Elsevier

Metabolism

Volume 92, March 2019, Pages 147-152
Metabolism

Childhood obesity: increased risk for cardiometabolic disease and cancer in adulthood

https://doi.org/10.1016/j.metabol.2018.12.001Get rights and content

Highlights

  • Prevalence of childhood obesity has doubled in many countries since 1980.

  • Effects of preventive or therapeutic approaches have been rather small to date.

  • Childhood/adolescent obesity leads to markedly increased morbidity and mortality due to cardiometabolic disease in adulthood.

  • Evidence for strong association between higher body mass index during adolescence and increased cancer risk in adulthood

  • Obesity induces major changes in the cytokine and hormone status of the growing organism.

Abstract

Prevalence of childhood obesity has worldwide more than doubled since 1980. Underlying factors are complex and are far from completely understood. Strategies to prevent childhood obesity have mainly focused on behavioral intervention; and obesity therapy was mainly based on lifestyle modification to date. However, effects for both have been quite limited so far and no country has succeeded in fighting the obesity epidemy we are facing.

Normalization of body weight before onset of puberty is crucial for several reasons: First, obese children and adolescents frequently stay obese until adulthood. Second, obesity during adolescence is significantly associated with increased risk for cardiovascular and metabolic disease such as type 2 diabetes in adulthood. And third, recent data have shown a strong association between higher body mass index (BMI) during adolescence and increased risk for several malignancies such as leukemia, Hodgkin's disease, colorectal cancer, breast cancer and others in adulthood.

This review summarizes our current understanding of epidemiology, underlying factors, concomitant disease, as well as available intervention strategies and gives an overview of what has been reached so far and what measures should be undertaken to counteract the obesogenic environment.

Section snippets

Introduction and Epidemiology

More than 50% of the population of the European Union was estimated to have overweight, and one person in six was estimated to be obese in 2012 [1]. The Global Burden of Disease Study has systematically evaluated prevalence of childhood overweight and obesity since 1980 and has shown that obesity prevalence has doubled in more than 70 countries worldwide since then. In 2015, a total of 107.7 million children (and 603.7 million adults) were classified as obese, corresponding to a worldwide

Underlying Factors

The increase in body weight at an individual level as well as development of obesity at a population-based level is attributable to a bunch of different factors and predispositions which are far from completely understood.

On the one hand, syndromic obesity forms that might have a monogenic or oligogenic underpinning are very rare and are responsible for the development of obesity only in the absolute minority of patients. To date, only about 50 genetically based syndromes are described that

Underlying Mechanisms Leading to Disease

The pathophysiology of obesity is not fully understood; however, several mechanisms that may interplay have been identified. On a pathophysiological level, the interplay between muscle and fat tissue, gut and brain is of significant importance [34,35]. Adipose tissue, especially the tissue surrounding internal organs (visceral fat) is today regarded as an active endocrine organ that secretes a variety of pro-inflammatory adipokines, which act at both the local and systemic level [36].

Childhood Obesity and the Risk of Cardiovascular or Metabolic Disease in Adulthood

About 4 million deaths worldwide were attributable to overweight and obesity in 2015, and almost 70% of them were due to cardiovascular disease [[2], [3], [4]]. Many obese adolescents already have cardiometabolic comorbidities which often start around the onset of puberty. The incidence of arterial hypertension, dyslipidemia, non-alcoholic fatty liver disease NASH, hyperuricemia and impaired glucose tolerance/hyperinsulinemia and insulin resistance is already considerably higher in obese

Childhood Obesity and Cancer Risk in Adulthood

Excess body fat is associated with predominantly twelve cancer sites – mouth/pharynx and larynx, esophagus (adenocarcinoma), stomach (cardia), bowel, liver, gall bladder, pancreas, postmenopausal breast, endometrium, ovary, kidney, prostate and womb [51]. Four to 38% of these cancers (depending on site and gender) can be attributed to overweight or obesity in adulthood [52]. Moreover, there is sufficient evidence to date in humans that avoiding overweight or obesity may markedly reduce the risk

Prevention of Childhood Obesity - What Has Been Reached So Far?

Much emphasis has been given towards preventive strategies during the past decades, which should start as early as possible. Preventive interventions were classified into behavior-oriented (individual-based) and community-based or environment-oriented (context-related) [68]. Most obesity prevention programs for children and adolescents have focused on the behavioral approach to date. However, effects on reducing children's BMI in the long term have been only marginal so far [69,70]. We know

Treatment Options for Childhood and Adolescent Obesity

As far as therapeutic options of childhood obesity are concerned, the most important approach for the majority of patients is lifestyle modification including behavioral treatment, a balanced diet with reduction in energy-dense, sugar- and fat-rich produces and increase in physical activity. These are the cornerstones for treatment of pediatric obesity [74]. However, effect sizes achievable over 12–24 months, measured in BMI-SDS (standard deviation score of body mass index) units are rather

Discussion and Outreach

Obesity prevalence has dramatically increased worldwide and increase in childhood obesity was as high as 8- to 8.7-fold since 1975 [67]. Overweight and obesity in adolescence account for as much as 20–25% of cardiovascular deaths in adulthood [50]. Already modest increase of BMI between 7 and 13 years of age is associated with a significantly higher risk to develop type 2 diabetes or cardiovascular disease later in life [43,50]. As pointed out in the Global Burden of Disease 2015 study, obesity

Conclusions

Obesity during childhood and adolescence has emerged to be a global health burden. Many obese adolescents stay obese until adulthood, which leads to markedly increased morbidity and mortality later in life.

Obesity induces major changes in the cytokine and hormone status of the growing organism in childhood and adolescence, which are involved in the pathogenesis of type 2 diabetes, cardiometabolic disease and different types of cancer. Thus, normalization of body weight before the onset of

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