Boyd, G. S., Koenigsberg, J., Falkner, B., Gidding, S., & Hassink, S. (2005).Pediatrics, 116(2), 442-446.

Clustering of risk factors consistent with the metabolic syndrome has been observed in overweight and obese children; however, the prevalence and extent of dyslipidemia and its association with high blood pressure (BP) is unknown. This was a retrospective, case-control study of 497 patients (2 to 18 years of age) enrolled in a pediatric weight management clinic to compare the prevalence of abnormal plasma lipid levels in overweight children (body mass index [BMI] > 95th percentile for age and sex) with high BP or overweight children with normal BP (NBP). Abnormal plasma lipids were designated as follows: total cholesterol (TC) > 200 mg/dL, triglycerides > 150 mg/dL, LDL-cholesterol > 130 mg/dL, and HDL-cholesterol < 40 mg/dL.

The results indicated an excess prevalence of dyslipidemia in overweight children and adolescents, regardless of BP percentile or BMI z score. Approximately 25% of NBP overweight children had high TC. Among overweight boys with elevated BP, nearly 50% had low cardioprotective HDL-cholesterol. Elevated BP was observed in 34.7% of the sample; 29.7% had pre-HTN and 6.8% had HTN. The prevalence of elevated BP was higher in severely obese boys and girls (46.5% and 39%) than moderately obese boys and girls (28.1% and 23.1%). Taken together, these results support recent recommendations to assess plasma lipid levels in overweight children with BP > 90th percentile (National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents, 2004). The high prevalence of dyslipidemia observed in NBP children in this sample also supports lipid screening in all overweight children as suggested by the American Heart Association (Daniels et al., 2005). Detection of children with multiple risk factors would identify those who require more intense interventions to reduce their cardiovascular risk.

Comment by Laura L. Hayman

References