].
Table 2: Baseline characteristics of hypercholesterolemic and nonhypercholesterolemic subjects

Click here to view
Figure 1: Serum lipids, fasting blood sugar and blood pressure in relation to weight status (body mass index, kg/m2) in each phase of the study. There was no difference between the two sexes

Click here to view


Spearman's correlation was used to determine the associations among BMI, BP, glucose, and lipid concentrations for hypercholesterolemic and nonhypercholesterolemic subjects [Table 3] and [Table 4]. Statistical significance was defined as a P ≤ 0.05 and data were analyzed by the statistical package for the social sciences (SPSS) 19 (SPSS Inc., Chicago, IL, USA).
Table 3: Spearman's correlation coefficients (r) between BMI and other cardiovascular risk factors for boys by age group

Click here to view
Table 4: Spearman's correlation coefficients (r) between BMI and other cardiovascular risk factors for girls by age group

Click here to view



  Results Top


There was a significant difference in BMI, systolic BP, glucose, and TG at baseline between boys and girls [Table 1]. There were 354 (25%) hypercholesteromic and 1057 (75%) nonhypercholestromic children identified. Hypertriglyceridemia and low HDL were observed in 362 (25.3%) and 321 (22.7%) of cases, respectively. 365 (25.8%) of cases had increased serum non-HDL-C level. Abnormal BP and blood glucose were detected in 320 (21.95%) and 91 (6.4%) of subjects orderly. Baseline characteristics of the cases are shown in [Table 2]. BMI was significantly higher in girls (17.18 ± vs. 16.71 ± 2.68, P < 0.05). There was a notable difference in systolic BP between boys and girls (P < 0.05) and in diastolic BP by LDL status (P < 0.05). Glucose was significantly more in boys (P < 0.05). TG concentrations were higher in girls and by LDL status in both sexes (P < 0.05) [Table 2].

To assess the longitudinal changes in relative weight, separate repeated-measures analysis of variance were completed, with BMI as the dependent variable and HDL, LDL, non-HDL, TG, FBS, and BP as independent variables. All analyses were adjusted for age and sex. Significant effects were found for the following factors: HDL (P = 0.019), LDL (P = 0.016), TG (P < 0.001), and BP (P = 0.001); nonsignificant factors were non-HDL and FBS (P = 0.258 and 0.446, respectively). To take into account the individual effects of independent variables on BMI, independent variables were concurrently considered in repeated-measures analysis of variance. The relation between BMI and age, sex, and LDL, TG, HDL, BP, and FBS did not change after the adjustment for baseline independent variables concentrations. There was also no difference between boys and girls and no age trend for increasing weight in both groups [Figure 1].

The associations among BMI, BP, glucose, and lipid concentrations were assessed cross-sectionally with the use of Spearman's correlations at the 4 phases of the study for the hypercholesterolemic and nonhypercholesterolemic girls and boys [Table 3] and [Table 4], respectively].

For both sexes, BMI was significantly correlated to systolic and diastolic BP and TG (P = 0.05). For girls, BMI was significantly related to HDL (P = 0.05), but in boys, the relation of BMI with HDL increased with age (P = 0.05). There was no noticeable difference between hypercholesterolemic and nonhypercholesterolemic subjects in either sex. BMI was significantly related to FBS only in hypercholesterolemic girls at 1st and 4th phases and in boys at 1st phase of the study.


  Discussion Top


In this longitudinal study, we observed that increased CVD risk factors are predictors of overweight risk in adolescents. This is discordant with literature reporting the precedence of obesity to theses CVD risk factors.[4],[5],[9],[10],[23],[24],[25],[26],[27],[28] Our findings are consistent with others reporting age-related increase in weight in children and adolescents with high cholesterol, TG, BP, and low HDL serum concentrations [29],[30] and in contrast to Byrnes's study [37] observing no relationship between weight change and plasma levels of HDL-C and TG in a 12 months period. We could not also identify any difference between boys and girls in developing overweight at follow-up. This is in keeping with Savva's study [29] and in contrast with Tershakovec's survey reporting increased relative weight in girls.[30] In the present study, we were unable to find any age trend for increasing weight in either sex. This finding is opposed with others explaining a greater increment in BMI from 5 to 12 years in girls [30] and between 6 and 10 years in both sexes.[31]

