Pediatric obesity and adult metabolic syndrome 2.
To the Editor: Although there is substantial evidence that childhood obesity continues into adulthood, the relationship between obesity and metabolic risk from childhood to adulthood remains controversial.1-4 Hosseinpanah et al5 have demonstrated that adolescent metabolic syndrome (MetS) or adiposity does not predict early adult MetS independent of adult body mass index (BMI). Their findings imply that adolescent MetS is unstable during puberty, and raise the question of whether there is an independent effect of childhood and adolescent obesity on adult metabolic risk, irrespective of the degree of adult adiposity. Based on a longitudinal population-based study, we have found that earlier adiposity rebound, defined as the age at which BMI starts to rise after infancy, is associated with higher BMI, an atherogenic lipoprotein phenotype (ie, higher plasma triglyceride and apolipoprotein B levels and lower high-density lipoprotein cholesterol level), and higher blood pressure, which may be representative of insulin resistance, at age 12 years.6 These findings indicate that the changes in body composition occurring during the early BMI increase, a period during which metabolic programming leading to future insulin resistance may be operative,6,7 is associated with lipoprotein profiles and the increase in blood pressure during adolescence. Thus, even if overweight or obese children do not meet the criteria for pediatric MetS, the metabolically atherogenic state resulting from the changes in body composition in early childhood appears to continue into adulthood. Thus, adolescent overweight or obesity resulting from early adiposity may have an independent effect on adult metabolic risk, independent of the degree of adult adiposity. We advise overweight or obese children to achieve an appropriate BMI. Furthermore, pediatricians must underscore the importance of preventing excessive weight gain early in life.8 Osamu Arisaka, MD, PhD Satomi Koyama, MD, PhD Go Ichikawa, MD, PhD Katsura Kariya, MD Ayako Yoshida, MD Naoto Shimura, MD, PhD Department of Pediatrics Dokkyo Medical University School of Medicine Mibu, Tochigi-ken, Japan http://dx.doi.org/10.1016/j.jpeds.2014.02.050
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litus but is no better than body mass index alone: the Bogalusa Heart Study and the Cardiovascular Risk in Young Finns Study. Circulation 2010;122:1604-11. Lloyd LJ, Langley-Evans SC, McMullen S. Childhood obesity and risk of the adult metabolic syndrome: a systematic review. Int J Obes (Lond) 2012;36:1-11. Gustafson JK, Yanoff LB, Easter BD, Brady SM, Keil MF, Roberts MD, et al. The stability of metabolic syndrome in children and adolescents. J Clin Endocrinol Metab 2009;94:4828-34. Juonala M, Magnussen CG, Berenson GS, Venn A, Burns TL, Sabin MA, et al. Childhood adiposity, adult adiposity, and cardiovascular risk factors. N Engl J Med 2011;365:1876-85. Hosseinpanah F, Asghari G, Barzin M, Ghareh S, Azizi F. Adolescence metabolic syndrome or adiposity and early adult metabolic syndrome. J Pediatr 2013;163:1663-9. Koyama S, Ichikawa G, Kojima M, Shimura N, Sairenchi T, Arisaka O. Adiposity rebound and the development of metabolic syndrome. Pediatrics 2014;133:e114-9. Rolland-Cachera MF, Peneau S. Growth trajectories associated with adult obesity. World Rev Nutr Diet 2013;106:127-34. Gillman MW, Ludwig DS. How early should obesity prevention start? N Engl J Med 2013;369:2173-5.
Reply To the Editor: There is high degree of short- and long-term diagnostic instability for pediatric metabolic syndrome (MetS), which can be explained by measurement error or physiological changes.1,2 However, our study focused on tracking obesity and MetS from adolescence to early adulthood.3 We found that adolescent MetS or adiposity did not predict early adult MetS independent of adult body mass index (BMI). The independent roles of some combinations of cardiometabolic risk factors, such as atherogenic dyslipidemia (low high-density lipoprotein cholesterol and high triglycerides) observed in our study suggest that the different components of MetS appear to have unequal weights. Moreover, it raises questions about the clinical utility of different definitions of pediatric MetS for predicting adulthood MetS. Juonala et al4 have reported similar risks in subjects who were overweight or obese in childhood but nonobese as adults and subjects with a consistently normal BMI with respect to all cardiometabolic risk factors. The points raised by Arisaka et al are well taken. Based on the concept of “earlier adiposity rebound,”5 we can hypothesize that the adiposity rebound would occur earlier in overweight or obese adolescents with atherogenic dyslipidemia compared with those without it. Unfortunately, there are no data available to test this hypothesis in the Tehran Lipid and Glucose Study. Nonetheless, it would be reasonable to encourage overweight or obese children, especially those with atherogenic dyslipidemia, to achieve an appropriate BMI.
