Childhood Obesity and Cardiovascular Health: Using 2010-2012 Data of the Korea National Health and Nutrition Examination Survey

Go Eun Lee; Jina Choo

doi:10.15384/kjhp.2017.17.2.109

Korean J Health Promot > Volume 17(2); 2017 > Article

Childhood Obesity and Cardiovascular Health: Using 2010-2012 Data of the Korea National Health and Nutrition Examination Survey

Original Article

Korean Journal of Health Promotion 2017;17(2):109-118.

Published online: January 19, 2017

DOI: https://doi.org/10.15384/kjhp.2017.17.2.109

Childhood Obesity and Cardiovascular Health: Using 2010-2012 Data of the Korea National Health and Nutrition Examination Survey

Go Eun Lee, Jina Choo

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

Received April 11, 2017 Accepted June 13, 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.

요약

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.

Keywords: Obesity, Obesity, abdominal, Cardiovascular disease, Risk factors, Adolescents

Table 1.

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).

Table 2.

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.

^bP<0.05.

^cP<0.01.

^dP<0.001.

Table 3.

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)

^aStandardized 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.

^bP<0.05.

^cP<0.01.

^dP<0.001.

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