Studies focusing on the expression of other cardiovascular risk factors, especially in hyperlipidemic children are limited. As opposed to our study most surveys stress on evaluating cardiovascular risk factors in children without predefined risk factors, like hypercholesterolemia.[1],[2],[3],[4],[7],[8],[10],[11],[38] Our data complying with others [30],[39] illustrated a significant correlation between BMI and other cardiovascular risk factors. In the present study, BMI was significantly correlated to systolic and diastolic BP and TG in both sexes. This is in line with other studies reporting three-fold higher risk of hypertension in overweight and obese children and adolescents especially for those who had BMI ≥ 95th percentile for age and sex.[40],[41]

The existing literature indicates that dyslipidemia occurs among overweight and obese children and adolescents, particularly those with a central fat distribution [42],[43] and especially with a positive family history of premature CAD.[44] The typical pattern is one of the elevated concentrations of serum LDL-C and TGs and decreased concentration of HDL-C.[13],[41],[45]

This is in agreement with our findings that BMI was significantly related to TG and inversely to HDL concentrations but in contrast not to hypercholesterolemia. Tershakovec's study [30] suggested that as was shown by the association between BMI and lipid concentrations, obesity further intensifies dyslipidemia especially in girls. In contrast, we could not demonstrate a noticeable difference between hypercholesterolemic and nonhypercholesterolemic subjects in either sex. It implies that increasing weight does not exacerbate dyslipidemia in our cases surprisingly. Contrasting to other studies which indicate age-related cardiovascular risk factors in children,[1],[10],[30],[46] we failed to find this age-related association except for HDL in boys.

Impaired glucose tolerance, which predicts the development of diabetes, is a common complication of childhood and adolescent obesity.[47],[48] In a study of >6000 students in the sixth grade with average age 11.8 years,[49],[50] impaired fasting glucose (fasting blood glucose ≥ 100 mg/dL) was present in 15.5% of overweight children, 20.2% of obese children, and 22.5% of severely obese children. In other population of obese children and adolescents, the prevalence of impaired glucose tolerance ranges from 7% to 13.5%, and the prevalence of type 2 diabetes was <1%.[51],[52] Type 2 diabetes mellitus (T2DM) is another comorbidity of obesity in children and adolescents.[53],[54],[55] In the Sinha's study, 4% of adolescents with BMI ≥ 95th percentile for age and sex had asymptomatic T2DM.[56] In accord with these studies, we were able to represent that BMI was significantly related to FBS in some occasions during our survey, but in contrast there was no case of T2DM detected.

A recent review article has reported the highest prevalence of childhood overweight in Eastern Europe and the Middle East.[57] In a study on 4500 randomly selected children aged 2-18 years in Iran, serum lipid levels were significantly higher than standard values in both sexes and all age groups. The increase in serum lipid levels was most marked in teenagers.[58]

Despite the familial propensity for obesity [59] and consistency of our findings with some other studies, we were not able to explain the rational for the predication of future adiposity by cardiovascular risk factors. Perhaps it might be a genetic susceptibility for weight gain in whom with CAD risk factors, so more studies are warranted to elucidate this issue. As a practical point hyperlipidemia and overweight in children should be managed to prevent future cardiovascular events. Although data from adult studies demonstrate a low risk of adverse side effects with statins,[60],[61],[62] similar long-term data regarding outcome are not available in children,[63] so changing dietary practices, e.g., improper intake of high amounts of saturated fat,[64] therapeutic lifestyle changes, and maintenance of regular physical activity through parental initiative and social support interventions are the most important strategies in managing future risk of these adverse events.


  Conclusion Top


Contradictory to the general opinion that obesity is associated with increased CVD risk factors in childhood and adolescents, we identified the reverse association, that is, increased CVD risk factors are predictors of future overweight. On the other hand, increased weight is linked significantly with dyslipidemia and hypertension in these age groups.


  Acknowledgments Top


The author would like to express his sincere gratitude to the Tehran Shahid Beheshty Endocrine and Metabolism Research Center especially professor Feraidon Azizi for the providing the author with the TLGS data.

 
  References Top

1.
Webber LS, Voors AW, Srinivasan SR, Frerichs RR, Berenson GS. Occurrence in children of multiple risk factors for coronary artery disease: The Bogalusa heart study. Prev Med 1979;8:407-18.  Back to cited text no. 1
[PUBMED]    
2.
Wilmore JH, McNamara JJ. Prevalence of coronary heart disease risk factors in boys, 8 to 12 years of age. J Pediatr 1974;84:527-33.  Back to cited text no. 2
[PUBMED]    
3.
Lauer RM, Connor WE, Leaverton PE, Reiter MA, Clarke WR. Coronary heart disease risk factors in school children: The Muscatine study. J Pediatr 1975;86:697-706.  Back to cited text no. 3
[PUBMED]    
4.
Raitakari OT, Porkka KV, Rönnemaa T, Knip M, Uhari M, Akerblom HK, et al. The role of insulin in clustering of serum lipids and blood pressure in children and adolescents. The Cardiovascular Risk in Young Finns Study. Diabetologia 1995;38:1042-50.  Back to cited text no. 4
    
5.
Guo S, Salisbury S, Roche AF, Chumlea WC, Siervogel RM. Cardiovascular disease risk factors and body composition: A review. Nutr Res 1994;11:1721-77.  Back to cited text no. 5
    
6.
Chen W, Srinivasan SR, Elkasabany A, Berenson GS. Cardiovascular risk factors clustering features of insulin resistance syndrome (syndrome X) in a biracial (black-white) population of children, adolescents, and young adults: The Bogalusa Heart Study. Am J Epidemiol 1999;150:667-74.  Back to cited text no. 6
    
7.
Burke GL, Webber LS, Srinivasan SR, Radhakrishnamurthy B, Freedman DS, Berenson GS. Fasting plasma glucose and insulin levels and their relationship to cardiovascular risk factors in children: Bogalusa Heart Study. Metabolism 1986;35:441-6.  Back to cited text no. 7
[PUBMED]    
8.
Jiang X, Srinivasan SR, Webber LS, Wattigney WA, Berenson GS. Association of fasting insulin level with serum lipid and lipoprotein levels in children, adolescents, and young adults: The Bogalusa Heart Study. Arch Intern Med 1995;155:190-6.  Back to cited text no. 8
    
9.
Boulton TJ, Johnston O. A coronary risk-factor profile of 4 year olds. II. Inter-relationships, clustering, and tracking of blood pressure, serum lipoproteins, and skinfold thickness. Aust Paediatr J 1978;14:278-82.  Back to cited text no. 9
    
10.
Smoak CG, Burke GL, Webber LS, Harsha DW, Srinivasan SR, Berenson GS. Relation of obesity to clustering of cardiovascular disease risk factors in children and young adults. The Bogalusa Heart Study. Am J Epidemiol 1987;125:364-72.  Back to cited text no. 10
[PUBMED]    
11.
Jiang X, Srinivasan SR, Urbina E, Berenson GS. Hyperdynamic circulation and cardiovascular risk in children and adolescents. The Bogalusa Heart Study. Circulation 1995;91:1101-6.  Back to cited text no. 11
    
12.
Brambilla P, Manzoni P, Sironi S, Simone P, Del Maschio A, di Natale B, et al. Peripheral and abdominal adiposity in childhood obesity. Int J Obes Relat Metab Disord 1994;18:795-800.  Back to cited text no. 12
    
13.
Caprio S, Hyman LD, McCarthy S, Lange R, Bronson M, Tamborlane WV. Fat distribution and cardiovascular risk factors in obese adolescent girls: Importance of the intraabdominal fat depot. Am J Clin Nutr 1996;64:12-7.  Back to cited text no. 13
    
14.
Monti LD, Brambilla P, Stefani I, Caumo A, Magni F, Poma R, et al. Insulin regulation of glucose turnover and lipid levels in obese children with fasting normoinsulinaemia. Diabetologia 1995;38:739-47.  Back to cited text no. 14
    
