Abstract
BackgroundThe aim of this study was to assess whether adjusting the weight categorisation of children for their biological maturity status could improve the accuracy of predicting weight status and cardiometabolic risk at age 17.MethodsData from 1525 participants (787 female) from the ALSPAC study were analysed. Participants’ weight status at age 11 was estimated using first standard chronological age and sex adjusted BMI cut-offs, and again using maturity adjusted BMI cut-offs. Each BMI category at age 11 was regressed against cardiometabolic risk score and BMI category at age 17, controlling for sex, ethnicity and socio-economic status.ResultsAt age 11 years, 22% of boys and 46% of girls who were categorised as overweight or having obesity based on chronological age were re-categorised into a lower BMI category after adjusting for biological maturity. Biologically adjusted BMI categories better predicted BMI category at age 17 compared with non-adjusted BMI categories (∆BIC = − 21.69); the odds of having obesity at age 17 were 18.28 times greater with each increase in BMI category at age 11. Adjusted and non-adjusted BMI status at 11 years showed equivalent accuracy in predicting cardiometabolic risk at age 17; the odds ratio of high cardiometabolic risk was 1.85, with heightened risk in boys, particularly early maturers.ConclusionThe traditional method of categorising adolescents into a BMI category may over-predict overweight and obesity, particularly in girls. Adjusting for biological maturity when estimating weight status through calculating adolescents’ BMI classification was equivalent to standard approaches in predicting other cardiovascular risk at age 17.
Highlights
Increasing rates of childhood obesity are a significant concern for public health [1, 2] due to the association of obesity with poor health outcomes that can track into adulthood [3]
The differential timing of biological maturity between children of the same chronological age may contribute to the varied sensitivity of BMI for diagnosing future obesity, overweight and cardiometabolic risk [3]
This study aims to investigate whether adjusting for biological age in obesity categorisation in early adolescence more accurately predicts weight status and cardiometabolic risk at age 17
Summary
Increasing rates of childhood obesity are a significant concern for public health [1, 2] due to the association of obesity with poor health outcomes that can track into adulthood [3]. The use of BMI in diagnosing overweight and obesity in children has been criticised as its sensitivity varies considerably, especially around the time of the adolescent growth spurt where sex specific differences in body fat accumulation occur [6, 7]. The variability in the timing of growth (i.e. the age at which a maturity event, such as a growth spurt, occurs) and tempo of growth (i.e. the rate at which each maturity event is attained) can result in large differences in lean and fat mass between youth of the same chronological age [11]. The differential timing of biological maturity between children of the same chronological age may contribute to the varied sensitivity of BMI for diagnosing future obesity, overweight and cardiometabolic risk [3]. The aim of this study was to assess whether adjusting the weight categorisation of children for their biological maturity status could improve the accuracy of predicting weight status and cardiometabolic risk at age 17
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