Objective To describe the prevalence and temporal trends of overweight/obesity and cardiometabolic risk indicators (blood pressure, lipids, and glucose, etc) among primary school students in Pudong New Area, Shanghai from 2020 to 2024, and to examine longitudinal associations of overweight/obesity and body mass index (BMI) with cardiometabolic risk, so as to provide evidence for early prevention of cardiovascular diseases in children and adolescents. Methods A prospective cohort was established in 2020 using stratified cluster random sampling from 13 primary schools in Pudong New Area.Children aged 6 - 7 years were assessed at baseline (2020) and followed up in 2022 (aged 8 - 9 years) and 2024 (aged 10 - 11 years).A total of 1 483 children completed all three assessments.Height and weight were measured to calculate BMI.Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured.Serum total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were assessed at each visit.Fasting plasma glucose (FPG) was measured in 2022 and 2024 but not at baseline.Repeated-measures analysis of variance was used to compare continuous outcomes across visits.Generalized estimating equations were used to assess temporal trends in abnormal detection rate of cardiometabolic indicators.Linear mixed-effects models were used to evaluate longitudinal associations between continuous BMI and cardiometabolic measures. Results The prevalence of overweight was 18.41%, 16.93%, and 16.79% in 2020, 2022, and 2024, respectively, whereas obesity prevalence was 18.95%, 22.25%, and 21.44%.The detection rate of elevated SBP increased from 11.94% to 19.96%, while elevated DBP decreased from 18.75% to 6.07%.Hypercholesterolemia increased from 6.61% to 17.73%.Hypertriglyceridemia decreased from 9.78% to 1.69% and then rebounded to 5.73%.Elevated LDL-C was 4.25%, 11.46%, and 7.35% in 2020, 2022, and 2024, respectively, and low HDL-C was 3.57%, 1.82%, and 4.18%, respectively.The detection rate of abnormal fasting plasma glucose was 0.47% in 2022 and increased to 10.18% in 2024.Compared with normal-weight peers, overweight/obese children had higher risk of elevated systolic blood pressure at all three visits (OR=1.621, 2.564, 2.693), as well as hypertriglyceridemia (OR=1.609, 8.151, 2.814) and low HDL-C (OR=3.001, 8.927, 3.154) (P<0.05).Differences in hypercholesterolemia, elevated LDL-C, and abnormal fasting plasma glucose were not statistically significant (P>0.05).In linear mixed-effects models, each 1 kg/m2 increment in BMI was associated with higher SBP (β=1.518 mmHg) and DBP (β=0.451 mmHg), higher TG (β=0.032 mmol/L), higher LDL-C (β=0.021 mmol/L), lower HDL-C (β=-0.035 mmol/L), and higher fasting plasma glucose (β=0.015 mmol/L) (P<0.001), while the association with total cholesterol was not significant (P=0.833). Conclusions Overweight and obesity are important risk factors for cardiovascular metabolic abnormalities in children, particularly associated with elevated blood pressure, increased TG, and decreased HDL-C.Continuous monitoring of BMI changes may be more sensitive than simple overweight/obesity categorization in detecting early signs of cardiometabolic risk.
Key words
overweight /
obesity /
blood pressure /
blood lipids /
blood glucose /
body mass index /
cardiovascular metabolic risk /
longitudinal study
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