Higher CVD Risk in Children as Young as 10 Who Have Central Adiposity

MALAGA, Spain—Children with growing waistlines are more likely to show signs of increased cardiovascular and metabolic risk by the time they reach 10 years of age, an observational analysis shows.

The research, which was presented this week at the European Congress on Obesity, suggests that kids with central adiposity need to be identified early and monitored closely, with clinicians encouraging lifestyle changes to reduce the long-term risk of adverse outcomes.

“One of the main takeaways is that risk starts early, really early, before the age of 10 years,” lead investigator David Horner, MD, PhD (Herlev and Gentofte Hospital/University of Copenhagen, Denmark), told TCTMD. “These are dysregulated metabolisms, changes we’re seeing in their blood tests, changes we can measure in their blood pressure. These are established risk factors where we know they’re on a trajectory towards heart disease, type 2 diabetes, [and] liver disease in 20 or 30 years.”

The study, an analysis of the Copenhagen Prospective Studies on Asthma in Childhood 2010 (COPSAC2010), showed that roughly one in six children had an increase in waist-to-height ratio during the first decade of life.

“Some of our [healthcare] systems aren’t designed to necessarily capture these children,” said Horner. Once identified, they might be referred to dedicated pediatric clinics where a multidisciplinary team could intervene. Dietary changes, nutritional counseling, and efforts to increase physical activity would all be warranted before medical therapy, he said.

High-definition Longitudinal Data

Waist-to-height ratio is a measure of central adiposity that overcomes some of the limitations of body mass index (BMI), which doesn’t account for body composition. Greater fat in the midsection in adults has been linked to higher risks of cardiovascular disease, high blood pressure, type 2 diabetes, and other conditions.

In this study, the researchers wanted to assess the relationship between waist-to-height trajectories in childhood and cardiovascular and cardiometabolic risk. The cohort included 700 children enrolled in COPSAC2010, an ongoing longitudinal study of pregnant women and their offspring. As part of the study, children underwent detailed examinations and phenotyping over 14 different hospital visits from birth until age 10. 

“We have this really, really high-definition longitudinal data where we know these children intimately,” said Horner. 

Among the cohort, there were three distinct waist-to-height ratio trajectories. Roughly two-thirds of children had a “flat” measurement, meaning the ratio was unchanged over time after adjusting for age and sex. Another 18% had a “high, then falling” waist-to-height ratio where they showed early signs of central adiposity that normalized over time. The remaining 15% of kids had “slowly rising” waist-to-height ratios over the entire 10-year follow-up period. 

Prevention is not very sexy, but it really is what should be done. David Horner

The slowly-rising group had a significantly higher cardiometabolic risk score—derived from HDL cholesterol, triglyceride, and glucose levels as well as height-adjusted blood pressure and HOMA-IR—when compared with those who had a flat waist-to-height ratio (β = 0.79; P < 0.0001). The cardiometabolic risk score, said Horner, is nearly 10 standard-deviations higher than the risk among those with consistent waist-to-height ratios, “and that’s very significant and probably clinically meaningful.”

The cardiovascular risk score, which was calculated using nuclear magnetic resonance blood metabolomics and modeling from the UK Biobank data, was also higher in those with increasing waist-to-height ratios (β = 0.53; P < 0.0001). High-sensitivity C-reactive protein was significantly elevated in the group with rising waist-to-height ratios, while HDL cholesterol, among other risk factors, was significantly lower.

In an analysis that adjusted for the waist-to-height ratio at 10 years, most of the variance in cardiovascular and cardiometabolic risk was explained in the group with growing central adiposity. “That suggests that it’s the destination of the waist-for-height that’s important and not the journey towards it,” said Horner. “We can actually get just as much information from measuring the waist-for-height at 10 years, not necessarily the whole way through life.”

Once these high-risk children are identified, interventions are necessary. “It may be, from many angles, a cheaper solution so we don’t deal with the huge health costs down the road. Prevention is not very sexy, but it really is what should be done.”

More data are coming, Horner said, noting that patients will again visit the clinic at 13 years and undergo a more thorough assessment of cardiometabolic risk, including measurements of pulse-wave velocity, postprandial meal challenge, and body composition measurements.