15.
Islam AH, Yamashita S, Kotani K, Nakamura T, Tokunaga K, Arai T, et al. Fasting plasma insulin level is an important risk factor for the development of complications in Japanese obese children – results from a cross-sectional and a longitudinal study. Metabolism 1995;44:478-85.  Back to cited text no. 15
    
16.
Agostoni C, Riva E, Bellù R, Vincenzo SS, Grazia BM, Giovannini M. Relationships between the fatty acid status and insulinemic indexes in obese children. Prostaglandins Leukot Essent Fatty Acids 1994;51:317-21.  Back to cited text no. 16
    
17.
Frerichs RR, Webber LS, Srinivasan SR, Berenson GS. Relation of serum lipids and lipoproteins to obesity and sexual maturity in white and black children. Am J Epidemiol 1978;108:486-96.  Back to cited text no. 17
[PUBMED]    
18.
Shear CL, Freedman DS, Burke GL, Harsha DW, Berenson GS. Body fat patterning and blood pressure in children and young adults. The Bogalusa Heart Study. Hypertension 1987;9:236-44.  Back to cited text no. 18
[PUBMED]    
19.
Kikuchi DA, Srinivasan SR, Harsha DW, Webber LS, Sellers TA, Berenson GS. Relation of serum lipoprotein lipids and apolipoproteins to obesity in children: The Bogalusa Heart Study. Prev Med 1992;21:177-90.  Back to cited text no. 19
    
20.
Zwiauer KF, Pakosta R, Mueller T, Widhalm K. Cardiovascular risk factors in obese children in relation to weight and body fat distribution. J Am Coll Nutr 1992;11 Suppl: 41S-50.  Back to cited text no. 20
    
21.
Rönnemaa T, Knip M, Lautala P, Viikari J, Uhari M, Leino A, et al. Serum insulin and other cardiovascular risk indicators in children, adolescents and young adults. Ann Med 1991;23:67-72.  Back to cited text no. 21
    
22.
Le Stunff C, Bougnères PF. Time course of increased lipid and decreased glucose oxidation during early phase of childhood obesity. Diabetes 1993;42:1010-6.  Back to cited text no. 22
    
23.
Walker M. Obesity, insulin resistance, and its link to noninsulin-dependent diabetes mellitus. Metabolism 1995;44:18-20.  Back to cited text no. 23
    
24.
Kissebah AH, Peiris AN. Biology of regional body fat distribution: Relationship to non-insulin-dependent diabetes mellitus. Diabetes Metab Rev 1989;5:83-109.  Back to cited text no. 24
    
25.
Howard BV, Mayer-Davis EJ, Goff D, Zaccaro DJ, Laws A, Robbins DC, et al. Relationships between insulin resistance and lipoproteins in nondiabetic African Americans, Hispanics, and non-Hispanic whites: The Insulin Resistance Atherosclerosis Study. Metabolism 1998;47:1174-9.  Back to cited text no. 25
    
26.
Blaak EE, Saris WH, Wolffenbuttel BH. Substrate utilization and thermogenic responses to beta-adrenergic stimulation in obese subjects with NIDDM. Int J Obes Relat Metab Disord 1999;23:411-8.  Back to cited text no. 26
    
27.
Okosun IS, Cooper RS, Prewitt TE, Rotimi CN. The relation of central adiposity to components of the insulin resistance syndrome in a biracial US population sample. Ethn Dis 1999;9:218-29.  Back to cited text no. 27
    
28.
Parks EJ, Hellerstein MK. Carbohydrate-induced hypertriacylglycerolemia: Historical perspective and review of biological mechanisms. Am J Clin Nutr 2000;71:412-33.  Back to cited text no. 28
    
29.
Savva SC, Kourides Y, Epiphaniou-Savva M, Tornaritis M, Kafatos A. Short-term predictors of overweight in early adolescence. Int J Obes 2004;28:451-8.  Back to cited text no. 29
    
30.
Tershakovec AM, Jawad AF, Stouffer NO, Elkasabany A, Srinivasan SR, Berenson GS. Persistent hypercholesterolemia is associated with the development of obesity among girls: The Bogalusa Heart Study. Am J Clin Nutr 2002;76:730-5.  Back to cited text no. 30
    
