Obesity and cardiometabolic disease risk factors among US adolescents with disabilities

Table 1 Demographic and anthropometric characteristics of of those 12-18 years old with and without disabilities in the United States, 1999-2010 National Health and Nutrition Examination Surveys n (%)

	Overall n = 5276	Disability n = 256	No disability n = 5020	P-valuea
Gender				0.31
Boys	2674 (50.8)	126 (2.5)	2548 (48.3)
Girls	2602 (49.2)	130 (2.6)	2472 (46.6)
Race/ethnicity				0.78
Non-hispanic white	1477 (61.1)	80 (64.3)	1397 (60.9)
Non-hispanic black	1414 (13.5)	64 (12.1)	1350 (13.6)
Hispanic	2146 (18.7)	97 (17.9)	2049 (18.7)
Other	239 (6.7)	15 (5.7)	224 (6.8)
Education level				0.22
Grade School	295 (5.2)	19 (6.1)	276 (5.1)
Middle School	2247 (41.5)	101 (34.7)	2146 (41.9)
High School	2264 (44.5)	117 (52.6)	2147 (44.1)
High School graduate/GED	292 (6.4)	9 (3.5)	283 (6.6)
More than High School	111 (2.3)	6 (2.9)	105 (2.3)
Household income				0.17
< $10000	236 (5.3)	22 (9.9)	214 (5.1)
$10000-$19999	595 (13.0)	32 (17.1)	563 (12.7)
$20000-$34999	692 (15.8)	32 (21.4)	660 (15.5)
$35000-$54999	644 (20.2)	24 (14.0)	620 (20.5)
$55000-$74999	375 (14.0)	16 (11.1)	359 (14.1)
> $75000	679 (31.7)	26 (26.4)	653 (32.0)
Body mass index percentile groupb
Normal weight	3281 (66.1)	135 (50.7)	3146 (66.9)	< 0.001
Overweight	1995 (33.9)	121 (49.3)	1874 (33.1)	< 0.001
Obese	1099 (18.0)	67 (27.6)	1032 (17.5)	0.01
Severely obese	261 (4.2)	16 (5.8)	245 (4.1)	0.26
Body mass index	Mean (SE)	Mean (SE)	Mean (SE)
Percentile	64.4 (0.6)	71.3 (2.4)	63.9 (0.6)	< 0.01
Z score	0.53 (0.02)	0.83 (0.1)	0.52 (0.0)	0.01
Age	15.1 (0.04)	15.1 (0.2)	15.1 (0.04)	0.68

^aRepresents mean difference between those with and without disabilities;

^bNormal weight = body mass index < 85^th percentile for age and sex, overweight = body mass index ≥ 85^th - < 95^th percentile for age and sex, obese = body mass index ≥ 95^th percentile for age and sex (Kuczmarski et al[23], 2000) severely obese = absolute body mass index ≥ 35 kg/m² (Kelly et al[24], 2000).

Table 2 Mean values of cardiometabolic disease risk factors among those 12-18 years old with and without disabilities in the United States by body mass index weight category^a, 1999-2010 National Health and Nutrition Examination Surveys

Cardiometabolic disease risk factors	Disability mean (SE)	No disability mean (SE)	P-value
Waist circumference, cm
Normal weight	74.7 (0.61)	73.1 (0.18)	0.01
Overweight	96.5 (1.63)	94.7 (0.38)	0.31
Obese	105.1 (1.59)	102.2 (0.50)	0.10
Severely Obese	122.2 (3.30)	116.6 (0.71)	0.09
Systolic blood pressure, mmHg
Normal weight	106.7 (1.22)	107.3 (0.26)	0.61
Overweight	114.2 (1.46)	112.2 (0.36)	0.19
Obese	115.7 (1.85)	113.7 (0.38)	0.31
Severely Obese	120.9 (3.49)	116.2 (0.65)	0.18
Diastolic blood pressure, mmHg
Normal weight	60.8 (0.45)	61.2 (1.72)	0.82
Overweight	59.8 (0.59)	61.7 (1.45)	0.19
Obese	59.7 (0.67)	60.8 (2.17)	0.59
Severely obese	61.1 (1.46)	60.8 (3.75)	0.94
High density lipoprotein, mg/dL
Normal weight	50.3 (1.23)	52.9 (0.29)	0.05
Overweight	44.9 (1.66)	45.9 (0.37)	0.53
Obese	41.0 (2.10)	43.9 (0.45)	0.19
Severely Obese	37.2 (3.07)	41.1 (0.92)	0.24
Triglycerides, mg/dL
Normal weight	92.3 (10.77)	78.4 (1.14)	0.21
Overweight	105.4 (11.05)	100.3 (3.27)	0.63
Obese	115.9 (15.40)	113.2 (4.53)	0.85
Severely Obese	173.0 (23.62)	131.0 (12.76)	0.12
Glucose, mg/dL
Normal weight	92.8 (1.32)	92.4 (0.37)	0.80
Overweight	96.7 (1.16)	94.0 (0.35)	0.03
Obese	96.8 (1.59)	95.2 (0.47)	0.32
Severely Obese	94.5 (1.10)	95.9 (1.00)	0.39

