Childhood Obesity and Cardiovascular Health: Using 2010-2012 Data of the Korea National Health and Nutrition Examination Survey

Go Eun Lee; Jina Choo

doi:10.15384/kjhp.2017.17.2.109

Korean J Health Promot > Volume 17(2); 2017 > Article

Childhood Obesity and Cardiovascular Health: Using 2010-2012 Data of the Korea National Health and Nutrition Examination Survey

Original Article

Korean Journal of Health Promotion 2017;17(2):109-118.

Published online: January 19, 2017

DOI: https://doi.org/10.15384/kjhp.2017.17.2.109

Childhood Obesity and Cardiovascular Health: Using 2010-2012 Data of the Korea National Health and Nutrition Examination Survey

Go Eun Lee, Jina Choo

College of Nursing, Korea University, Seoul, Korea

Corresponding author : Jina Choo, PhD, DrPH, RN College of Nursing, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Korea
Tel: +82-2-3290-4925, Fax: +82-2-3290-9127 E-mail: jinachoo@korea.ac.kr

Received April 11, 2017 Accepted June 13, 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

요약

Background:

Abdominal obesity as measured by waist-to-height ratio (WHtR) may have stronger and inverse associations with cardiovascular (CV) health than overall obesity as measured by body mass index (BMI). However, there was some challenges for controversies. We aimed to examine the associations of WHtR and BMI with CV health among Korean children using data of the 2010-2012 Korea National Health and Nutrition Examination Survey.

Methods:

A cross-sectional study was conducted with the sample of 2,363 children by analyzing by gender and two-age groups (10-12 and 13-18 years). Overall obesity was categorized into 3 groups by BMI percentile: non-overweight (<85), overweight (≥85), and obesity groups (≥95). Abdominal obesity was categorized into 2 groups by WHtR: normal (<0.5) and abdominal obesity groups (≥0.5). The CV health score was defined as a z-score by calculating the sum of 7 CV factors.

Results:

The overweight/obesity groups had significantly lower CV health scores than the normal group (P<0.05) in boys and girls aged either 10-12 years or 13-18 years after adjusting for covariates. The abdominal obesity group also showed significantly lower CV health scores than the normal group (P<0.05) in all the groups; this significant association remained significant in boys aged 13-18 years even after further adjusting for BMI category (P<0.01).

Conclusions:

Among boys aged 13-18 years, abdominal obesity as measured by WHtR was significantly and inversely associated with CV health, independent of BMI category. Therefore, it should be considered to assess the level of abdominal obesity as a measure of CV health in late adolescent boys.

Keywords: Obesity, Obesity, abdominal, Cardiovascular disease, Risk factors, Adolescents

Table 1.

Participant's general characteristics (n=2,363)

	Total (n=2,363)	Girls (n=1,093)	Boys (n=1,270)	t/χ2	P
Sociodemographic characteristics
Age	13.7 (0.05)	13.7 (0.07)	13.74 (0.08)	0.07	0.940
Parents’ highest education				0.84	0.840
<College	1,506 (67.3)	707 (68.2)	799 (66.6)
≥College	731 (32.7)	330 (31.8)	401 (33.4)
Household monthly income				1.66	0.198
≤Low	264 (11.2)	132 (12.1)	132(10.4)
≥Med-low	2,098 (88.8)	961 (87.9)	1,137(89.6)
Family type				2.75	0.098
Normal	1,893 (80.1)	892 (81.6)	1,001 (78.9)
Vulnerable	469 (19.9)	201 (18.4)	268 (21.1)
Health-behavioral characteristics
Energy intake, kcal	2,183.6 (18.4)	1,928.9 (23.3)	2,407.7 (26.1)	13.67	<0.001
Physical activity				30.70	<0.001
≥1 day	914 (51.4)	359 (44.2)	555 (57.4)
None	865 (48.6)	453 (55.8)	412 (42.6)
Menarche status
Yes		798 (73.8)
No		283 (26.2)
Anthropometric characteristics
BMI category
Total				2.57	0.277
Non-overweight	1,920 (81.3)	901 (82.4)	1,019 (80.3)
Overweight	273 (11.6)	114 (10.4)	159 (12.5)
Obesity	169 (7.2)	78 (7.1)	91 (7.2)
Ages 10-12 years (n=852)				5.99	0.050
Non-overweight	689 (80.9)	331 (84.4)	358 (77.8)
Overweight	106 (12.4)	40 (10.2)	66 (14.3)
Obesity	57 (6.7)	21 (5.4)	36 (7.8)
Ages 13-18 years (n=1,511)				1.21	0.547
Non-overweight	1231 (81.5)	570 (81.3)	661 (81.7)
Overweight	167 (11.1)	74 (10.6)	93 (11.5)
Obesity	112 (7.4)	57 (8.1)	55 (6.8)
WHtR category
Total				23.69	<0.001
Normal (<0.5)	2,091 (88.6)	1,005 (92.0)	1,086 (85.6)
Abdominal obesity (≥0.5)	269 (11.4)	87 (8.0)	182 (14.4)
Ages 10-12 years (n=852)				34.52	<0.001
Normal (<0.5)	739 (86.7)	369 (94.1)	370 (80.4)
Abdominal obesity (≥0.5)	113 (13.3)	23 (5.9)	90 (19.6)
Ages 13-18 years (n=1,511)				2.04	0.175
Normal (<0.5)	1,352 (89.7)	636 (90.9)	716 (88.6)
Abdominal obesity (≥0.5)	156 (10.3)	64 (9.1)	92 (11.4)

