## 7 Childhood Obesity as an Adult Risk Factor  
In adults, there is a well-documented link between obesity and a wide array of cardiovascular diseases, including ischemic heart disease, hypertension, cerebrovascular disease, atrial fibrillation, ventricular arrhythmia, and sudden cardiac death [38; 279]. Furthermore, obesity promotes the development of a series of afflictions which are themselves individual risk factors for cardiovascular diseases, such as type 2 diabetes, dyslipidemia, and obstructive sleep apnea. In this view, obesity appears to be more than a standalone ailment and can be better described as a complex dysmetabolic and mechanically dysfunctional condition [280; 281; 282].  
Considerable efforts have been made to study whether the link between adipose excess and cardiometabolic disease finds its origin during childhood. Table 4 summarizes some of the available observational evidence showing childhood obesity leading to adult disease.  
\begin{table}
\begin{tabular}{c c c c c c c} \hline \hline
**Reference** & **Obesity** & **Investigated Association** & **Subject Ages** & **Subject Ages** & **Parameter** & **Result (95\%Cl)** \\ \hline  & & & 6 and under & & & 1.23 \\  & & & & & (1.10–1.37) \\ \cline{3-6}  & & Diabetes type 2 & 7 to 11 & & 1.78 \\  & & & & (1.51–2.10) \\ \cline{3-6}  & & & 12 to 18 & & 1.70 \\  & & & & (1.30–2.22) \\ \cline{3-6}  & & & 7 to 11 & 19–73 & OR/StdBMI & 1.14 \\  & & Coronary heart disease & & (1.08–1.21) \\ \cline{3-6}  & & & 12 to 18 & & 1.30 \\  & & & & (1.16–1.47) \\ \cline{3-6}  & & & 7 to 11 & & 1.67 \\  & & Hypertension & & (0.89–3.13) \\ \cline{3-6}  & & & 12 to 18 & & 1.29 \\  & & & & (1.19–1.40) \\ \hline  & & Diabetes type 2 & & & 2.4 (1.6–3.6) \\ \cline{3-6}  & & Hypertension & & & 1.8 (1.5–2.1) \\ \cline{3-6}  & & High-risk LDL cholesterol & 3 to 19 & 23–46 & RR (O) & 1.4 (1.2–1.8) \\ \cline{3-6}  & & High-risk HDL cholesterol & & & 1.4 (1.2–1.6) \\ \cline{3-6}  & & High risk triglycerides & & & 1.6 (1.3–1.9) \\ \hline [PERSON] et al. * [285] & BMI & Coronary heart disease & 7 to 18 & 25–77 & OR/StdBMI & 1.09 (1–1.20) \\ \hline [PERSON] et al. [286] & BMI & Heart failure & 8 vs. 20 & \begin{tabular}{c} Mean FUP = \\ 37.7 yrs after \\ age 20 \\ \end{tabular} & \begin{tabular}{c} HR(Nw/O) \\ HR(O/O) \\ \end{tabular} & \begin{tabular}{c} 3.14 \\ (2.25–4.38) \\ \end{tabular} \\ \hline [PERSON] et al. [287] & BMI & Eccentric LV hypertrophy & 6 to 18 & 34–49 & OR(O/Ob) & \
\begin{tabular}{c} 2.04 \\ (1.35–3.07) \\ \end{tabular} \\ \hline  & & & & Boys & & 1.35 \\  & & & 7 & & (1.25–1.45) \\ \cline{3-6}  & & & Girls & & 1.26 \\  & & & & (1.14–1.38) \\ \cline{3-6}  & BMI (\textgreater{}90 th \\ \cline{3-6}  & percentile of \\ \cline{3-6}  & study \\ \cline{3-6}  & population) & & 10 & \textgreater{}25 & HR &
\begin{tabular}{c} 1.32 \\ (1.20–1.45) \\ \end{tabular} \\ \cline{3-6}  & & & & & 1.46 \\  & & & & (1.36–1.56) \\ \cline{3-6}  & & & & 1.38 \\  & & & & (1.27–1.51) \\ \hline \hline \end{tabular}  
* Studies marked with an asterisk
* are meta-analyses. The following notations refer to the characteristics of the study subgroups: Nw = normal weight, Ov = overweight, Ob = obese, O = Overweight or obese. When more than one BMI measurement was carried out during the study, the first value represents the group category on initial determination, while the second refers to the later measurement. Childhood age refers to the age at which the obesity parameter was determined. Entries containing “vs” describe the ages of BMI measurement when more than one determination of this parameter was carried out during the study. Addhood ages represent the ages at which the investigated associations were explored. OR/StdBMI = odds ratio/increase of 1 standard deviation of BMI, RR = relative risk, and HR = hazard ratio.  
\end{table}
Table 4: Observational evidence showing childhood obesity leading to adult disease.