The stronger predictive role of early life exposures versus current lifestyle behaviors on the development of childhood severe obesity and metabolic dysfunction

Abstract

Background: Current studies tend to stress on the overall prevention of pediatric obesity, whereas few of them focus on effective measures of preventing diagnosed obesity from deteriorating into severe obesity and from developing cardio-metabolic comorbidities. Objective: This study was conducted to thoroughly analyze: (i) the cardio-metabolic characteristics, and (ii) the importance ranking and warning model of risk factors of metabolic disorder in children and adolescents with severe obesity. Methods: This is designed as a nested cohort study with data sourced from an ongoing Southwest China Pediatric Obesity Prevention and Control Study (SCPOPCS). Children and adolescents with obesity aged 3–18 years were enrolled. Anthropometric indices, vital signs, metabolic laboratory tests, and self-administrated questionnaire were collected at first outpatient visit. Results: 236 cases of children and adolescents with obesity were enrolled (176 mild; 60 severe). Results showed that systolic blood pressure, diastolic blood pressure and heart rate, as well as weight, height, BMI, body circumferences, triceps and abdominal skinfold were significantly higher in children with severe obesity. Besides, a remarkably higher prevalence of metabolically unhealthy obesity was shown in children with severe obesity. Moreover, five independent contributing risk factors of severe obesity were derived from multivariate analyses, namely: Allergy diagnosed before 3 years old (aOR 2.696; 95% CI 1.350–5.436; p = 0.005), Pregnancy complicated with obesity (aOR 3.881; 95% CI 1.213–12.471; p = 0.021), Pregnancy complicated with cholestasis (aOR 4.641; 95% CI 1.141–19.582; p = 0.031), Frequency of siesta per week (aOR 1.773; 95% CI 1.177–2.693; p = 0.006) and Frequency of dining out per week (aOR 1.804; 95% CI 1.040–3.144; p = 0.036), as well as one independent protective factor, which was Bedtime on weekday nights (aOR 0.571; 95% CI 0.339–0.938; p = 0.030). Conclusions: This study attempted to understand the physiological changes induced by severe obesity, and we found that severe obesity had higher risk of metabolic syndromes, including especially hypertension, abnormal glucose metabolism, fatty liver and abnormal uric acid metabolism. A predictive model with good fitting degree was built, from which we derived five independent risk factors and one protective factor of severe obesity.