kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2017.17.2.109 kjhp-17-109 Original Article Childhood Obesity and Cardiovascular Health: Using 2010-2012 Data of the Korea National Health and Nutrition Examination Survey LeeGo Eun ChooJina College of Nursing, Korea University, Seoul, Korea Corresponding author : Jina Choo, PhD, DrPH, RN College of Nursing, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Korea Tel: +82-2-3290-4925, Fax: +82-2-3290-9127 E-mail: jinachoo@korea.ac.kr 012017 19012017 172109 118 11042017 13062017 Copyright © 2017 The Korean Society of Health Promotion and Disease Prevention 2017 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background:

Abdominal obesity as measured by waist-to-height ratio (WHtR) may have stronger and inverse associations with cardiovascular (CV) health than overall obesity as measured by body mass index (BMI). However, there was some challenges for controversies. We aimed to examine the associations of WHtR and BMI with CV health among Korean children using data of the 2010-2012 Korea National Health and Nutrition Examination Survey.

 Methods:

A cross-sectional study was conducted with the sample of 2,363 children by analyzing by gender and two-age groups (10-12 and 13-18 years). Overall obesity was categorized into 3 groups by BMI percentile: non-overweight (<85), overweight (≥85), and obesity groups (≥95). Abdominal obesity was categorized into 2 groups by WHtR: normal (<0.5) and abdominal obesity groups (≥0.5). The CV health score was defined as a z-score by calculating the sum of 7 CV factors.

 Results:

The overweight/obesity groups had significantly lower CV health scores than the normal group (P<0.05) in boys and girls aged either 10-12 years or 13-18 years after adjusting for covariates. The abdominal obesity group also showed significantly lower CV health scores than the normal group (P<0.05) in all the groups; this significant association remained significant in boys aged 13-18 years even after further adjusting for BMI category (P<0.01).

 Conclusions:

Among boys aged 13-18 years, abdominal obesity as measured by WHtR was significantly and inversely associated with CV health, independent of BMI category. Therefore, it should be considered to assess the level of abdominal obesity as a measure of CV health in late adolescent boys.

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Participant's general characteristics (n=2,363)

  Total (n=2,363) Girls (n=1,093) Boys (n=1,270) t/χ2 P
Sociodemographic characteristics          
Age 13.7 (0.05) 13.7 (0.07) 13.74 (0.08) 0.07 0.940
Parents’ highest education       0.84 0.840
<College 1,506 (67.3) 707 (68.2) 799 (66.6)    
≥College 731 (32.7) 330 (31.8) 401 (33.4)    
Household monthly income       1.66 0.198
≤Low 264 (11.2) 132 (12.1) 132(10.4)    
≥Med-low 2,098 (88.8) 961 (87.9) 1,137(89.6)    
Family type       2.75 0.098
Normal 1,893 (80.1) 892 (81.6) 1,001 (78.9)    
Vulnerable 469 (19.9) 201 (18.4) 268 (21.1)    
Health-behavioral characteristics          
Energy intake, kcal 2,183.6 (18.4) 1,928.9 (23.3) 2,407.7 (26.1) 13.67 <0.001
Physical activity       30.70 <0.001
≥1 day 914 (51.4) 359 (44.2) 555 (57.4)    
None 865 (48.6) 453 (55.8) 412 (42.6)    
Menarche status          
Yes   798 (73.8)      
No   283 (26.2)      
Anthropometric characteristics          
BMI category          
Total       2.57 0.277
Non-overweight 1,920 (81.3) 901 (82.4) 1,019 (80.3)    
Overweight 273 (11.6) 114 (10.4) 159 (12.5)    
Obesity 169 (7.2) 78 (7.1) 91 (7.2)    
Ages 10-12 years (n=852)       5.99 0.050
Non-overweight 689 (80.9) 331 (84.4) 358 (77.8)    
Overweight 106 (12.4) 40 (10.2) 66 (14.3)    
Obesity 57 (6.7) 21 (5.4) 36 (7.8)    
Ages 13-18 years (n=1,511)       1.21 0.547
Non-overweight 1231 (81.5) 570 (81.3) 661 (81.7)    
Overweight 167 (11.1) 74 (10.6) 93 (11.5)    
Obesity 112 (7.4) 57 (8.1) 55 (6.8)    
WHtR category          
Total       23.69 <0.001
Normal (<0.5) 2,091 (88.6) 1,005 (92.0) 1,086 (85.6)    
Abdominal obesity (≥0.5) 269 (11.4) 87 (8.0) 182 (14.4)    
Ages 10-12 years (n=852)       34.52 <0.001
Normal (<0.5) 739 (86.7) 369 (94.1) 370 (80.4)    
Abdominal obesity (≥0.5) 113 (13.3) 23 (5.9) 90 (19.6)    
Ages 13-18 years (n=1,511)       2.04 0.175
Normal (<0.5) 1,352 (89.7) 636 (90.9) 716 (88.6)    
Abdominal obesity (≥0.5) 156 (10.3) 64 (9.1) 92 (11.4)    

Abbreviations: BMI, body mass index; WHtR, waist-to-height ratio.

Values are presented as n (weighted %), weighted mean (standard error).

