Systematic Review and Meta-Analyses to identify the Prevalence of Obesity-associated Co-morbidities/Co-morbidity Indicators in Children and Adolescents (aged 5-18)

Aim: Identify the prevalence of weight-related co-morbidities in children and adolescents aged 5-18. Data sources: Embase, Medline, Medline-in-Process, PsycINFO, and Web of Science; from database inception up to March 2015. Inclusion: Observational studies reporting prevalence of obesity-associated co-morbidities/co-morbidity indicators by weight/BMI category in children/adolescents aged 5-18 from any country; Exclusion: non-English articles. Appraisal/Data Extraction: Abstracts were screened for eligibility by VS and MB. Prevalence data for each co-morbidity/co-morbidity indicator was extracted by weight status (healthy weight/overweight/obese) and prevalence ratios calculated for comparable studies using a random effects meta-analysis. Results: Of the 10,391 abstracts screened, 215 eligible studies (1,930,906 participants) reported 24 co-morbidities (e.g. diabetes, hypertension) and 39 indicators (e.g diabetes had 6 indicators including fasting glucose and Hb1Ac). Overall prevalence ratios ranged from 0.9 (95% CI 0.6-1.4) for traumatic dental injuries to 11.9 (95% CI 7.1-20.2) for metabolic syndrome for participants who were overweight relative to healthy weight participants. For participants with obesity relative to healthy weight participants, prevalence ratios ranged from 0.6 (95% CI 0.5-1.1) for traumatic dental injuries to 53.3 (95% CI 30.4-67.1) for metabolic syndrome. Study quality scores (assessed using the Joanna Briggs Institute’s Appraisal Checklist) ranged from 1-10 out of 10. Conclusion: The majority of co-morbidities and co-morbidity indicators (e.g. metabolic syndrome and non-alcoholic fatty liver disease), were more prevalent in children/adolescents with overweight/obesity. However, some co-morbidities (e.g. dental injuries and depression), were less or equally prevalent in children/adolescents with overweight/obesity than those of a healthy weight. The results have implications for screening and management of children/adolescents with obesity.