Cardiometabolic Risk Factors among Severely Obese Children and Adolescents in the United States, 1999-2012.

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Severely obese children and adolescents are at high risk of suffering obesity-related comorbidities. This article is to examine the dose-response relationship between weight status and cardiometabolic risk factors among US adolescents.


Youths aged 6-19 years participating in the National Health and Nutrition Examination Surveys (NHANES) 1999-2012 were included (N = 20,905). Severe obesity was defined as BMI ≥120% of 95th percentile of gender-specific BMI-for-age or BMI ≥35 kg/m(2). Obesity-related cardiometabolic risk factors included blood pressure (BP), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), total cholesterol (TC), triglycerides, and fasting glucose (FG). Weighted multiple logistic regression was used to assess whether severe obesity significantly changed the odds of having cardiometabolic risk factors.


The prevalence of high BP, high TC, low HDL, high triglycerides, high LDL, and high FG among severely obese adolescents was 9.9%, 16.5%, 40.0%, 30.0%, 13.0%, and 26.8%, respectively. Severely obese adolescents had at least twice the odds compared to normal weight adolescents of presenting high BP (OR = 5.3, 95% CI: 3.8-7.3); high TC (OR = 2.3, 95% CI: 1.8-3.0); low HDL (OR = 7.3, 95% CI: 6.1-8.8); high triglycerides (OR = 4.5, 95% CI: 3.4-5.9); high LDL (OR = 2.3, 95% CI: 1.5-3.5); and high FG (OR = 2.7, 95% CI: 1.8-4.0). Significant differences were also found between severely obese status and moderately obese status in the odds of having high BP (OR = 1.8, 95% CI: 1.7-2.2) and low HDL (OR = 1.9, 95% CI: 1.6-2.3).


Adolescents classified as severe status exhibit higher odds of having cardiometabolic risk factors compared to those with normal weight and moderately obese weight status.





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Publication Info

Li, Linlin, Adriana Pérez, Li-Tzy Wu, Nalini Ranjit, Henry S Brown and Steven H Kelder (2016). Cardiometabolic Risk Factors among Severely Obese Children and Adolescents in the United States, 1999-2012. Childhood obesity (Print), 12(1). pp. 12–19. 10.1089/chi.2015.0136 Retrieved from

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Li-Tzy Wu

Professor in Psychiatry and Behavioral Sciences

Education/Training: Pre- and post-doctoral training in mental health service research, psychiatric epidemiology (NIMH T32), and addiction epidemiology (NIDA T32) from Johns Hopkins University School of Public Health (Maryland); Fellow of the NIH Summer Institute on the Design and Conduct of Randomized Clinical Trials.

Director: Duke Community Based Substance Use Disorder Research Program.

Research interests: COVID-19, Opioid misuse, Opioid overdose, Opioid use disorder, Opioid addiction prevention and treatment, Pain and addiction, Chronic diseases and substance use disorders, diabetes, pharmacy-based care models and services, medication treatment for opioid use disorder (MOUD), Drug overdose, Polysubstance use and disorders, cannabis, alcohol, tobacco, hallucinogens, stimulants, e-cigarette, SBIRT (substance use Screening, Brief Intervention, Referral to Treatment), EHR-based research and intervention, data science, psychometric analysis (IRT), epidemiology of addictions and comorbidity, behavioral health care integration, health services research (mental health disorders, substance use disorders, chronic diseases), nosology, research design, HIV risk behavior. 

FUNDED Research projects (Principal Investigator [PI], Site PI, or Sub-award PI): 
R03: Substance use/dependence (PI).
R21: Treatment use for alcohol use disorders (PI).
R21: Inhalant use & disorders (PI).
R01: MDMA/hallucinogen use/disorders (PI).
R01: Prescription pain reliever (opioids) misuse and use disorders (PI).
R01: Substance use disorders in adolescents (PI).
R21: CTN Substance use diagnoses & treatment (PI).
R33: CTN Substance use diagnoses & treatment (PI).
R01: Evolution of Psychopathology in the Population (ECA Duke site PI).
R01: Substance use disorders and treatment use among Asian Americans and Pacific Islanders (PI).
UG1: SBIRT in Primary Care (NIDA, PI).
UG1: TAPS Tool, Substance use screening tool validation in primary care (NIDA, PI).
UG1: NIDA CTN Mid-Southern Node (Clinical Trials Network, PI).
UG1: EHR Data Element Study (NIDA, PI).
UG1: Buprenorphine Physician-Pharmacist Collaboration in the Management of Patients With Opioid Use Disorder (NIDA, PI).
PCORI: INSPIRE-Integrated Health Services to Reduce Opioid Use While Managing Chronic Pain (Site PI).
CDC R01: Evaluation of state-mandated acute and post-surgical pain-specific CDC opioid prescribing (Site PI).
Pilot: Measuring Opioid Use Disorders in Secondary Electronic Health Records Data (Carolinas Collaborative Grant: Duke PI).
R21: Developing a prevention model of alcohol use disorder for Pacific Islander young adults (Subaward PI, Investigator).
UG1: Subthreshold Opioid Use Disorder Prevention Trial (NIH HEAL Initiative) (NIDA supplement, CTN-0101, Investigator).
NIDA: A Pilot Study to Permit Opioid Treatment Program Physicians to Prescribe Methadone through Community Pharmacies for their Stable Methadone Patients (NIDA/FRI: Study PI).
UG1: Integrating pharmacy-based prevention and treatment of opioid and other substance use disorders: A survey of pharmacists and stakeholder (NIH HEAL Initiative, NIDA, PI).
UG1: NorthStar Node of the Clinical Trials Network (NIDA, Site PI).
R34: Intervention Development and Pilot Study to Reduce Untreated Native Hawaiian and Pacific Islander Opioid Use Disorders (Subaward PI, Investigator).
UG1: Optimal Policies to Improve Methadone Maintenance Adherence Longterm (OPTIMMAL Study) (NIDA, Site PI).
R01: Increasing access to opioid use disorder treatment by opening pharmacy-based medication units of opioid treatment programs (NIDA, PI)

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