Associations between overall obesity and cardiovascular health (n=2,363)　

  β (SE)a
  SBP, mmHg DBP, mmHg Glucose, mg/dL TC, mg/dL HDL-C, mg/dL LDL-C, mg/dL Triglycerides, mg/dL CV health score
Ages 10-12 years (n=852)                
Boys Overweight 6.1 (1.47)d 2.5 (1.97)d 2.7 (1.66)c 2.6 (4.58) -7.2 (1.46)d 3.5 (3.67) 38.4 (8.14)d -2.9 (0.51)d
Obesity 9.6 (1.99)d 6.6 (2.03)d 4.1 (1.37) 18.4 (9.34) -6.1 (2.95)b 16.8 (7.61)b 31.4 (7.53)d -5.2 (0.92)d
Girls                
Overweight 4.1 (1.62)b 2.7 (1.43) 2.3 (1.19) 1.9 (4.81) -6.0 (2.12)c -1.5 (7.00) 47.3 (29.78) -2.5 (0.83)c
Obesity 6.0 (2.52)b 0.0 (2.51) 2.7 (1.52) 2.2 (7.65) -10.9 (2.10)d 1.2 (8.61) 59.7 (18.44)c -3.0 (0.97)c
Ages 13-18 years (n=1,511) Boys                
Overweight 9.1 (1.43)d 3.3 (1.24)c 1.4 (0.97) 14.5 (3.57)d -5.7 (1.02)d 12.1 (3.52)c 40.0 (10.11)d -3.1 (0.42)d
Obesity 11.2 (1.78)d 4.4 (1.97)b -0.5 (1.19) 28.3 (8.70)c -6.5 (1.67)d 24.1 (7.08)c 53.4 (9.39)d -5.2 (0.98)d
Girls                
Overweight 3.7 (1.71)b 1.5 (1.43) 0.7 (1.06) 1.5 (4.08) -5.5 (1.51)d 3.4 (3.49) 18.2 (8.02)b -1.5 (0.57)c
Obesity 2.6 (1.67) 0.6 (1.38) 5.7 (2.84)b 11.2 (6.88) -8.8 (1.69)d 12.6 (5.28)b 37.3 (13.24)c -3.4 (0.89)d

Abbreviations: SE, standard error; SBP, systolic blood pressure; DBP, diastolic blood pressure; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; CV, cardiovascular.

Standardized coefficient adjusted for age, household monthly income, parents’ highest education and family type; further controlled menarche status for girls; further controlled energy intake and physical activity for age 13-18 years.

P<0.05.

P<0.01.

P<0.001.

Associations between waist-to-height ratio and cardiovascular health (n=2,363)　

β (SE)a
  SBP, mmHg DBP, mmHg Glucose, mg/dL TC, mg/dL HDL-C, mg/dL LDL-C, mg/dL Triglycerides, mg/dL CV health score
Model I                
Ages 10-12 years (n=852)                
Boys                
Abdominal obesity 7.1 (1.42)d 0.9 (1.67) 1.7 (0.99) 8.9 (5.17) -4.9 (1.60)c 8.1 (4.11) 29.0 (6.65)d -2.8 (0.63)d
Girls Abdominal obesity 4.9 (2.37)b 1.7 (2.27) 3.5 (1.34)c 1.2 (5.58) -9.3 (1.95)d 3.9 (6.36) 32.5 (18.0) -2.9 (0.98)c
Ages 13-18 years (n=1,511)                
Boys                
Abdominal obesity 9.1 (1.54)d 4.3 (1.48)c 0.5 (0.88) 23.3 (5.95)d -6.6 (1.10)d 20.4 (4.97)d 47.6 (9.00)d -4.4 (0.65)d
Girls Abdominal obesity 1.6 (1.61) -0.5 (1.23) 4.8 (2.60) 10.3 (6.23) -7.4 (1.70)d 11.1 (4.82)b 33.4 (12.09)c -2.9 (0.83)d
Model II                
Ages 10-12 years (n=852)                
Boys                
Abdominal obesity 2.8 (2.18) -6.0 (3.04) -2.1 (2.13) 2.8 (6.38) 0.6 (2.31) 1.1 (5.09) 5.4 (8.43) 0.6 (0.75)
Girls                
Abdominal obesity 1.5 (2.38) 1.6 (2.51) 2.5 (1.46) -0.6 (6.62) -3.8 (2.53) 5.8 (7.70) -13.1 (22.64) -1.2 (1.16)
Ages 13-18 years (n=1,511)                
Boys                
Abdominal obesity 1.2 (2.26) 2.6 (1.84) 1.0 (1.38) 9.9 (6.00) -4.1 (1.22)c 10.0 (5.56) 19.6 (15.90) -1.8 (0.64)c
Girls                
Abdominal obesity -1.8 (2.57) -2.7 (1.90) 1.8 (2.07) 5.3 (5.37) -1.1 (2.28) 4.2 (5.39) 10.9 (9.89) -0.8 (0.69)

Abbreviations: SE, standard error; SBP, systolic blood pressure; DBP, diastolic blood pressure; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; CV, cardiovascular.

Standardized coefficient adjusted for age, household monthly income, parents’ highest education and family type; further controlled menarche status for girls; further controlled energy intake and physical activity for age 13-18 years. Model I, adjusted model for the above covariates; Model II, further adjusted model for obesity category.

P<0.05.

P<0.01.

P<0.001.