Childhood Adiposity/Adult Adiposity

Childhood Adiposity, Adult Adiposity, and Cardiovascular Risk Factors. NEJM 2011.


Originally sent by Priya

So as most of you know, while I love the pediatric population, there is a special place in my heart for the adult patients as well - which is why this article caught my eye when it came out late last year.  This article looks at childhood overweight/obesity and adult obesity and relates this to CV risk factors.  These are the patient's we see every day - for a cold, an ankle sprain or an asthma exacerbation.  While we are all capable of treating their acute issue, we *aren't* very good at addressing the fact that they are inhaling slices of pizza and drinking mountain dew's while they wait to be seen, or the fact that they are obese and that this may have long-term consequences... or does it?

This article looked at the following 4 groups:
  Normal children --> normal adults
  Overweight/obese children --> normal adults
  Normal children --> obese adults
  Overweight children --> obese adults

They followed these various groups and looked for various CV risk factors in adulthood - HTN, DM2, elevated HDL, decreased HDL, elevated TGs and carotid intima-media thickness (for those of you who remember the ENHANCE trial back in 2008, you recognize that this may not be the best surrogate marker but it is the best we have).  What they found was interesting - other than HTN, the other CV risk factors did not depend on childhood overweight/obesity status, but only on adult obesity.  HTN risk was attenuated but seemed to remain despite returning to normal weight as an adult.  So one may say "Great, so it's an adult problem, not for us pediatricians to deal with."... BUT how many of those overweight/obese children actually became "normal" adults?  The answer is "not many".  In this study, of the "normal" children, 14.6% became obese adults, while 82.3% of obese children became obese adults.

So maybe we DO owe this some attention?  Maybe, given that a large portion of our patients use the ER as their primary medical home, we should start addressing this issue?  Maybe we should be handing out water instead of juice?  Or encouraging healthy snacks instead of chips?  Maybe we should start putting weight management tips/tricks in our discharge instructions?  Or do we follow the model of the IMPACT clinic and start a *insert catchy name for weight management* clinic for more long term treatment?

Who knows, we could be saving these kids a lifetime of insulin shots, caths and CABGs!  Just food for thought....