title: The use of measures of obesity in childhood for predicting obesity and the development of obesity-related diseases in adulthood: a systematic review and meta-analysis.
abstract: BACKGROUND
  It is uncertain which simple measures of childhood obesity are best for predicting future obesity-related health problems and the persistence of obesity into adolescence and adulthood.
  
  
  OBJECTIVE
  To investigate the ability of simple measures, such as body mass index (BMI), to predict the persistence of obesity from childhood into adulthood and to predict obesity-related adult morbidities. To investigate how accurately simple measures diagnose obesity in children, and how acceptable these measures are to children, carers and health professionals.
  
  
  METHODS
  Multiple sources including MEDLINE, EMBASE and The Cochrane Library were searched from 2008 to 2013.
  
  
  METHODS
  Systematic reviews and a meta-analysis were carried out of large cohort studies on the association between childhood obesity and adult obesity; the association between childhood obesity and obesity-related morbidities in adulthood; and the diagnostic accuracy of simple childhood obesity measures. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and a modified version of the Quality in Prognosis Studies (QUIPS) tool. A systematic review and an elicitation exercise were conducted on the acceptability of the simple measures.
  
  
  RESULTS
  Thirty-seven studies (22 cohorts) were included in the review of prediction of adult morbidities. Twenty-three studies (16 cohorts) were included in the tracking review. All studies included BMI. There were very few studies of other measures. There was a strong positive association between high childhood BMI and adult obesity [odds ratio 5.21, 95% confidence interval (CI) 4.50 to 6.02]. A positive association was found between high childhood BMI and adult coronary heart disease, diabetes and a range of cancers, but not stroke or breast cancer. The predictive accuracy of childhood BMI to predict any adult morbidity was very low, with most morbidities occurring in adults who were of healthy weight in childhood. Predictive accuracy of childhood obesity was moderate for predicting adult obesity, with a sensitivity of 30% and a specificity of 98%. Persistence of obesity from adolescence to adulthood was high. Thirty-four studies were included in the diagnostic accuracy review. Most of the studies used the least reliable reference standard (dual-energy X-ray absorptiometry); only 24% of studies were of high quality. The sensitivity of BMI for diagnosing obesity and overweight varied considerably; specificity was less variable. Pooled sensitivity of BMI was 74% (95% CI 64.2% to 81.8%) and pooled specificity was 95% (95% CI 92.2% to 96.4%). The acceptability to children and their carers of BMI or other common simple measures was generally good.
  
  
  CONCLUSIONS
  Little evidence was available regarding childhood measures other than BMI. No individual-level analysis could be performed.
  
  
  CONCLUSIONS
  Childhood BMI is not a good predictor of adult obesity or adult disease; the majority of obese adults were not obese as children and most obesity-related adult morbidity occurs in adults who had a healthy childhood weight. However, obesity (as measured using BMI) was found to persist from childhood to adulthood, with most obese adolescents also being obese in adulthood. BMI was found to be reasonably good for diagnosing obesity during childhood. There is no convincing evidence suggesting that any simple measure is better than BMI for diagnosing obesity in childhood or predicting adult obesity and morbidity. Further research on obesity measures other than BMI is needed to determine which is the best tool for diagnosing childhood obesity, and new cohort studies are needed to investigate the impact of contemporary childhood obesity on adult obesity and obesity-related morbidities.
  
  
  BACKGROUND
  This study is registered as PROSPERO CRD42013005711.
  
  
  BACKGROUND
  The National Institute for Health Research Health Technology Assessment programme.
authors.affiliation: Centre for Reviews and Dissemination, University of York, York, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Simmonds
authors.affiliation: Centre for Reviews and Dissemination, University of York, York, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Burch
authors.affiliation: Centre for Reviews and Dissemination, University of York, York, UK.
authors.forename: Alexis
authors.initials: A
authors.lastname: Llewellyn
authors.affiliation: School of Sport, Leeds Metropolitan University, Leeds, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Griffiths
authors.affiliation: Centre for Reviews and Dissemination, University of York, York, UK.
authors.forename: Huiqin
authors.initials: H
authors.lastname: Yang
authors.affiliation: Division of Population Health Sciences and Education, St George's, University of London, London, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Owen
authors.affiliation: Centre for Reviews and Dissemination, University of York, York, UK.
authors.forename: Steven
authors.initials: S
authors.lastname: Duffy
authors.affiliation: Centre for Reviews and Dissemination, University of York, York, UK.
authors.forename: Nerys
authors.initials: N
authors.lastname: Woolacott
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D005544:Forecasting; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends*; D063766:Pediatric Obesity / Q000503:physiopathology*; D055815:Young Adult