Abbreviations: BMI, body mass index; WHtR, waist-to-height ratio.

Values are presented as n (weighted %), weighted mean (standard error).

Table 2.

Associations between overall obesity and cardiovascular health (n=2,363)　

	β (SE)^a
	SBP, mmHg	DBP, mmHg	Glucose, mg/dL	TC, mg/dL	HDL-C, mg/dL	LDL-C, mg/dL	Triglycerides, mg/dL	CV health score
Ages 10-12 years (n=852)
Boys Overweight	6.1 (1.47)^d	2.5 (1.97)^d	2.7 (1.66)^c	2.6 (4.58)	-7.2 (1.46)^d	3.5 (3.67)	38.4 (8.14)^d	-2.9 (0.51)^d
Obesity	9.6 (1.99)^d	6.6 (2.03)^d	4.1 (1.37)	18.4 (9.34)	-6.1 (2.95)^b	16.8 (7.61)^b	31.4 (7.53)^d	-5.2 (0.92)^d
Girls
Overweight	4.1 (1.62)^b	2.7 (1.43)	2.3 (1.19)	1.9 (4.81)	-6.0 (2.12)^c	-1.5 (7.00)	47.3 (29.78)	-2.5 (0.83)^c
Obesity	6.0 (2.52)^b	0.0 (2.51)	2.7 (1.52)	2.2 (7.65)	-10.9 (2.10)^d	1.2 (8.61)	59.7 (18.44)^c	-3.0 (0.97)^c
Ages 13-18 years (n=1,511) Boys
Overweight	9.1 (1.43)^d	3.3 (1.24)^c	1.4 (0.97)	14.5 (3.57)^d	-5.7 (1.02)^d	12.1 (3.52)^c	40.0 (10.11)^d	-3.1 (0.42)^d
Obesity	11.2 (1.78)^d	4.4 (1.97)^b	-0.5 (1.19)	28.3 (8.70)^c	-6.5 (1.67)^d	24.1 (7.08)^c	53.4 (9.39)^d	-5.2 (0.98)^d
Girls
Overweight	3.7 (1.71)^b	1.5 (1.43)	0.7 (1.06)	1.5 (4.08)	-5.5 (1.51)^d	3.4 (3.49)	18.2 (8.02)^b	-1.5 (0.57)^c
Obesity	2.6 (1.67)	0.6 (1.38)	5.7 (2.84)^b	11.2 (6.88)	-8.8 (1.69)^d	12.6 (5.28)^b	37.3 (13.24)^c	-3.4 (0.89)^d

Abbreviations: SE, standard error; SBP, systolic blood pressure; DBP, diastolic blood pressure; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; CV, cardiovascular.

^b P<0.05.

^c P<0.01.

^d P<0.001.

Table 3.