31.
Tershakovec AM, Jawad AF, Stallings VA, Cortner JA, Zemel BS, Shannon BM. Age-related changes in cardiovascular disease risk factors of hypercholesterolemic children. J Pediatr 1998;132:414-20.  Back to cited text no. 31
    
32.
Bao W, Srinivasan SR, Wattigney WA, Bao W, Berenson GS. Usefulness of childhood low-density lipoprotein cholesterol level in predicting adult dyslipidemia and other cardiovascular risks. The Bogalusa Heart Study. Arch Intern Med 1996;156:1315-20.  Back to cited text no. 32
[PUBMED]    
33.
Azizi F, Rahmani M, Emami H, Madjid M. Tehran lipid and glucose study: Rationale and design. CVD Prev 2000;3:242-7.  Back to cited text no. 33
    
34.
Daniels SR, Benuck I, Christakis DA, Dennison BA, Gidding SS, Gillman MW, et al. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents. Pediatrics 2011;128;S213.  Back to cited text no. 34
    
35.
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ 2000;320:1240-3.  Back to cited text no. 35
    
36.
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114 2 Suppl 4th Report: 555-76.  Back to cited text no. 36
    
37.
Byrnes SE, Baur LA, Bermingham M, Brock K, Steinbeck K. Leptin and total cholesterol are predictors of weight gain in pre-pubertal children. Int J Obes Relat Metab Disord 1999;23:146-50.  Back to cited text no. 37
    
38.
Arslanian S, Suprasongsin C. Differences in the in vivo insulin secretion and sensitivity of healthy black versus white adolescents. J Pediatr 1996;129:440-3.  Back to cited text no. 38
    
39.
Braun B, Zimmermann MB, Kretchmer N, Spargo RM, Smith RM, Gracey M. Risk factors for diabetes and cardiovascular disease in young Australian aborigines. A 5-year follow-up study. Diabetes Care 1996;19:472-9.  Back to cited text no. 39
    
40.
Sinaiko AR, Donahue RP, Jacobs DR Jr, Prineas RJ. Relation of weight and rate of increase in weight during childhood and adolescence to body size, blood pressure, fasting insulin, and lipids in young adults. The Minneapolis Children's Blood Pressure Study. Circulation 1999;99:1471-6.  Back to cited text no. 40
    
41.
Friedemann C, Heneghan C, Mahtani K, Thompson M, Perera R, Ward AM. Cardiovascular disease risk in healthy children and its association with body mass index: Systematic review and meta-analysis. BMJ 2012;345:e4759.  Back to cited text no. 41
    
42.
Sorof J, Daniels S. Obesity hypertension in children: A problem of epidemic proportions. Hypertension 2002;40:441-7.  Back to cited text no. 42
    
43.
Dietz WH. Health consequences of obesity in youth: Childhood predictors of adult disease. Pediatrics 1998;101:518-25.  Back to cited text no. 43
[PUBMED]    
44.
Kelishadi R, Zadegan NS, Naderi GA, Asgary S, Bashardoust N. Atherosclerosis risk factors in children and adolescents with or without family history of premature coronary artery disease. Med Sci Monit 2002;8:CR425-9.  Back to cited text no. 44
    
45.
Kelishadi R, Pour MH, Sarraf-Zadegan N, Sadry GH, Ansari R, Alikhassy H, et al. Obesity and associated modifiable environmental factors in Iranian adolescents: Isfahan Healthy Heart Program-Heart Health Promotion from Childhood. Pediatr Int 2003;45:435-42.  Back to cited text no. 45
    
46.
Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: The Bogalusa Heart Study. Pediatrics 1999;103:1175-82.  Back to cited text no. 46
    
47.
Williams DE, Cadwell BL, Cheng YJ, Cowie CC, Gregg EW, Geiss LS, et al. Prevalence of impaired fasting glucose and its relationship with cardiovascular disease risk factors in US adolescents, 1999-2000. Pediatrics 2005;116:1122-6.  Back to cited text no. 47
    
