Original Articles
Severe obesity associated with cardiovascular deconditioning, high prevalence of cardiovascular risk factors, diabetes mellitus/hyperinsulinemia, and respiratory compromise

https://doi.org/10.1016/j.jpeds.2004.03.043Get rights and content

Abstract

Objective

To determine the extent and severity of obesity-related cardiorespiratory morbidity in children with body mass index (BMI) ≥40 kg/m2.

Study design

Cross-sectional analysis of a cohort comprised of 48 boys and girls aged 8 to 17 years with BMI ≥40 kg/m2. Cardiorespiratory fitness (graded cycle exercise test), left ventricular (LV) mass (echocardiography), blood pressure, fasting lipid profile, fasting insulin, fasting glucose, HbA1c, and pulmonary function (spirometry and sleep studies) were measured.

Results

The cohort averaged 14.2 ± 2 years of age with mean BMI of 45.5 kg/m2. Only 2 patients had normal fitness; 37 of 48 had peak oxygen consumption <20 mL O2/minute. Hypertension was present in 10 of 48 patients. Mean lipid values were: triglycerides 103 ± 48 mg/dL, HDL cholesterol 41 ± 10 mg/dL, and LDL cholesterol 108 ± 26 mg/dL. Type II diabetes mellitus was diagnosed in 6 patients. Mean fasting insulin was 31 ± 19 μU/mL. Asthma treatment, small airways disease by pulmonary function testing, or both were present in 35 of 48 patients; upper airway obstruction was present in 7 patients. LV hypertrophy was present in 8 patients, with a mean LV mass of 43 ± 11 g/m2.7.

Conclusions

Children and adolescents with BMI ≥40 kg/m2 have substantial cardiorespiratory morbidity including severe physical deconditioning.

Section snippets

Methods

Forty eight children and adolescents from a specialized center for the management of obesity were studied. The study entry criterion was the presence of BMI ≥40 kg/m2. The cohort represents approximately 80% of patients with BMI ≥40 kg/m2 currently being followed. All study children underwent a complete laboratory evaluation of the cardiac and respiratory systems. Review of medical records for this report was approved by the Institutional Review Board of the A. I. duPont Hospital for Children.

Results

The cohort was comprised of 48 children and adolescents with a mean age of 14.2 years (range, 8-17.6 years); there were 26 girls and 22 boys. Average BMI was 45.5 ± 4.3 kg/m2. Results of the graded exercise test are presented in Table I, stratified by the presence of a maximal or submaximal effort. The rate of those achieving the anaerobic threshold (26/48 [54%]) is well below that of leaner patients who exercised for other indications in our laboratory, about 80%. Those with a submaximal

Discussion

Obese children with BMI ≥40 presenting to a referral center for clinical management have substantial cardiovascular and respiratory morbidity. Severe physical deconditioning, hyperinsulinemia, dyslipidemia, and respiratory abnormalities were present in the majority of patients. Hypertension, LV hypertrophy, and diabetes mellitus were present in 15% to 20%. The average value for LV mass in this cohort is higher than the value obtained in a recent series of children with chronic hypertension.11

References (19)

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