Associations between waist-to-height ratio and cardiovascular health (n=2,363)　

β (SE)^a
	SBP, mmHg	DBP, mmHg	Glucose, mg/dL	TC, mg/dL	HDL-C, mg/dL	LDL-C, mg/dL	Triglycerides, mg/dL	CV health score
Model I
Ages 10-12 years (n=852)
Boys
Abdominal obesity	7.1 (1.42)^d	0.9 (1.67)	1.7 (0.99)	8.9 (5.17)	-4.9 (1.60)^c	8.1 (4.11)	29.0 (6.65)^d	-2.8 (0.63)^d
Girls Abdominal obesity	4.9 (2.37)^b	1.7 (2.27)	3.5 (1.34)^c	1.2 (5.58)	-9.3 (1.95)^d	3.9 (6.36)	32.5 (18.0)	-2.9 (0.98)^c
Ages 13-18 years (n=1,511)
Boys
Abdominal obesity	9.1 (1.54)^d	4.3 (1.48)^c	0.5 (0.88)	23.3 (5.95)^d	-6.6 (1.10)^d	20.4 (4.97)^d	47.6 (9.00)^d	-4.4 (0.65)^d
Girls Abdominal obesity	1.6 (1.61)	-0.5 (1.23)	4.8 (2.60)	10.3 (6.23)	-7.4 (1.70)^d	11.1 (4.82)^b	33.4 (12.09)^c	-2.9 (0.83)^d
Model II
Ages 10-12 years (n=852)
Boys
Abdominal obesity	2.8 (2.18)	-6.0 (3.04)	-2.1 (2.13)	2.8 (6.38)	0.6 (2.31)	1.1 (5.09)	5.4 (8.43)	0.6 (0.75)
Girls
Abdominal obesity	1.5 (2.38)	1.6 (2.51)	2.5 (1.46)	-0.6 (6.62)	-3.8 (2.53)	5.8 (7.70)	-13.1 (22.64)	-1.2 (1.16)
Ages 13-18 years (n=1,511)
Boys
Abdominal obesity	1.2 (2.26)	2.6 (1.84)	1.0 (1.38)	9.9 (6.00)	-4.1 (1.22)^c	10.0 (5.56)	19.6 (15.90)	-1.8 (0.64)^c
Girls
Abdominal obesity	-1.8 (2.57)	-2.7 (1.90)	1.8 (2.07)	5.3 (5.37)	-1.1 (2.28)	4.2 (5.39)	10.9 (9.89)	-0.8 (0.69)

^a Standardized coefficient adjusted for age, household monthly income, parents’ highest education and family type; further controlled menarche status for girls; further controlled energy intake and physical activity for age 13-18 years. Model I, adjusted model for the above covariates; Model II, further adjusted model for obesity category.

^b P<0.05.

^c P<0.01.

^d P<0.001.

REFERENCES

1.. World Health Organization. The world health report 2002-Reducing Risks, Promoting Healthy Life [Internet]. Geneva: World Health Organization; 2017. [Accessed Apr 3, 2017]. Available from:. http://www.who.int/whr/2002/en/.

2.. Seo JW. Obesity in children and adolescents. Korean J Pediatr 2009;52(12):1311-20.

3.. Skinner AC, Skelton JA. Prevalence and trends in obesity and severe obesity among children in the United States, 1999-2012. JAMA Pediatr 2014;168(6):561-6.

4.. Kim HR, Cho JH, Kim SW, Kang YH. A report: development of policies on childhood obesity prevention in South Korea. Korea Institute for Health and Social Affairs. Sejong: Korea Institute for Health and Social Affairs; 2014. p. 21-64.

5.. Reilly JJ, Methven E, McDowell ZC, Hacking B, Alexander D, Stewart L, et al. Health consequences of obesity. Arch Dis Child 2003;88(9):748-52.

6.. Crowley DI, Khoury PR, Urbina EM, Ippisch HM, Kimball TR. Cardiovascular impact of the pediatric obesity epidemic: higher left ventricular mass is related to higher body mass index. J Pediatr 2011;158(5):709-14.

7.. Byun WW, Dowda M. Pate RR. Association between screen-based sedentary behavior and cardiovascular disease risk factors in Korean youth. J Korean Med Sci 2012;27:388-94.

