Childhood obesity: increased risk for cardiometabolic disease and cancer in adulthood☆
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
References (95)
- et al.
Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013
Lancet
(2014) - et al.
Introduction of complementary feeding before 4 months of age increases the risk of childhood overweight or obesity: a meta-analysis of prospective cohort studies
Nutr Res
(2016) - et al.
The global obesity pandemic: shaped by global drivers and local environments
Lancet
(2011) - et al.
Short sleep duration and obesity among children: a systematic review and meta-analysis of prospective studies
Obes Res Clin Pract
(2017) - et al.
Adipokines in nonalcoholic fatty liver disease
Metabolism
(2016) - et al.
Inflammation: a key player linking obesity with malignancies
Metabolism
(2018) - et al.
The metabolic syndrome in children and adolescents
Lancet
(2007) - et al.
Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies
Lancet
(2008) - et al.
Obesity but not overweight increases the incidence and mortality of leukemia in adults: a meta-analysis of prospective cohort studies
Leuk Res
(2012) - et al.
Reducing cancer and cancer disparities: lessons from a youth-generated diabetes prevention campaign
Am J Prev Med
(2017)
Adolescent obesity and paternal country of origin predict renal cell carcinoma: a cohort study of 1.1 million 16 to 19-year-old males
J Urol
Obesity over the life course and risk of acute myeloid leukemia and myelodysplastic syndromes
Cancer Epidemiol
Smart food policies for obesity prevention
Lancet
Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking
Lancet
Metformin decreases plasma resistin concentrations in pediatric patients with impaired glucose tolerance: a placebo-controlled randomized clinical trial
Metabolism
Effects of liraglutide in the treatment of obesity: a randomised, double-blind, placebo-controlled study
Lancet
Metformin and sulfonylureas in relation to cancer risk in type II diabetes patients: a meta-analysis using primary data of published studies
Metabolism
Transition from metabolic healthy to unhealthy phenotypes and association with cardiovascular disease risk across BMI categories in 90 257 women (the nurses' health study): 30 year follow-up from a prospective cohort study
Lancet Diabetes Endocrinol
Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015
Lancet
Health effects of overweight and obesity in 195 countries over 25 years
N Engl J Med
Evidence that the prevalence of childhood overweight is plateauing: data from nine countries
Int J Pediatr Obes
Age-specific stabilization in obesity prevalence in German children: a cross-sectional study from 1999 to 2008
Int J Pediatr Obes
Do adolescents with extreme obesity differ according to previous treatment seeking behavior? The Youth with Extreme obesity Study (YES) cohort
Int J Obes (Lond)
Cardiovascular risk factor profiles of normal and overweight children and adolescents: insights from the Canadian Health Measures Survey
Can J Cardiol
Bogalusa Heart Study group. Health consequences of obesity
Pediatr Blood Cancer
Body fatness and cancer – viewpoint of the IARC working group
N Engl J Med
Higher body mass index in 16–19 year-old Israeli adolescents of North African, Middle Eastern, and European origins is a predictor of acute myeloid leukemia: a cohort of 2.3 million Israelis
Cancer Causes Control
The genetics of obesity in humans. Endotext.com 2005, chapter 8
Maternal physical activity during pregnancy, child leisure-time activity, and child weight status at 3 to 9 years
J Phys Act Health
Systematic review and meta-analysis of the association between maternal smoking in pregnancy and childhood overweight and obesity
J Epidemiol Community Health
Risk of childhood overweight or obesity associated with excessive weight gain during pregnancy: a meta-analysis
Arch Gynecol Obstet
Gestational weight gain in relation to offspring obesity over the life course: a systematic review and bias-adjusted meta-analysis
Obes Rev
Birth weight and subsequent risk of obesity: a systematic review and meta-analysis
Obes Rev
Maternal smoking during pregnancy and child overweight: systematic review and meta-analysis
Int J Obes (Lond)
Little appetite for obesity: meta-analysis of the effects of maternal obesogenic diets on offspring food intake and body mass in rodents
Int J Obes (Lond)
Association between caesarean section and childhood obesity: a systematic review and meta-analysis
Obes Rev
Early life factors influencing the risk of obesity
Pediatr Gastroenterol Hepatol Nutr
The association between antibiotic use in infancy and childhood overweight or obesity: a systematic review and meta-analysis
Obes Rev
Antibiotic exposure in early life and childhood overweight and obesity: a systematic review and meta-analysis
Diabetes Obes Metab
The relationship between famine exposure during early life and body mass index in adulthood: a systematic review and meta-analysis
PLoS One
Exposure to the Chinese famine of 1959–61 in early life and long-term health conditions: a systematic review and meta-analysis
Int J Epidemiol
Traffic-related air pollution and obesity formation in children: a longitudinal, multilevel analysis
Environ Health
The impact of long-term school-based physical activity interventions on body mass index of primary school children - a meta-analysis of randomized controlled trials
BMC Public Health
Objective sleep characteristics and cardiometabolic health in young adolescents
Pediatrics
Digital media and sleep in childhood and adolescence
Pediatrics
Sleep quality and obesity in young subjects: a meta-analysis
Obes Rev
Cited by (295)
Effects of childhood obesity on heart failure and its associated risk factors in the European population: A Mendelian randomization study
2024, Nutrition, Metabolism and Cardiovascular DiseasesGenome-wide analysis reveals extensive genetic overlap between childhood phenotypes and later-life type 2 diabetes
2024, Computers in Biology and MedicineTrends and risk factors of diabetes and prediabetes in US adolescents, 1999–2020
2024, Diabetes Research and Clinical PracticeParticipant Perspectives on the Impact of a School-Based, Experiential Food Education Program Across Childhood, Adolescence, and Young Adulthood
2024, Journal of Nutrition Education and Behavior
- ☆
The authors do not have any conflict of interest.