Comparison of different severe obesity definitions in predicting future cardiometabolic risk in a longitudinal cohort of children.

Severe obesity (SO) prevalence varies between reference curve-based definitions (WHO: ≥99th percentile, Centers for Disease Control and Prevention (CDC): >1.2×95th percentile). Whether SO definitions differentially predict cardiometabolic disease risk is critical for proper clinical care and management but is unknown. Prospective cohort study SETTING: SO definitions were applied at baseline (2005-2008, M Respondents were youth who had at least one biological parent with obesity. Unfavourable cardiometabolic levels of fasting blood glucose (≥6.1 mmol/L), insulin resistance (HOMA-IR index ≥2.0), high-density lipoprotein <1.03 mmol/L, low-density lipoprotein ≥2.6 mmol/L and triglycerides Area under the receiver operating characteristic curve (AUC) and McFadden psuedo R Baseline SO prevalence differed (WHO: 18%, CDC: 6.7%). AUCs ranged from 0.52 to 0.77, with fair agreement (kappa=37%-55%). WHO-SO AUCs for detecting unfavourable HOMA-IR (AUC>0.67) and high-density lipoprotein (AUC>0.59) at F1 were statistically superior than CDC-SO (AUC>0.59 and 0.53, respectively; p<0.05). Only HOMA-IR and the presence of more than three risk factors had acceptable model fit. WHO-SO was not more predictive than WHO-obesity, but CDC-SO was statistically inferior to CDC-obesity. WHO-SO is statistically superior at predicting cardiometabolic risk than CDC-SO. However, as most AUCs were generally uninformative, and obesity definitions were the same if not better than SO, the improvement may not be clinically meaningful.

Informations de copyright

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Déclaration de conflit d'intérêts

Competing interests: None declared.