The Influence of Familial Predisposition to Cardiovascular Complications upon Childhood Obesity Treatment

March The Influence of Familial Predisposition to Cardiovascular Complications upon Childhood Obesity Treatment Louise A. Nielsen 0 1 Christine Bjse 0 1 Julie T. Kloppenborg 0 1 Caecilie Trier 0 1 Michael Gamborg 0 1 Jens-Christian Holm 0 1 0 1 The Children's Obesity Clinic, Department of Paediatrics, Copenhagen University Hospital Holbaek , DK 4300, Holbaek , Denmark , 2 Department of Paediatrics, Copenhagen University Hospital Herlev , DK 2730, Herlev , Denmark , 3 The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen , DK 2200, Copenhagen , Denmark , 4 Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospitals , The Capital Region, DK 2000, Frederiksberg, Copenhagen , Denmark , 5 University of Copenhagen, Faculty of Health and Medical Sciences , DK 2200, Copenhagen , Denmark 1 Academic Editor: Yvonne Bottcher, University of Leipzig , GERMANY - Funding: This study is part of research activities in TARGET (The impact of our genomes on individual treatment response in obese children, see www. target.ku.dk) and BIOCHILD (Genetics and systems biology of childhood obesity in India and Denmark, see (www.biochild.ku.dk)) consortia supported by the Region Zealand Health Scientific Research Foundation (see, http://www.regionsjaelland.dk/ Sundhed/forskning/forskningsfinansiering/Sider/ The aim was to investigate whether a familial predisposition to obesity related cardiovascular complications was associated with the degree of obesity at baseline and/or changes in the degree of obesity during a multidisciplinary childhood obesity treatment program. The study included 1421 obese children (634 boys) with a median age of 11.5 years (range 3.117.9 years), enrolled in treatment for 0.04 to 5.90 years (median 1.3 years) at the Children's Obesity Clinic, Denmark. At baseline, weight and height were measured, body mass index (BMI) standard deviation score (SDS) calculated, and self-reported information on familial predisposition to obesity, hypertension, type 2 diabetes mellitus (T2DM), thromboembolic events, and dyslipidaemia were obtained. A familial predisposition included events in biological parents, siblings, grandparents, uncles, and aunts. The treatment outcomes were categorically analysed according to the prevalence of familial predispositions. The median BMI SDS at enrolment was 3.2 in boys and 2.8 in girls. One-thousand-andforty-one children had obesity in their family, 773 had hypertension, 551 had T2DM, 568 had thromboembolic events, and 583 had dyslipidaemia. Altogether, 733 had three or more predispositions. At baseline, familial T2DM was associated with a higher mean BMI SDS dren's degree of obesity. During treatment, girls with familial obesity lost more weight, oekonomi.aspx) and the Danish Council for Strategic Research (grant 11-115917 and 11-116714) (see, http://ufm.dk/en/research-and-innovation/councilsand-commissions/the-danish-council-for-strategicresearch). Funding was received by J-CH. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. compared to girls without familial obesity (p = 0.04). No other familial predispositions were associated with changes in BMI SDS during treatment. Obese children with a familial predisposition to T2DM showed a significantly higher degree of obesity at baseline and girls with familial obesity responded better to treatment. Besides these findings, no other associations were found between the occurrence of familial predispositions and the degree of obesity or changes herein during multidisciplinary childhood obesity treatment. Through the past few decades, the prevalence of obesity in children and adolescents has increased though new studies suggest that the prevalence may have reached a plateau; nevertheless, obesity represents a serious challenge to the public health worldwide [1,2]. Childhood obesity is associated with severe comorbidities in regards to metabolic complications, such as dyslipidaemia, hypertension, insulin resistance, and prediabetes [36]. Furthermore, obese children are at risk of developing coronary heart disease and remaining obese as adults [3,7]. In order to treat childhood obesity effectively, an early intervention is of great importance, and a multidisciplinary approach involving the family combining counselling on diet, behaviour, and activity seems pivotal, but the response to treatment may be inadequate for some patients [813]. One explanation may be the metabolic state of the children and their families, since it has been shown that a familial predisposition to obesity is associated with a poorer response to treatment [9,10,12,14]. Furthermore, a familial predisposition to obesity has been associated with the development of obesity in childhood [1518]. The influence of a familial predisposition to obesity has been described in regards to parents [9,11,12,1416] especially the weight status of the mother [9,11,15], siblings [10], and grandparents [17,18] indicating that the high prevalence of overweight and obese children is dependent upon obesity among the family members. The knowledge regarding the influence of familial type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) upon the degree of obesity in later generations is less established. At present, the literature outlines that adolescents with T2DM show a tendency of being obese and having a familial predisposition to T2DM [19], but this particular familial predisposition has not been shown to influence the treatment outcome in obese children [12]. In addition, parental T2DM and hypertension have been associated with increased weight and skinfold thickness in a large cohort of children [20], whereas another study shows that children with a family history of CVD are more obese and that children suffering from metabolic complications also exhibit a higher prevalence of the very same complications in their families [21]. The present study investigated the association between body mass index (BMI) standard deviation score (SDS) and a familial predisposition to obesity, hypertension, T2DM, thromboembolic events, and dyslipidaemia in obese children and adolescents enrolled in a multidisciplinary childhood obesity treatment program. The study investigated whether these familial predispositions influenced the degree of obesity at baseline or the changes in BMI SDS during treatment. Materials and Methods Study population This prospective study was based on 1732 children and adolescents enrolled in treatment at The Childrens Obesity Clinic, Department of Paediatrics, Copenhagen University Hospital Holbaek, Denmark. The children had a BMI above the 90th percentile adjusted for age and gender and were enrolled in the clinic from January 2008 to January 2014. Of th (...truncated)