Body Composition and Cardiometabolic Risk in Children

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Cardiometabolic risk factors and weight status in schoolchildren (n=4280). Intervention: Secular time period (2022 vs 1992/2004/2010) vs. Earlier survey cohorts (1992-2010). Primary outcome: Prevalence of obesity and mean levels of cardiometabolic risk factors (total cholesterol, LDL-C, blood pressure, insulin) (95% CI 8.1%-13.2%, p=<0.001).

Q: What does this research mean for the field?

From 1992 to 2022, Spanish schoolchildren experienced a plateauing of childhood obesity along with marked improvements in blood pressure and lipid profiles, despite a concurrent rise in fasting insulin levels. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To examine secular patterns in the prevalence of underweight, normal weight, overweight, obesity, and cardiometabolic risk factors among Spanish schoolchildren from 1992 to 2022.

Irene Sequí‐Domínguez; Mairena Sánchez‐López; Miriam Garrido‐Miguel; Monserrat Solera-Martínez; Valentina Díaz‐Goñi; Sergio Núñez de Arenas‐Arroyo; Pontus Henriksson; Ángel Herráiz-Adillo; Vicente Martínez‐Vizcaíno; Eva Rodríguez‐Gutiérrez

doi:10.1001/jamanetworkopen.2025.35004

October 2, 2025JAMA Network OpenOpen Access

Body Composition and Cardiometabolic Risk in Children

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Key result

Secular trends from 1992 to 2022 in Spanish children showed plateauing obesity (10.4% in 2022) and improved LDL-C (113.6 to 90.1 mg/dL) and SBP (113.5 to 101.0 mm Hg), but rising insulin (P<0.001).

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Why the study?

Understanding secular patterns in body composition and cardiometabolic risk factors is essential to identify early-life determinants of cardiovascular health, guide public health policies, and develop early prevention strategies.

Key Points

To examine secular patterns in the prevalence of underweight, normal weight, overweight, obesity, and cardiometabolic risk factors among Spanish schoolchildren from 1992 to 2022.
Repeated cross-sectional study analyzing 7 cohorts across 30 years (1992, 1996, 1998, 2004, 2010, 2018, and 2022) in public primary schools in Cuenca, Spain.
Included 4280 children aged 8 to 11 years (mean age, 9.6 years; 50.0% girls) with an overall response rate of 77.3%.
Assessed body mass index categories, serum lipid parameters, glycemic markers, and resting systolic and diastolic blood pressure.
Obesity prevalence peaked at 13.4% (95% CI, 11.5% to 15.5%) in 2010 before plateauing at 8.1% (95% CI, 6.0% to 10.5%) in 2018 and 10.4% (95% CI, 8.1% to 13.2%) in 2022 (P < .001).
Total cholesterol decreased from 184.6 mg/dL to 160.3 mg/dL and low-density lipoprotein cholesterol decreased from 113.6 mg/dL to 90.1 mg/dL between 1992 and 2022 (P < .001).
Resting blood pressure declined from 113.5 to 101.0 mm Hg for systolic and 70.4 to 60.7 mm Hg for diastolic (P < .001), while fasting insulin rose from 6.3 μIU/mL in 2004 to 8.7 μIU/mL in 2022 (P < .001).

Study Design

Type

Cross-Sectional (n=4,280)

Multicenter

Yes

Structured PICO

P

Population

4,280 Spanish schoolchildren aged 8 to 11 years (mean age 9.6 years, 50.0% female) from 20 public primary schools in Cuenca evaluated across 7 repeated cross-sectional cohorts over 30 years (1992-2022).

O

Outcome

Secular patterns in the prevalence of weight status (underweight, normal weight, overweight, and obesity according to International Obesity Task Force criteria), lipid parameters (total cholesterol, HDL-C, LDL-C, triglycerides, non-HDL-C, remnant cholesterol), glycemic markers (fasting plasma glucose, insulin), and resting systolic and diastolic blood pressure from 1992 to 2022.surrogate

Main Result

Absolute Event Rate: 10.4% vs 13.4%

p-value: p=<0.001

Limitations

Limited to children aged 8 to 11 years from Cuenca, Spain, restricting generalizability to other populations
Cohort effect limits the ability to generalize findings to other birth cohorts
Potential compromise in analytical determinations due to evolution of measurement methods over the 30-year study period
Lack of data on pubertal maturation status (e.g., Tanner stage), which may act as a confounding variable
Differences in population characteristics, measurement criteria, and time periods limit comparisons with other studies
Analyses were limited to children aged 8 to 11 years from Cuenca, Spain, limiting extrapolation to other populations.
Cohort effect limits the ability to generalize findings to other birth cohorts.
Measurements might have been compromised due to the long 30-year period studied and evolution of measurement methods despite using the same laboratory and protocols.
Maturation status (e.g., Tanner stage) was not collected in earlier project phases and could not be included as a confounding variable, particularly among girls.
Difficulties in comparing results with other studies due to differences in population characteristics, measurement criteria, and time periods.

