ESPE Abstracts (2016) 86 RFC13.4

Management of Obesity

Which Amount of BMI-SDS Reduction is Necessary to Improve Cardiovascular Risk Factors in Overweight and Obese Children?

Thomas Reinehra, Nina Lassa, Christina Toschkea, Juliane Rothermela, Stefanie Lanzingerb & Reinhard Hollb


aVestische Kinderklinik, Datteln, Germany; bInstitute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany

Background: Knowing the changes of cardiovascular risk factors (CRF) in relation to weight loss would be helpful to advise overweight children and their parents and to decide whether drugs should be prescribed in addition to lifestyle intervention.

Objective and hypotheses: The aim of the study was to determine the degree of overweight reduction to improve CRFs in overweight children.

Method: We studied changes of blood pressure (BP), fasting HDL-, LDL- cholesterol, triglycerides, glucose, and insulin resistance index HOMA in 1388 overweight children (mean BMI 27.9±0.1, mean age 11.4±0.1 year, 43.8% male, 45.5% prepubertal) participating in the uniform 1-year lifestyle intervention “Obeldicks”. Change of weight status was determined by delta BMI-SDS based on the recommended percentiles of the International Task Force of Obesity.

Results: BMI-SDS reduction was associated with a significant improvement of all analyzed CRFs except fasting glucose and LDL-cholesterol after adjusting for multiple confounders such as baseline CRF, age, gender, BMI, pubertal stage and its changes in BMI-SDS reduction >0.25–0.5 (systolic BP −3.2±1.4 mmHg, diastolic BP −2.2±1.1 mmHg, triglycerides −6.9±5.8 mg/dl, HDL-cholesterol +1.3±1.2 mg/dl, HOMA −0.5±0.3). A reduction of >0.5 BMI-SDS led to more pronounced improvement (systolic BP −6.0±1.3 mmHg, diastolic BP −5.1±1.3 mmHg, triglycerides −16.4±7.1 mg/dl, HDL-cholesterol +1.6±1.5 mg/dl, HOMA −0.9±0.3). Per 0.1 BMI-SDS reduction systolic BP (−1.0 mmHg), diastolic BP (−0.7 mmHg), triglycerides (−2.3 mg/dl), and HOMA (−0.2) decreased significantly, while HDL-cholesterol (0.2 mg/dl) increased significantly in linear regression analyses accounted for multiple confounders.

Conclusion: A BMI-SDS reduction >0.25 improved significantly key factors of the Metabolic Syndrome such as hypertension, hypertriglyceridemia and low HDL-cholesterol, while a BMI-SDS >0.5 doubled the effect.

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