European Journal of Cardiovascular Medicine

Obesity is generally understood to be the levelof somatic overweight associated with negative health outcomes. While there is no set cutoffpoint in this classification, it does provide medical professionals the freedom to evaluate at-risk youngsters based on their unique susceptibility, which may include underlying medicalissues, family history, medication use, and lifestyle choices.The recognised indicator of childhood and teenage obesity is body mass index (BMI).In children when comparing normal curves of BMI to age and sex, BMI over the 85thpercentile can be classified as overweight, and above the 95th percentile as obese.(1)

According tosurveys conducted in 144 countries in 2010, 43 million preschool-aged children—35 millionof them are in developing nations—are overweight or obese, andanother 92 million are atrisk of becoming overweight.(2) Between 1990 and 2010, the globalprevalence of juvenileobesity and overweight rose from 4.2% to 6.7%. It is anticipated thatthis tendency willcontinue and that in 2020, the prevalence will reach 9.1%, or 60 million cases.India is home to the world's largest adolescent population in the world and nearly one-fourth of India's population is contributed by adolescents.(3) Adolescence is a stage ofchangeover from childhood to adulthood and is generally divided into three phases: Early(10- 13years), mid (14-16 years) and late adolescence (17-19 years). During this stage of life,changes occur first in physical maturity, reproductive capability, and then psychological andsocial maturity.(4)

Because obesity promotes insulin resistance and other related physiologicalabnormalities such as dyslipidemia, hypertension, and enlarged left ventricular mass, it is significantly connected with cardiovascular disease and Type 2 diabetes mellitus. There is substantial evidence that obesity in childhood lays the metabolic groundwork for adult cardiovascular disease.(5) Insulin resistance can be defined as a state in which greater than normal amounts ofinsulin are required to produce a normal biological response.(6) Obesity and the related insulinresistance have a major impact on the metabolism of glucose, with both obese adults andchildren—who do not have diabetes—having persistent hyperinsulinemia and excessiveinsulin secretion.(7) Type 2 diabetes commonly develops as a result of this situation.(8)

This cross sectional study was carried out in the department of Physiology, UPUMS, Saifai , Etawah, U.P. , India after taking the approval of the protocol review committee and institutional ethics committee. Total 110 participants with 10-19 years age group free from any substance abuse, not under any long term medication and willing to participate in the study were included in this study. All the subjects with any acute and chronic illness or any cardiovascular disease, under long term medication were excluded from the study.

A detailed history of each subject was taken which includes their personal history, past history and family history. A thorough general and systemic examination was carried out to rule out any clinically apparent disease. The information was entered on a data sheet given to each subject.  Blood sugar level was measured by ACCU-CHEK Performa (model: NC) and HbA1c was measured by Bio-RAD (D-10).

In our study, we noted that 59.1% were male and the rest were female with a meanage of 14.50±2.51 years adolescent subjects. 70.0% of adolescents had non-vegetarian dietaryhabits, 51.8 % were living in the rural living area and 48.2% were in middle socioeconomicstatus.

Table No. 1: Age and Anthropometric variables

The above table shows the anthropometric distribution of the studied patients; we observed a statistically significant higher weight and BMI among the obese group as compared to the overweight and control group (P<0.05). However, age and height showed insignificant differences among various groups.

Table No. 2 : Comparison of blood sugar profiles between overweight and obese

The above table shows the blood sugar profile distribution of the studied patients; we observed statistically significant higher fasting blood sugar and HbA1c in the obese group in comparison to the overweight and control group (P<0.05).

The prevalence of obesity among adolescents has increased over the last decade. In the Indian context, a similar trend can be witnessed among adolescents. The National FamilyHealth Survey – 4 (NFHS–4), which was carried out in 2015–16, found that 4.2% of teenagers between the ages of 15 and 19 were overweight or obese, which is a considerable increase from the previous round.(9,10) Furthermore, a comprehensive study was carried outin 2016 in India among teenagers between the ages of 10 and 18 revealed rising rates of obesity and overweight.(11 ) We aimed to study the effects of obesity on cardiovascular parameters and blood glucose levels in adolescents. Shah AS et al(12) studied the effects oftype 2 diabetes mellitus and obesity on the structure and function of the heart in adolescentsand young adults and came to the conclusion that adolescents with type 2 diabetes andobesity exhibit alterations in cardiac geometry that are consistent with heart remodeling.Eklioglu BS et al(13) carried out cross sectional research that examined the cardiovascularparameters and prediabetes in obese children and adolescents and found that there was adecline in heart function in these individuals.Mansour M et al(14)examined the connectionbetween teenage obesity, blood lipid levels, and blood glucose levels, and concluded thatsaturated fat was linked to higher lipid levels in obese kids.

The present observational cross-sectional study was conducted in the Department of Physiology, Uttar Pradesh University of Medical Sciences, Saifai, Etawah. Subjects, 10 to 19years of age group, free from any substance abuse, and under no long-term medication wereenrolled in this study. Subjects with diabetes, cardiovascular disease or any chronic diseaseand acute illness at the time of recording ECG were excluded from the study. A detailedhistory of each subject was taken which includes their personal history, past history andfamily history. A thorough general and systemic examination was carried out to rule out anyclinically apparent disease. Shah AS et al(12),Eklioglu BS et al(13), Mansour M et al(14),Yadav PKS et al (15) and Bdair BWH et al (16)also opted for a similar methodology in their respective study.

In the present study, we noted that the fasting blood sugar and HbA1c levels were statistically significant in the obese group in comparison to the overweight and control group(p<0.001).>110mg/dl fasting blood sugar and >6.5g% HbA1c level were significantly higherin overweight and obese group in comparison to the control group (p<0.001). Tanamas SKet al (17) reported that one of the main causes of type 2 diabetes in teenagers and young adultsis extreme obesity. Bendor CD et al (18) reported that severe obesity in children andadolescents increases the risk of type 2 diabetes, hypertension, fatty liver disease, anddyslipidemia, even in early childhood and adolescence, compared to mild obesity. Mehdad Set al (19) reported that FBG showed a strong correlation with FM and PBF in both overweightand obese girls as well as research sample girls. While there was no significant correlationfound between FBG and other factors in boys or normal-weight girls, there was a similarsubstantial link found between FBG and both BMI and WC in overweight-obese girls.

A higher body weight predisposes kids to severe obesity related issues and impaired glucose metabolism. Prompt intervention might result from appropriate risk stratification, which could help doctors identify overweight kids who are more likely to develop type 2 diabetes

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