Severity of obesity is associated with worse cardiometabolic risk profile in adolescents: findings from a Brazilian national study (ERICA)

Abstract Background The prevalence of obesity and severe obesity among adolescents has increased dramatically in developing countries. However, the distribution of cardiometabolic risk factors through the severity of obesity continuum is relatively unknown among youth. Objective To evaluate the association of weight categories with cardiometabolic risk factors among Brazilian adolescents. Methods The Study of Cardiovascular Risk in Adolescents - ERICA, was a multicenter, school-based, cross-sectional study composed of Brazilian adolescents (12-17 years). Severity of obesity was classified according to the IOTF reference values for body mass index (BMI) and several cardiometabolic risk factors were measured after clinical and biochemical exams and categorized using standard definitions of abnormal values. Results Among the 37,892 adolescents enrolled, 8,708 had weight excess, being classified with overweight (17.2%), obesity (5.6%) and severe obesity (1.3%). Increasing severity of obesity was associated with a worse cardiometabolic profile in the overall sample. Multivariable models that controlled for age, sex, skin color, socioeconomic status, physical activity and total energy intake, showed that individuals in higher categories of severity of obesity tended to have higher prevalence ratios of most cardiometabolic risk factors compared to the other weight groups; except for high fasting blood glucose among boys. Conclusions Progressive degrees of weight excess are positively associated with cardiometabolic risk factors in youth from a middle-income country, indicating the importance in classifying the severity of weight excess among adolescents and considering this to plan prevention programs against early development of obesity related disease.