Association of Pediatric Obesity with Adult Cardiovascular Disease: A Narrative Review of Published Evidence

The prevalence of pediatric obesity is increasing globally because of lifestyles, which fundamentally create an imbalance that favors caloric intake over expenditure [1]. These lifestyles include sedentary habits such as addiction to computer games, internet, and television, as well as a regular intake of energy-dense fast foods [2]. Several reports reveal the health burden of childhood and adolescent obesity in both developing and developed countries [3-9]. Whereas obesity is prevalent in the lower socio-economic class in developed countries, it is more common in the upper socio-economic class in developing countries. In the latter, sedentary habits and indulgence in fast foods (nutritional transition) are regarded as signs of affluence [10]. Obesity in children and adolescents is associated with several comorbidities and complications, like hypertension [11], obstructive sleep apnea syndrome [12], orthopedic disorders [13], insulin resistance and type 2 diabetes mellitus (T2DM) [14,15], dyslipidemia [16], and malignancies [17]. In the pediatric cardio-metabolic syndrome, genetic and environmental factors synergistically act as triggers; but obesity remains the primary etiologic factor which leads to hyperinsulinemia, and subsequently to hypertension and dyslipidemia [18]. Some authors have, however, proposed five diagnostic components for the syndrome, namely abdominal obesity (increased waist circumference), hyperglycemia (glucose intolerance), hypertriglyceridemia, low high-density lipoprotein-cholesterol (LDL-C) and hypertension [19]. More importantly, some of these diagnostic components are also putative risk factors for T2DM and adult cardiovascular diseases (CVD) such as coronary heart disease (CHD), cerebrovascular accident (CVA), heart failure, hypertensive heart disease, cardiac dysrhythmias, and thrombo-embolic disease.