Journal List > Korean J Health Promot > v.17(2) > 1089907

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

Abstract

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.

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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref

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.

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.

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)

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.

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.

TOOLS
Similar articles