Epidemiological studies of short- and long term consequences of pediatric obesity

Background

Comorbidities such as insulin resistance and high blood pressure are early consequences of obesity that can manifest even in young children. However, the exact proportion of children and adolescents with obesity who experience morbidity related to obesity remains unclear.

Additionally, it is not well understood whether there are specific risk factors or success factors that influence the future psychosocial and physiological health of children with obesity. Many published studies are based on small sample sizes with limited representativeness. Fortunately, we have a quality register that allows us to answer several important questions using data from a large number of children.

The Swedish Childhood Obesity Treatment Register, known as BORIS, is a national quality register for children receiving treatment for overweight or obesity. This register provides a valuable resource for addressing these critical questions and improving our understanding of childhood obesity and its long-term impacts.

Methods

BORIS was initiated in 2005 and is the World’s second largest clinical register of children and adolescents undergoing obesity treatment. At clinical obesity treatment visits, anthropometrical and biochemical data are entered. In December 2020, approximately 32 000 patients were registered in BORIS and were eligible for a register linkage with national registers. 

A contemporaneous comparison group was matched with a ratio of 1:5 by sex, year of birth, and living area (n ≈ 157 000). In addition, were parents identified, both for the individuals in BORIS and for the matched comparison group (n ≈ 336 000). As of today, more than 55 percent in the obesity cohort are over 18 years old and can thereby be followed-up as adults. Data have been retrieved from:

• The Total Population Register contains date of immigration and emigration. 
• The Swedish Medical Birth Register contains characteristics and events at time of delivery. 
• The Medical Drug Register contains data of prescribed and dispensed drugs.
• The Patient Register contains diagnosis and procedure performed in specialized outpatient care and inpatient care.
• The Cause of Death Register contains date and cause of death.
• The Longitudinal Integration Database for Health Insurance and Labor Market Studies contains socio-demographic data such as income, education, employment, sick leave, etc. 

Aim

The overall aim is to investigate short and long-term consequences in young adults who have undergone obesity treatment as children compared to a group from the general population. More specifically, we intend to investigate the risk of future morbidity and identify risk and success factors. We will also evaluate the long-term health economic consequences (consumption and cost).

Originality

The first generation affected by the childhood obesity epidemic has now reached young adulthood. This timing provides a unique opportunity to evaluate the long-term risks associated with childhood obesity, something that previously has been challenging du to limited generalizability. This makes the current epidemiological research exceptionally valuable.

Thanks to the quality register BORIS and the unique register-linking capabilities in Sweden, we can now evaluate and analyze subgroups within the population of children and adolescents with obesity. This allows us to compare these subgroups with a matched control group from the general population, providing unique insights into the long-term impacts of childhood obesity.

Grants

• The Center for Innovative Medicine (CIMED)
• Åke Wiberg’s foundation
• Ollie & Elof Ericssons foundation
• Magnus Bergvalls foundation
• The Freemason Foundation for Children’s Welfare

Publications

Putri RR, Danielsson P, Marcus C, Hagman E. Height and Growth Velocity in Children and Adolescents Undergoing Obesity Treatment: A Prospective Cohort Study. The Journal of clinical endocrinology and metabolism. 2023;109(1):e314-e320.

Prinz N, Putri RR, Reinehr T, Danielsson P, Weghuber D, Norman M, et al. The association between perinatal factors and cardiometabolic risk factors in children and adolescents with overweight or obesity: A retrospective two-cohort study. PLoS medicine. 2023;20(1):e1004165.

Putri RR, Casswall T, Hagman E. Risk and protective factors of non-alcoholic fatty liver disease in paediatric obesity: A nationwide nested case-control study. Clin Obes 2021: e12502.

Putri RR, Casswall T, Hagman E. Prevalence of increased transaminases and its association with sex, age, and metabolic parameters in children and adolescents with obesity - a nationwide cross-sectional cohort study. BMC Pediatr 2021; 21(1): 271.

Lindberg L, Persson M, Danielsson P, Hagman E, Marcus C. Obesity in childhood, socioeconomic status, and completion of 12 or more school years: a prospective cohort study. BMJ Open 2021; 11(3): e040432.

Lindberg L, Hagman E, Danielsson P, Marcus C, Persson M. Anxiety and depression in children and adolescents with obesity: a nationwide study in Sweden. BMC medicine. 2020;18(1):30.

Lindberg L, Danielsson P, Persson M, Marcus C, Hagman E. Association of childhood obesity with risk of early all-cause and cause-specific mortality: A Swedish prospective cohort study. PLoS medicine. 2020;17(3):e1003078.

Brissman M, Lindberg L, Beamish AJ, Marcus C, Hagman E. High estimated prevalence of bariatric surgery in young adults treated for pediatric obesity. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2020.

Hagman E, Ek AE, Marcus C. Insulin function in obese children within the low and high ranges of impaired fasting glycemia. Pediatric diabetes. 2019;20(2):160-165.

Hagman E, Danielsson P, Elimam A, Marcus C. The effect of weight loss and weight gain on blood pressure in children and adolescents with obesity. Int J Obes (Lond). 2019;43(10)

Hagman E, Danielsson P, Brandt L, Ekbom A, Marcus C. Association between impaired fasting glycaemia in pediatric obesity and type 2 diabetes in young adulthood. Nutr Diabetes. 2016;6(8):e227.

Hagman E, Danielsson P, Brandt L, Svensson V, Ekbom A, Marcus C. Childhood Obesity, Obesity Treatment Outcome, and Achieved Education: A Prospective Cohort Study. The Journal of adolescent health. 2017;61(4):508-513.

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