Analysis Shows Childhood Overweight and Obesity Influence Dyslipidemia, Diabetes, NAFLD Risk

A significant portion of US children aged 6-17 with overweight and obesity have borderline or abnormal cardiometabolic risk markers for dyslipidemia, diabetes, and non-alcoholic fatty liver disease, with higher body mass index (BMI) measures correlating to a greater likelihood of abnormal lab values, according to a recent study.1

Obesity and severe obesity have been rising steadily across the country since 1980; in 2017 and 2018, >4.5 million children and adolescents had severe obesity. In 2000, the Centers for Disease Control and Prevention (CDC) released a series of BMI-for-age growth charts, which were based on data from 1963-1980. However, these charts did not extend beyond the 97th percentile. To that end, the CDC developed new percentiles, aiming to evaluate and monitor very high BMI values. These charts were released in 2022 and form the backbone of the present study.1,2

“It is well established that many youths with obesity have cardiometabolic risk factors, but research to date has not yet assessed risk by CDC’s extended BMI percentiles (BMIp),” Samantha Pierce, MPH, an epidemiologist at the CDC, and colleagues wrote. “Understanding what thresholds of extended BMIp are associated with obesity-related comorbidities is important for both clinical practice and the health services research field.”1

Pierce and colleagues collected data from IQVIA’s Ambulatory Electronic Medical Record (AEMR)-US database, including laboratory test results and medication orders. Patient data was then cleaned cross-sectionally, excluding outlier values, including height-for-age z-score < -5 or >5, weight-for-age z-score < -10 or >5, BMI-for-age z-score < -4 or >10, or BMI <150 kg/m2. BMI was categorized based on the CDC’s extended BMIp: <5th percentile (underweight), ≥5th to <85th (healthy weight), ≥85th to <95th (overweight), and 4 obesity subcategories, including 95th to <98th (moderate or class 1 obesity), 98th to <99th, 99th to <99.9th, and ≥99.9th percentile.1

Ultimately, a total of 282,709 patients were included in the study; all patients were aged 6-17 years and had a BMI ≥85th percentile for sex and age in 2022. Patients were excluded if they had a prescription for a statin, insulin, or other diabetes medication, among other conditions. Pierce and colleagues extracted nonmissing, nonzero results for 6 laboratory tests, including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides. HbA1c was used for diabetes lab tests, and alanine aminotransferase for nonalcoholic fatty liver disease.1

Ultimately, among the 282,709 patients included, roughly 43% had BMIp 85th to <95th (overweight), 32% had BMIp ≥95th to <98th, and 10% had BMIp ≥98th to <99th. The remaining 15% had BMIp ≥99th percentile. Males had a higher proportion in the 95th to <98th percentile than females (34% vs 30%) but a lower proportion in the 85th to <95th percentile (40% vs 46%) (P <.0001).1

Overall, patients in higher extended BMIp categories had a higher prevalence of borderline or abnormal HbA1c (aPR range: 1.46 to 2.79), ALT (aPR range: 1.58 to 2.59), triglycerides (aPR range: 1.24 to 1.46), total cholesterol (aPR range: 1.11 to 1.23), HDL-C (aPR range: 1.4 to 1.94), and LDL-C (aPR range: 1.23 to 1.55). Dose-response relationships were also observed for several cardiometabolic biomarkers, and similar patterns were found for abnormal lab values.1

“Understanding what thresholds of BMIp are associated with these chronic disease markers can facilitate clinical practice, including identifying patients at highest risk and informing when to escalate evaluation or treatment of children and adolescents with excess weight,” Pierce and colleagues wrote.1

References

1. Pierce SL, Porter RM, Kompaniyets L, He S, Goodman AB. Examining biomarkers for dyslipidemia, diabetes, and NAFLD by CDC’s 2022 extended BMI percentiles in US youth aged 6–17 years. Obesity. Published online December 21, 2025. doi:10.1002/oby.70077

2. Centers for Disease Control and Prevention. CDC Extended BMI-for-Age Growth Charts. CDC. September 2, 2024. Accessed January 16, 2026. https://www.cdc.gov/growthcharts/extended-bmi.htm