editorials June 01, 2015 June 01, 2015

Obesity and dyslipidemia – An urgent matter in youth from the general population and in type 1 diabetic patients

DOI: 10.1590/2359-3997000000037

The prevalence of obesity among children and adolescents has significantly risen in the past decades. An analysis from the Centers for Disease Control and Prevention (CDC) reported that 16.5% of children and teenagers are overweight (body mass index or BMI in the 85^th-94^th percentiles) and 21.4% are obese (BMI at or above the 95^th percentile) (). Obesity in childhood has been associated with comorbidities such as hypertension, dyslipidemia and type 2 diabetes. Shashaj and cols. identified that a significant proportion of children has cardiometabolic risk factors at the onset of overweight or obesity (). Therefore, it is important to detect overweight as soon possible in children, in order to prevent its consequences. Criteria to identify the presence of excess weight in children have to be studied and improved to enable prompt diagnosis. The current CDC charts have been elaborated in 2000 and are widely used to classify children and adolescents according to their BMI percentile. In 2007, however, the WHO suggested that these charts should be reviewed and that new cutoffs for obesity and overweight would have to be established.

In this issue of Archives of Endocrinology and Metabolism, Kuba and cols. () compared the CDC and WHO BMI z scores (,) for screening of overweight and cardiometabolic risk in 175 subjects between 6 and 10 years of age. The 2000 CDC and 2007 WHO reference values were concordant in classifying 161 children (92%). However, the reference values showed a discrepancy in the classification in 14 children (8%). Eleven children would be rated as overweight by the CDC and as obese by the WHO. These children were more prone to have higher blood pressure and HOMA-IR than children classified as overweight in the two classifications. Therefore, the authors suggest that the 2007 WHO reference was more sensitive in screening for overweight and obesity and their cardiometabolic associated conditions in this population. Other authors have studied the discrepancies between the two criteria. In general, the WHO has been reported to be more sensitive in pre-pubertal young children (,). In older children and teenagers the differences tend to disappear in different populations (,). Exceptions to this rule have been identified. In a retrospective cohort study with 140.265 school age students in Chile, CDC tended to overestimate the normal and underestimate the overweight, while obesity was not significant differences (). Therefore it is possible that different criteria should be suitable for different populations, considering their predominant body composition, ethnicity and also their age.

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