Cardiovascular morbidity, diabetes and cancer risk among children and adolescents with severe obesity
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Cardiovascular Diabetology Open Access
REVIEW
Cardiovascular morbidity, diabetes and cancer risk among children and adolescents with severe obesity Cole D. Bendor1,2†, Aya Bardugo1,2†, Orit Pinhas‑Hamiel3,4, Arnon Afek3,5 and Gilad Twig1,2,3,4*
Abstract Severe obesity among children and adolescents is a significant global public health concern. The prevalence has markedly increased over the last decades, becoming common in many countries. Overwhelming rates of obesity among youth have prompted efforts to identify an evidence-based immediate- and long-term cardiometabolic risk factor profile in childhood-onset severe obesity, and to highlight gaps that require further investigation. The Pub‑ Med database was systematically searched in accordance with PRISMA guidelines. The search yielded 831 results, of which 60 fulfilled stringent criteria and were summarized in this review. The definition of severe obesity was vari‑ able, with only one half the publications using the definition BMI > 120% of the 95th percentile. Point estimates of the prevalence of at least one cardiometabolic risk factor in children with severe obesity reportedly range from 67 to 86%. Cross-sectional studies indicate that children and adolescents with severe obesity are at greater risk than those with mild obesity for type 2 diabetes, hypertension, fatty liver disease and dyslipidemia, already at childhood and adolescence. Robust epidemiological data on the long-term risk and actual point estimates in adulthood are lacking for these diseases as well as for other diseases (coronary heart disease, stroke, chronic kidney disease and cancer). Recent longitudinal studies indicate an increased risk for cardiomyopathy, heart failure, cardiovascular mortality and all-cause mortality in adulthood for adolescents with severe obesity compared to those with mild obesity. Given the alarming increase in the prevalence of severe obesity, the persistence of adiposity from childhood to adulthood and the precarious course of young adults with chronic comorbidities, the economic and clinical services burden on the healthcare system is expected to rise. Keywords: Severe obesity, Morbid obesity, Adolescence, Paediatrics, Youth, Cardiovascular, Diabetes, Hypertension, NAFLD, Mortality, Cancer Background The prevalence of childhood obesity has dramatically increased over the last decades [1, 2]. This has prompted the need for obesity stratification to identify those at increased cardiometabolic risk. Substantial data have accumulated on the association of childhood obesity with *Correspondence: [email protected] † Drs. Cole D. Bendor and Aya Bardugo contributed equally to this work 2 Academy and Research Division, Surgeon General Headquarters, Israel Defense Forces, Medical Corps, Ramat Gan, Israel Full list of author information is available at the end of the article
cardiometabolic risk, though obesity was usually considered as a single entity [3–8]. Extreme values of body mass index (BMI), categorized as severe obesity, were once a phenomenon of adults. Howe
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