48.
Sabin MA, Ford AL, Holly JM, Hunt LP, Crowne EC, Shield JP. Characterisation of morbidity in a UK, hospital based, obesity clinic. Arch Dis Child 2006;91:126-30.  Back to cited text no. 48
    
49.
Healthy Study Group, Kaufman FR, Hirst K, Linder B, Baranowski T, Cooper DM, et al. Risk factors for type 2 diabetes in a sixth- grade multiracial cohort: The HEALTHY study. Diabetes Care 2009;32:953-5.  Back to cited text no. 49
[PUBMED]    
50.
Marcus MD, Baranowski T, DeBar LL, Edelstein S, Kaufman FR, Schneider M, et al. Severe obesity and selected risk factors in a sixth grade multiracial cohort:The HEALTHY study. J Adolesc Health 2010;47:604-7.  Back to cited text no. 50
    
51.
Shalitin S, Abrahami M, Lilos P, Phillip M. Insulin resistance and impaired glucose tolerance in obese children and adolescents referred to a tertiary-care center in Israel. Int J Obes (Lond) 2005;29:571-8.  Back to cited text no. 51
    
52.
Maffeis C, Pinelli L, Brambilla P, Banzato C, Valzolgher L, Ulmi D, et al. Fasting plasma glucose (FPG) and the risk of impaired glucose tolerance in obese children and adolescents. Obesity (Silver Spring) 2010;18:1437-42.  Back to cited text no. 52
    
53.
Molnár D. The prevalence of the metabolic syndrome and type 2 diabetes mellitus in children and adolescents. Int J Obes Relat Metab Disord 2004;28 Suppl 3:S70-4.  Back to cited text no. 53
    
54.
Pinhas-Hamiel O, Dolan LM, Daniels SR, Standiford D, Khoury PR, Zeitler P. Increased incidence of non-insulin-dependent diabetes mellitus among adolescents. J Pediatr 1996;128:608-15.  Back to cited text no. 54
    
55.
Goran MI, Davis J, Kelly L, Shaibi G, Spruijt-Metz D, Soni SM, et al. Low prevalence of pediatric type 2 diabetes: Where's the epidemic? J Pediatr 2008;152:753-5.  Back to cited text no. 55
    
56.
Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K, et al. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med 2002;346:802-10.  Back to cited text no. 56
    
57.
Gupta N, Goel K, Shah P, Misra A. Childhood obesity in developing countries: Epidemiology, determinants, and prevention. Endocr Rev 2012;33:48-70.  Back to cited text no. 57
    
58.
Kelishadi R, Hashemipour M, Sarraf-Zadegan N, Amiri M. Trend of atherosclerosis risk factors in children of Isfahan. Asian Cardiovasc Thorac Ann 2001;9:36-40.  Back to cited text no. 58
    
59.
Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 1997;337:869-73.  Back to cited text no. 59
    
60.
Kashani A, Phillips CO, Foody JM, Wang Y, Mangalmurti S, Ko DT, et al. Risks associated with statin therapy: A systematic overview of randomized clinical trials. Circulation 2006;114:2788-97.  Back to cited text no. 60
    
61.
Armitage J. The safety of statins in clinical practice. Lancet 2007;370:1781-90.  Back to cited text no. 61
    
62.
Kalantari S, Naghipour M. Statin therapy and hepatotoxicity: Appraisal of the safety profile of atorvastatin in hyperlipidemic patients. Adv Biomed Res 2014;3:168.  Back to cited text no. 62
[PUBMED]  Medknow Journal  
63.
Psaty BM, Rivara FP. Universal screening and drug treatment of dyslipidemia in children and adolescents. JAMA 2012;307:257-8.  Back to cited text no. 63
    
64.
Kelishadi R, Hashemi Pour M, Sarraf-Zadegan N, Kahbazi M, Sadry G, Amani A, et al. Dietary fat intake and lipid profiles of Iranian adolescents: Isfahan Healthy Heart Program-Heart Health Promotion from Childhood. Prev Med 2004;39:760-6.  Back to cited text no. 64
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

Top
Previous article  Next article
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
Acknowledgments
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed696    
    Printed13    
    Emailed0    
    PDF Downloaded147    
    Comments [Add]    

Recommend this journal