^aNormal weight = body mass index < 85^th percentile for age and sex, overweight = body mass index ≥ 85^th - < 95^th percentile for age and sex, obese = body mass index ≥ 95^th percentile for age and sex (Kuczmarski et al[23], 2000) severely obese = absolute body mass index ≥ 35 kg/m² (Kelly et al[24], 2000).

Table 3 Prevalence of abnormal cardiometabolic disease risk factors among those who are overweight, obese and severely obese and 12-18 years old with and without disabilities in the United States compared to those of normal weight^a, 1999-2010 National Health and Nutrition Examination Surveys n (%)

Cardiometabolic disease risk factors	Normal weighta	Overweight	P-value	Obese	P-value	Severely obese	P-value
Waist circumference, cmb
Disability	0 (0)	33 (29.7)	< 0.0001	33 (53.0)	< 0.0001	15 (90.7)	< 0.0001
No disability	0 (0)	441 (23.8)	< 0.0001	432 (43.6)	< 0.0001	225 (94.6)	< 0.0001
Systolic blood pressure, mmHgc
Disability	5 (4.2)	20 (17.6)	0.02	16 (24.2)	0.01	7 (37.4)	0.004
No disability	145 (3.7)	251 (12.8)	< 0.0001	169 (14.5)	< 0.0001	57 (21.5)	< 0.0001
Diastolic blood pressure, mmHgc
Disability	15 (11.6)	17 (16.5)	0.49	8 (16.0)	0.69	2 (16.2)	0.86
No disability	367 (11.2)	194 (11.4)	0.83	121 (12.5)	0.35	45 (19.6)	0.0002
High density lipoprotein, mg/dLd
Disability	23 (15.7)	42 (37.8)	< 0.001	30 (47.0)	0.001	11 (62.0)	0.006
No disability	370 (13.2)	583 (33.7)	< 0.0001	390 (41.0)	< 0.0001	113 (56.0)	< 0.0001
Triglycerides, mg/dLd
Disability	13 (23.3)	21 (34.2)	0.82	16 (45.8)	0.06	7 (67.1)	0.007
No disability	224 (16.6)	271 (31.4)	< 0.0001	182 (40.8)	< 0.0001	46 (50.1)	< 0.0001
Glucose, mg/dLe
Disability	9 (6.1)	13 (15.5)	0.03	8 (13.9)	0.5	0 (0)	-
No disability	232 (7.4)	171 (8.5)	0.35	107 (10.7)	0.02	26 (12.1)	0.05
Metabolic syndrome (≥ 3 risk factors)
Disability	0 (0)	17 (15.7)	< 0.0001	17 (28.1)	< 0.0001	11 (61.3)	< 0.0001
No disability	8 (0.20)	153 (9.1)	< 0.0001	144 (15.4)	< 0.0001	71 (31.2)	< 0.0001

^aNormal weight = body mass index < 85^th percentile for age and sex, overweight = body mass index ≥ 85^th-< 95^th percentile for age and sex, obese = body mass index ≥ 95^th percentile for age and sex (Kuczmarski et al[23], 2000) severely obese = absolute body mass index ≥ 35 kg/m² (Kelly et al[24], 2000);

^b> 90^th percentile for age and sex (Fernandez et al[18], 2004);

^c> 90^th percentile for age and sex (National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents, 2004);

^d> 90^th percentile for age and sex for triglycerides, < 10^th percentile for age and sex for HDL cholesterol (Hickman et al[20], 1998);

^e> 100 mg/dL (American Diabetes Association, 2006).

Table 4 Odds Ratios to predict the metabolic syndrome by selected covariates among those 12-18 years old with and without disabilities in the United States, 1999-2010 National Health and Nutrition Examination Survey

	OR (95%CI)	P-value
Disability status
No disability (ref)	1	-
Disability	3.45 (1.08-10.99)	0.03
Age
12 years old (ref)	1	-
> 12 years old	1.22 (1.03-1.44)	0.02
Sex
Male (ref)	1	-
Female	0.33 (0.21-0.53)	< 0.0001
Ethnicity
Non-Hispanic white (ref)	1	-
Race/Ethnicity	0.77 (0.59-1.00)	0.05
Education
< High School (ref)
Education level	1.01 (0.97-1.05)	0.70
Household income
> $75000
Household Income	1.02 (1.00-1.03)	0.05