8.. Lim HJ, Park HR, Gu HG. A report: childhood obesity and its policies in South Korea. Sejong: National Youth Policy Institute; 2009.

9.. Korea Center for Disease Control. Obesity index for the prevention of cardiovascular disease. Public health weekly report 2009;2(39):649-52.

10.. Sung EJ, Shin TS. The effect of overweight to cardiovascular risk factors among korean adolescents. Korean J Fam Med 2003;24(11):1017-25.

11.. Duncan MJ, Vale S, Santos MP, Ribeiro JC, Mota J. The association between cardiovascular disease risk and parental educational level in Portuguese children. Int J Environ Res Public Health 2012;9(12):4311-20.

12.. Brown TL, Maahs DM, Bishop FK, Snell-Bergeon JK, Wadwa RP. Influences of gender on cardiovascular disease risk factors in adolescents with and without type 1 diabetes. Int J Pediatr Endocrinol 2016;2016:8.

13.. Keefer DJ, Caputo JL, Tseh W. Waist-to-height ratio and body mass index as indicators of cardiovascular risk in youth. J Sch Health 2013;83(11):805-9.

14.. Chan NP, Choi KC, Nelson EA, Chan JC. Kong AP. Associations of pubertal stage and body mass index with car-diometabolic risk in Hong Kong Chinese children: a cross-sectional study. BMC Pediatr 2015;15:136.

15.. Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr 2004;79(3):379-84.

16.. Savva SC, Tornaritis M, Savva ME, Kourides Y, Panagi A, Silikiotou N, et al. Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index. Int J Obes Relat Metab Disord 2000;24(11):1453-8.

17.. Sardinha LB, Santos DA, Silva AM, Grøntved A, Andersen LB, Ekelund U. A comparison between BMI, waist circumference, and waist-to-height ratio for identifying cardio-metabolic risk in children and adolescents. PLoS One 2016;11(2):e0149351.

18.. Barlow SE. Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: Summary report. Pediatrics 2007;120(Suppl 4):S164-92.

19.. Ashwell M, Hsieh SD. Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int J Food Sci Nutr 2006;56(5):303-7.

20.. Kim M, Kim OS, Jo MS, Hong YJ. Understanding Health Science: An Integrated Approach. 1st ed.. Seoul: Ewha Womans University Press; 2008. p.175..

21.. Liu J, Sempos C, Donahue RP, Dorn J, Trevisan M, Grundy SM. Joint distribution of non-HDL and LDL cholesterol and coronary heart disease risk prediction among individuals with and without diabetes. Diabetes Care 2005;28(8):1916-21.

22.. Tolfrey K, Jones AM, Campbell IG. Lipid-lipoproteins in children: an exercise dose-response study. Med Sci Sports Exerc 2004;36(3):418-27.

23.. Azita F, Asghar Z. Gholam-Reza S. Relationship of body mass index with serum lipids in elementary school students. Indian J Pediatr 2009;76(7):729-31.

24.. 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(6 Pt 1):1175-82.

25.. Muntner P, He J, Cutler JA, Wildman RP, Whelton PK. Trends in blood pressure among children and adolescents. JAMA 2004;291(17):2107-13.

26.. Zhang YX, Wang SR. The relationship of body mass index distribution to relatively high blood pressure among children and adolescents in Shandong, China. Ann Hum Biol 2011;38(5):630-4.

27.. Zhang YX, Wang SR. Comparison of blood pressure levels among children and adolescents with different body mass index and waist circumference: study in a large sample in Shandong, China. Eur J Nutr 2014;53(2):627-34.

28.. Bijari B, Taheri F, Chahkandi T, Kazemi T, Namakin K, Zardast M. The relationship between serum lipids and obesity among elementary school in Birjand: a case control study. J Res Health Sci 2015;15(2):83-7.

29.. Taylor SA, Hergenroeder AC. Waist circumference predicts increased cardiometabolic risk in normal weight adolescent males. Int J Pediatr Obes 2011;6(2-2):e307-11.

30.. Skinner AC, Perrin EM, Moss LA, Skelton JA. Cardiometa-bolic risks and severity of obesity in children and young adults. N Engl J Med 2015;373(14):1307-17.