Diabetes Status and Ethnicity Affect Cardiovascular Risk Factors in Obese Children

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 677-696-Obesity Physiology & Epidemiology
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-690
Caroline W Colvin*1, Carroll M Harmon2, Russell L Griffin3, Joffre E Johnson2, Alan P Lucas2, Cody B Smith2 and Ambika P Ashraf1
1University of Alabama School of Medicine, Birmingham, AL, 2University of Alabama School of Medicine, 3University of Alabama at Birmingham School of Public Health
Background: In order to target the most high-risk pediatric populations for appropriate cardiovascular (CV) risk reduction interventions, we must understand the epidemiology of risk factors among obese children.  The objective of the study was to evaluate the differences in CV co-morbidities based on diabetes status and also between ethnic groups.

Subjects and Methods: This was a retrospective, cross sectional study on obese children between the ages of 10-20 years that attended the pediatric endocrinology or weight management clinics at Children’s of Alabama between the years 2000-2012. Exclusion criteria included low-density lipoprotein (LDL) >190 mg/dL, triglycerides (TG) >500 mg/dL, weight >205 kg, body mass index (BMI)>50 kg/m2, thyroid stimulating hormone > 10 miu/L and total cholesterol (TC) >300 mg/dL. Subjects were classified by glycosylated hemoglobin (HbA1c) as having simple obesity (<5.7%), pre-diabetes (5.7-6.4%), or type 2-diabetes (T2DM, >6.4%).

Results: 489 obese children (AA= 333, EA =158) were included in the study.  Mean age was 13.3 ± 3.0 years.  There was no significant difference in the BMI, weight, or gender between diabetes classification groups (simple obesity vs. pre-diabetes vs. T2DM) or ethnic groups.  Children with T2DM were older (P= <0.0001), had higher systolic blood pressure (P= <0.001), and had higher TC (161.6±32.2 vs. 162.2±30.5 vs. 178.8±43.3 mg/dl , P= <0.0001), non high-density lipoprotein (HDL) cholesterol (nHDLC, 119.0±30.8 vs. 119.0±31.0 vs. 136.6±42.1 mg/dl, P= <0.0001), LDL (P= <0.005) and TC/HDL ratios (4.0±1.1 vs. 4.0±1.2 vs. 4.5±1.4, P= <0.0001) than those with simple obesity or pre-diabetes. There was no significant difference in age between African American (AA) and European Americans (EA).  AA had a higher prevalence of pre-diabetes and T2DM with a higher mean HbA1c (P= 0.0002) than EA.  EA had a higher mean nHDLC (129.6±36.2 vs. 122.5±37.5 mg/dl, P= 0.05) and lower HDL (40.4±10.4 vs. 44.3±11.9 mg/dl, P= 0.0005) than AA. HbA1c was the most significant determinant of CV risk and was strongly predictive of both TC and nHDLC (P<0.0001) but not of HDL (P=0.7296).

Conclusion: This study demonstrates that obese children with T2DM have more CV risk factors than equally obese children with simple obesity or pre-diabetes.  African American obese children are more likely to develop T2DM than equally obese European American children.  CV disease prevention efforts are especially important in these highest-risk groups.

Nothing to Disclose: CWC, CMH, RLG, JEJ, APL, CBS, APA

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm