Preschoolers at Risk-Obesity and Cardiometabolic Risk Factors: Towards Early Identification

Dr Catherine Birken, Hospital for Sick Children, Toronto, Ontario


Over the last decade, the relationships between the metabolic syndrome and important health outcomes such as type 2 diabetes mellitus and atherosclerotic cardiovascular disease have been well described in adults. There are conflicting data on the components of the metabolic syndrome in children and youth.

Until recently there have been no published normal values for waist circumference in childhood, a key component in many of the adult definitions. Further, critical gaps exist in accurate normal values of cardiometabolic laboratory tests performed in children, and prevalence varies by definitions developed through expert opinion. Consequently there are varying childhood conceptualizations, definitions, and prevalence of metabolic syndrome. Recently, the International Diabetes Federation (IDF) published its definition of the Metabolic syndrome in children and adolescents. Key components of this definition include obesity (using waist circumference), hypertriglyceridemia, hypertension, high glucose, and low high density lipoprotein (HDL). However, the IDF did not have enough data to publish recommendations for children less than 10 years of age. Given the importance of early childhood, this represents a critical gap in knowledge. The components of these cardiometabolic risk outcomes, namely blood pressure and laboratory tests (for example insulin, glucose, lipids) are the outcomes of interest for this proposed PROMOTE longitudinal study, and are referred to in this proposal, as ‘cardiometabolic risk factors’.


  1. To follow an existing cohort of n=2004 1-5 year old children prospectively for 4 additional years to determine if growth trajectories (BMI) in early childhood are associated with cardiometabolic risk, as defined by abnormal laboratory factors and blood pressure.
  2. To characterize growth trajectories (BMI, waist circumference) in early childhood
  3. To characterize lifestyle patterns (diet, physical activity, sedentary behaviour, sleep) in early childhood
  4. To determine how lifestyle patterns (diet, physical activity, sedentary behaviour, sleep) influence growth trajectories (BMI, waist circumference) over time in early childhood
  5. To determine how lifestyle patterns (diet, physical activity, sedentary behavior, sleep) influence the relationship between growth trajectories and cardiometabolic risk over time in early childhood
  6. To explore clustering of cardiometabolic risk (laboratory tests, and blood pressure) and growth factors (BMI and waist circumference) in early childhood