Risk Factors and Adult Body Mass Index Among Overweight Children: The Bogalusa Heart Study

OBJECTIVE. Compared with thinner children, overweight children (BMI for age between the 85th and 94th Centers for Disease Control and Prevention percentiles) have moderately elevated levels of lipids and blood pressure and are at increased risk for becoming obese adults. We examined the ability of BMI for age, the skinfold sum (subscapular + triceps), and the waist/height ratio to identify which overweight children are at greatest risk. METHODS. Cross-sectional (n = 2501) and longitudinal (n = 2124) analyses were performed among subjects who participated in the Bogalusa Heart Study. RESULTS. Levels of risk factors and adult BMI (median: 32 kg/m(2)) among overweight children were midway between those of thinner children and obese children (BMI for age >= 95th percentile). Although there was a wide range of skinfold sums among the overweight children, levels of BMI for age and the skinfold sum provided relatively little information on adverse risk-factor levels and adult BMI. Overweight children with a relatively high (upper tertile) waist/height ratio, however, were similar to 2 to 3 times more likely to have adverse levels of most risk factors than were those with a low waist/height ratio. CONCLUSIONS. Overweight children vary substantially in terms of body fatness and risk-factor levels. Among these overweight children, levels of waist/height ratio are more strongly associated with adverse risk-factor levels than are levels of BMI for age or skinfold thickness. Additional information is needed on the relation of childhood waist/height ratio to adult complications. Pediatrics 2009; 123: 750-757