Severe obesity and cardiometabolic risk in children: Comparison from two international classification systems

Giuliana Valerio, Claudio Maffeis, Antonio Balsamo, Emanuele Miraglia Del Giudice, Claudia Brufani, Graziano Grugni, Maria Rosaria Licenziati, Paolo Brambilla, Melania Manco

Research output: Contribution to journalArticlepeer-review


Objectives: There is no agreed-upon definition for severe obesity (Sev-OB) in children. We compared estimates of Sev-OB as defined by different cut-points of body mass index (BMI) from the Centers for Disease Control and Prevention (CDC) or the World Health Organization (WHO) curves and the ability of each set of cut-points to screen for the presence of cardiometabolic risk factors. Research Design and Methods: Cross-sectional, multicenter study involving 3,340 overweight/obese young subjects. Sev-OB was defined as BMI ≥99th percentile or ≥1.2 times the 95th percentile of the CDC or the WHO curves. High blood pressure, hypertriglyceridemia, low High Density Lipoprotein -cholesterol and impaired fasting glucose were considered as cardiometabolic risk factors. Results: The estimated prevalence of Sev-OB varied widely between the two reference systems. Either using the cut-point ≥99th percentile or ≥1.2 times the 95th percentile, less children were defined as Sev-OB by CDC than WHO (46.8 vs. 89.5%, and 63.3 vs. 80.4%, respectively pth percentile had lower sensitivity (58.5 vs 94.2), higher specificity (57.6 vs 12.3) and higher positive predictive value (34.4 vs 28.9) than WHO in identifying obese children with ≥2 cardiometabolic risk factors. These differences were mitigated using the 1.2 times the 95th percentile (sensitivity 73.9 vs. 88.1; specificity 40.7 vs. 22.5; positive predictive value 32.1 vs. 30.1). Substantial agreement between growth curves was found using the 1.2 times the 95 th percentile, in particular in children ≤10 years. Conclusions: Estimates of Sev-OB and cardiometabolic risk as defined by different cut-points of BMI are influenced from the reference systems used. The 1.2 times the 95 th percentile of BMI of either CDC or WHO standard has a discriminatory advantage over the 99th percentile for identifying severely obese children at increased cardiometabolic risk, particularly under 10 years of age.

Original languageEnglish
Article numbere83793
JournalPLoS One
Issue number12
Publication statusPublished - Dec 27 2013

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)


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