References 1. Magnussen CG, Koskinen J, Chen W, Thomson R, Schmidt MD, Srinivasan SR, et al. Pediatric metabolic syndrome predicts adulthood metabolic syndrome, subclinical atherosclerosis, and type 2 diabetes mel1502
Farhad Hosseinpanah, MD Golaleh Asghari, MS Maryam Barzin, MD, MPH
To the Editor: Although there is substantial evidence that childhood obesity continues into adulthood, the relationship between obesity and metabolic risk from childhood to adulthood remains controversial.1-4 Hosseinpanah et al5 have demonstrated that adolescent metabolic syndrome (MetS) or adiposity does not predict early adult MetS independent of adult body mass index (BMI). Their findings imply that adolescent MetS is unstable during puberty, and raise the question of whether there is an independent effect of childhood and adolescent obesity on adult metabolic risk, irrespective of the degree of adult adiposity. Based on a longitudinal population-based study, we have found that earlier adiposity rebound, defined as the age at which BMI starts to rise after infancy, is associated with higher BMI, an atherogenic lipoprotein phenotype (ie, higher plasma triglyceride and apolipoprotein B levels and lower high-density lipoprotein cholesterol level), and higher blood pressure, which may be representative of insulin resistance, at age 12 years.6 These findings indicate that the changes in body composition occurring during the early BMI increase, a period during which metabolic programming leading to future insulin resistance may be operative,6,7 is associated with lipoprotein profiles and the increase in blood pressure during adolescence. Thus, even if overweight or obese children do not meet the criteria for pediatric MetS, the metabolically atherogenic state resulting from the changes in body composition in early childhood appears to continue into adulthood. Thus, adolescent overweight or obesity resulting from early adiposity may have an independent effect on adult metabolic risk, independent of the degree of adult adiposity. We advise overweight or obese children to achieve an appropriate BMI. Furthermore, pediatricians must underscore the importance of preventing excessive weight gain early in life.8 Osamu Arisaka, MD, PhD Satomi Koyama, MD, PhD Go Ichikawa, MD, PhD Katsura Kariya, MD Ayako Yoshida, MD Naoto Shimura, MD, PhD Department of Pediatrics Dokkyo Medical University School of Medicine Mibu, Tochigi-ken, Japan http://dx.doi.org/10.1016/j.jpeds.2014.02.050
3.
4.
5.
6.
7. 8.
litus but is no better than body mass index alone: the Bogalusa Heart Study and the Cardiovascular Risk in Young Finns Study. Circulation 2010;122:1604-11. Lloyd LJ, Langley-Evans SC, McMullen S. Childhood obesity and risk of the adult metabolic syndrome: a systematic review. Int J Obes (Lond) 2012;36:1-11. Gustafson JK, Yanoff LB, Easter BD, Brady SM, Keil MF, Roberts MD, et al. The stability of metabolic syndrome in children and adolescents. J Clin Endocrinol Metab 2009;94:4828-34. Juonala M, Magnussen CG, Berenson GS, Venn A, Burns TL, Sabin MA, et al. Childhood adiposity, adult adiposity, and cardiovascular risk factors. N Engl J Med 2011;365:1876-85. Hosseinpanah F, Asghari G, Barzin M, Ghareh S, Azizi F. Adolescence metabolic syndrome or adiposity and early adult metabolic syndrome. J Pediatr 2013;163:1663-9. Koyama S, Ichikawa G, Kojima M, Shimura N, Sairenchi T, Arisaka O. Adiposity rebound and the development of metabolic syndrome. Pediatrics 2014;133:e114-9. Rolland-Cachera MF, Peneau S. Growth trajectories associated with adult obesity. World Rev Nutr Diet 2013;106:127-34. Gillman MW, Ludwig DS. How early should obesity prevention start? N Engl J Med 2013;369:2173-5.
Reply To the Editor: There is high degree of short- and long-term diagnostic instability for pediatric metabolic syndrome (MetS), which can be explained by measurement error or physiological changes.1,2 However, our study focused on tracking obesity and MetS from adolescence to early adulthood.3 We found that adolescent MetS or adiposity did not predict early adult MetS independent of adult body mass index (BMI). The independent roles of some combinations of cardiometabolic risk factors, such as atherogenic dyslipidemia (low high-density lipoprotein cholesterol and high triglycerides) observed in our study suggest that the different components of MetS appear to have unequal weights. Moreover, it raises questions about the clinical utility of different definitions of pediatric MetS for predicting adulthood MetS. Juonala et al4 have reported similar risks in subjects who were overweight or obese in childhood but nonobese as adults and subjects with a consistently normal BMI with respect to all cardiometabolic risk factors. The points raised by Arisaka et al are well taken. Based on the concept of “earlier adiposity rebound,”5 we can hypothesize that the adiposity rebound would occur earlier in overweight or obese adolescents with atherogenic dyslipidemia compared with those without it. Unfortunately, there are no data available to test this hypothesis in the Tehran Lipid and Glucose Study. Nonetheless, it would be reasonable to encourage overweight or obese children, especially those with atherogenic dyslipidemia, to achieve an appropriate BMI.
References 1. Magnussen CG, Koskinen J, Chen W, Thomson R, Schmidt MD, Srinivasan SR, et al. Pediatric metabolic syndrome predicts adulthood metabolic syndrome, subclinical atherosclerosis, and type 2 diabetes mel1502
Farhad Hosseinpanah, MD Golaleh Asghari, MS Maryam Barzin, MD, MPH
