Temporal stability of cardiometabolic risk factors from the perspective of primordial disease prevention in children

CONTEXT AND OBJECTIVE: Excess adiposity and circulating lipoprotein lipids in childhood are predictive of cardiometabolic disease in adulthood. We analysed temporal tracking for body mass and lipid biomarkers using population-based time-series to assess the statistical feasibility of primordial prediction and prevention. DESIGN AND PARTICIPANTS: Individuals born between 1962-1992 were included from four European local community cohorts. Serial measurements of weight, height, waist and lipoprotein lipids were analysed for 12,212 participants (ages 5-49 years, follow-ups 15-31 years depending on cohort). Longitudinal tracking was quantified by autocorrelation R2 over the same individuals between any two visits in the series; the weakening of R2(Δt) with increasing follow-up time was modelled by exponential decay. RESULTS: Based on the decay model, we calculated autocorrelation for two surveys fifteen years apart as a simplified tracking indicator: R2(15) = 35.7% for body-mass index, R2(15) = 28.1% for waist-height ratio and R2(15) = 32.5% for low-density lipoprotein (LDL) cholesterol. Total and high-density lipoprotein cholesterol were comparable to LDL cholesterol. Triglycerides exhibited weak tracking. The detection rate (DR5) at 5% false positive rate (FPR) of children who were in the top risk decile as adults was DR5(15) = 38.9% for body mass index and DR5(15) = 30.9% for LDL cholesterol. CONCLUSIONS: Individualised biomarker screening at low FPR misclassifies the majority of children who will have high values as adults (low statistical feasibility). Biomarker tracking is more useful for guiding broad population-based primordial prevention programmes that can be extended to all children at risk without harm from false positives.