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Implication

Over a 30-year period in Spanish schoolchildren, childhood obesity prevalence has plateaued and lipid profiles and blood pressure have significantly improved, although rising fasting insulin levels suggest emerging risks for insulin resistance.

Abstract

Importance: Understanding secular patterns in body composition and cardiometabolic risk factors (CMRFs) is essential for identifying early-life determinants of cardiovascular health, guiding public health policies, and developing early prevention strategies. Objective: To examine secular patterns in the prevalence of underweight, overweight, obesity, and CMRFs among schoolchildren in Spain from 1992 to 2022. Design, Setting, and Participants: Repeated cross-sectional study analyzing data from 7 time points over a 30-year period in public primary schools from the Cuenca province in Spain. Participants were children aged 8 to 11 years (fourth to fifth grade) from 7 cohorts studied in 1992, 1996, 1998, 2004, 2010, 2018, and 2022. Data were analyzed from April 2024 to May 2025. Main outcomes and measures: Prevalence of weight status (underweight, normal weight, overweight, and obesity), lipid parameters, glycemic markers, and resting systolic blood pressure (SBP) and diastolic blood pressure (DBP). Results: In a total of 4280 participants (mean [SD] age, 9.6 [0.7] years; 2137 [50.0%] girls), patterns in the prevalence of weight status show that increases in obesity appear to have slowed down and plateaued since 2018 (13.4%; 95% CI, 11.5% to 15.5% in 2010; 8.1%; 95% CI, 6.0% to 10.5% in 2018; 10.4% 95% CI, 8.1% to 13.2% in 2022; P < .001). A statistically significant decrease in mean (SD) total cholesterol (184.6 [27.4] to 160.3 [27.4] mg/dL) and low-density lipoprotein cholesterol (113.6 [24.0] to 90.1 [24.0] mg/dL) was observed, which was reflected in a reduction in non-high-density lipoprotein cholesterol (HDL-C) (125.3 [26.2] to 99.8 [26.1] mg/dL) from 1992 to 2022. Mean (SD) serum HDL-C appear to have peaked from 1998 to 2004 (66.2 [13.3] vs 66.9 [13.3] mg/dL, respectively), and its levels have decreased since then (60.5 [13.4] mg/dL in 2022; P < .001). Mean (SD) resting blood pressure showed a substantial decrease over the study period (SBP: 113.5 [9.6] to 101.0 [9.7] mm Hg and DBP: 70.4 [7.2] to 60.7 [7.3] mm Hg; P < .001). However, mean (SD) insulin levels show a significant rise from 2004 to 2022 (6.3 [5.3] to 8.7 [5.2] μIU/mL; P < .001). Conclusions and Relevance: This repeated cross-sectional study provides a picture of the evolution of CMRFs in children over the last 30 years, showing that, in Spain, despite the concerning prevalences of excess weight, lipid parameters and blood pressure have improved over the studied period.

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Cite This Study

Sequí‐Domínguez et al. (2025) conducted a cross-sectional in Cardiometabolic risk factors and weight status in schoolchildren (n=4,280). Secular time period (2022 vs 1992/2004/2010) vs. Earlier survey cohorts (1992-2010) was evaluated on Prevalence of obesity and mean levels of cardiometabolic risk factors (total cholesterol, LDL-C, blood pressure, insulin) (95% CI 8.1%-13.2%, p=<0.001). Secular trends from 1992 to 2022 in Spanish children showed plateauing obesity (10.4% in 2022) and improved LDL-C (113.6 to 90.1 mg/dL) and SBP (113.5 to 101.0 mm Hg), but rising insulin (P<0.001).

synapsesocial.com/papers/6a10210b01be78fe81607575 https://doi.org/10.1001/jamanetworkopen.2025.35004

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Body Composition and Cardiometabolic Risk in Children

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Body Composition and Cardiometabolic Risk in Children

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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