Natural History of Childhood Obesity: Cardiometabolic and Sleep Outcomes and their Underlying Mechanisms
Open Access
- Author:
- Danisi, Jacqueline
- Graduate Program:
- Anatomy
- Degree:
- Master of Science
- Document Type:
- Master Thesis
- Date of Defense:
- March 04, 2019
- Committee Members:
- Julio Fernandez-Mendoza, Thesis Advisor/Co-Advisor
Edward Oren Bixler, Committee Member
Patricia Mclaughlin, Committee Member - Keywords:
- pediatrics
obesity
metabolic disorder
sleep disordered breathing
sleep medicine
inflammation - Abstract:
- The ever-increasing obesity epidemic has led to a corresponding increase in cardiometabolic co-morbidities. Although it is agreed upon that childhood obesity is detrimental for future health, little is known about the trajectories of such weight disorder and its corresponding impact on adverse health outcomes in adolescence. The aim of this study was to examine the natural history of childhood overweight into adolescence and to analyze its association with cardiovascular and metabolic health, sleep disorders, and immune biomarkers. We hypothesized that overweight children will remain overweight in adolescence, and will be associated with more severe forms of cardiometabolic and sleep dysfunction and inflammation, while those with new-onset, incident overweight in adolescence will have less severe adverse outcomes. In Aim 1, we studied the trajectories (natural history) of childhood weight in the transition to adolescence. In Aim 2, we studied the association between such natural history of childhood overweight with adverse cardiometabolic, sleep, and stress/immune-related outcomes in adolescence. In Aim 3, we studied sex differences in the natural history of childhood overweight and its association with adverse health outcomes. We used data from the Penn State Child Cohort, a random general population sample of 700 5-12 year old children, of whom 421 were followed-up as 12-23 year old adolescents. At both time points, subjects underwent a clinical history, physical examination, and in-lab polysomnography study. At follow-up, subjects underwent a dual-energy X-ray absorptiometry scan, to assess for adipose tissue distribution and composition, and a fasting blood draw, to assess for pro-inflammatory cytokines and adipokines. We found that 72% of children with a body mass index (BMI) percentile ≥ 85 persisted in their overweight category into adolescence, especially if they were female. These persistently overweight children were significantly associated with a blood pressure dysregulation, higher apnea/hypopnea index, visceral adipose tissue, cytokines and leptin, and lower adiponectin in adolescence. Interestingly, children with new-onset overweight in adolescence were associated with adverse health outcomes similar to persistently overweight children but only in specific cardiometabolic, sleep, and inflammatory outcomes. This study further supports that early prevention of comorbidities should focus on childhood-onset overweight. However, new-onset overweight in adolescence should not be regarded as a less severe form in terms of its adverse health risks. These data also support the clinical utility of a variety of measures of adiposity, other than BMI, to help identify a child’s risk for future adverse health outcomes.