Atherogenic lipid profile changes and their cardiovascular consequences across degrees of obesity in children and adolescents: a structured narrative review.

Abstract

Childhood and adolescent obesity is strongly associated with an atherogenic lipid profile and silent cardiovascular injury that begins early and evolves over time. In this structured review, we synthesized PubMed-indexed evidence from the past 25 years on lipid profile changes in children and adolescents with varying degrees of obesity- overweight, obesity, and severe obesity-and their cardiovascular consequences from childhood through young adulthood, as well as interventions that improve lipid profile and cardiovascular risk. Obesity-related dyslipidemia consistently involves elevated triglyceride, reduced high-density lipoprotein cholesterol (HDL-C), and elevated non-HDL-C levels, as well as increased triglyceride/ HDL-C ratio, whereas low-density lipoprotein cholesterol levels, although clinically important, are less consistently abnormal; the burden rises with obesity severity. In childhood, this pattern manifests with subclinical endothelial dysfunction and early carotid intimal thickening; during adolescence, arterial stiffness, elevated blood pressure levels, and early left ventricular remodeling with diastolic dysfunction become detectable, particularly in severe obesity; by young adulthood, these changes progress into accelerated atherosclerosis and clinical car diovascular risk. Mechanistically, visceral adiposity increases free fatty acid flux and promotes hepatic very-lowdensity lipoprotein overproduction, while adipose tissue inflammation, low adiponectin levels, oxidative stress, and impaired nitric oxide bioavailability link the lipid profile to vascular and cardiac injury through insulin resistance. Lifestyle interventions and improving physical fitness and dietary quality remain first-line treatments. Antiobesity pharmacotherapy and metabolic-bariatric surgery can improve weight and cardiometabolic risk in selected adolescents with severe obesity, but long-term pediatric cardiovascular outcome data remain limited. Routine lipid profile screening combined with blood pressure, insulin resistance, and obesity severity assessments should be integrated with early, family-centered intervention to reduce lifelong cardiovascular risk.