Dietary Intervention Combined With Exercise Improves Vascular Dysfunction but Also Obstructive Sleep Apnea in Obese Children

To the Editor: We write in response to the article “Effects of Diet and Exercise on Obesity-Related Vascular Dysfunction in Children” by Woo et al.1 We agree with the conclusion of Woo et al that diet and exercise should be regarded as an important strategy to reduce the risk of arterial dysfunction in obese children. However, we believe Woo et al overlooked the important issue of obstructive sleep apnea syndrome (OSAS) in obese children. Woo et al used a prospectively defined value based on US reference data, ie, body mass index (BMI) >23, to define obesity. A fixed BMI value should not be used in children for defining obesity because the normal range of BMI varies with age and gender. Moreover, data from the United States cannot be used as an international reference.2 For Hong Kong, local …