Investigations
Your Organisational Guidance
ebpracticenet urges you to prioritise the following organisational guidance:
Obesitas bij kinderenPublished by: Domus Medica | SSMGLast published: 2008Obésité chez l'enfantPublished by: Domus Medica | SSMGLast published: 20081st investigations to order
clinical diagnosis
Test
Diagnosis is based primarily on a thorough history and examination in conjunction with the child's body mass index (BMI).
Result
BMI ≥95th percentile
Investigations to consider
fasting blood glucose
Test
To screen for type 2 diabetes mellitus.
The American Diabetes Association recommends that children >10 years of age (or at onset of puberty, if it begins at an earlier age) with a body mass index (BMI) >85th percentile plus one or more other risk factors (e.g., family history of type 2 diabetes mellitus in a first- or second-degree relative, non-white race, and/or conditions associated with insulin resistance such as acanthosis nigricans, polycystic ovary syndrome, hypertension, dyslipidaemia, small for gestational age, or maternal history of diabetes mellitus or gestational diabetes mellitus during the child’s gestation) should have a fasting blood glucose test, a 2 hour plasma glucose during a 75 g oral glucose tolerance test, or haemoglobin A1c. Screening should be conducted at a minimum of every 2 years or more frequently if BMI is increasing, or risk factor profile is deteriorating.[78][79]
Result
normal, or impaired glucose tolerance (5.6-6.9 mmol/L [100-125 mg/dL]), or diabetic (≥7 mmol/L [≥126 mg/dL])
serum lipids
Test
To screen for dyslipidaemia.
All children should be screened for lipid abnormalities with a non-fasting, non-HDL cholesterol level between ages 9 to 11 years and 17 to 21 years.[75]
A fasting lipid panel should be obtained in children with a BMI ≥85th percentile.[19]
Lipid abnormalities in children often persist into adulthood.[75]
Cut-off values are as follows.[75] Normal: cholesterol <4.40 mmol/L (<170 mg/dL), LDL <2.85 mmol/L (<110 mg/dL); borderline: cholesterol 4.40 to 5.15 mmol/L (170-199 mg/dL), LDL 2.85 to 3.34 mmol/L (110-129 mg/dL); elevated: cholesterol >5.18 mmol/L (>200 mg/dL), LDL >3.37 mmol/L (>130 mg/dL).
Result
normal or elevated
liver function tests
Test
To screen metabolic dysfunction-associated steatotic liver disease, as most patients will be asymptomatic.
Children >10 years of age with a BMI ≥95th percentile, or with a BMI ≥85th percentile and other risk factors, should be screened twice a year with a serum alanine aminotransferase (ALT).[76]
Children should be referred to a hepatologist if ALT or AST is ≥2 times the upper limit of normal.[69]
Result
normal or elevated transaminases
Emerging tests
DEXA
Test
Can be used to assess total body fat.
Use of this method is limited by the expense of the method and the inability to distinguish between subcutaneous and visceral fat.
It is used mainly in the research setting.
Result
elevated for age and sex
bioelectric impedance analysis
Test
A non-invasive and relatively inexpensive assessment of body composition. However, measurements are highly variable, as they are affected by the patient's hydration status.[80]
Result
elevated for age and sex
abdominal CT or MRI
Test
Can be used to accurately measure visceral fat.[81] However, these methods are costly, and should only be done in the research setting.
Result
increased visceral fat
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