Highlight
Over the past 30 years in Spain, the rise in childhood obesity has plateaued since 2018. Concurrently, children’s lipid profiles and blood pressure levels have improved significantly, though insulin levels have increased since 2004, suggesting evolving cardiometabolic health trends.
Study Background and Disease Burden
Cardiometabolic risk factors (CMRFs) during childhood are crucial determinants of long-term cardiovascular health. Early-life changes in body composition—encompassing underweight, overweight, and obesity statuses—alongside alterations in lipid profiles, blood pressure, and glycemic markers, inform future risk of cardiovascular disease (CVD). Globally, childhood obesity rates have surged over recent decades, imposing a significant public health challenge. However, temporal trends in the prevalence of obesity and other risk factors vary by region and are influenced by socioeconomic, lifestyle, and policy factors.
Spain has experienced notable epidemiological changes, with an evolving landscape of pediatric health concerns related to nutrition and metabolic risk. Understanding secular patterns in body composition and CMRFs among children is essential for identifying early determinants of cardiovascular health, refining prevention strategies, and guiding public health policies to mitigate future CVD burden.
Study Design
The reviewed study is a repeated cross-sectional analysis in public primary schools within the Cuenca province of Spain, spanning from 1992 to 2022. Data collection occurred at seven time points: 1992, 1996, 1998, 2004, 2010, 2018, and 2022. Participants included 4,280 schoolchildren aged 8 to 11 years (fourth to fifth grade), with an approximately equal sex distribution (50% girls).
Primary outcome measures encompassed prevalence assessments of:
– Weight status categories: underweight, normal weight, overweight, and obesity
– Lipid parameters, including total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and non-HDL cholesterol
– Glycemic markers, specifically fasting insulin levels
– Resting systolic blood pressure (SBP) and diastolic blood pressure (DBP)
Data analysis was performed from April 2024 to May 2025, applying robust statistical methods to assess trends over the three decades.
Key Findings
The study reveals nuanced trends regarding adiposity and cardiometabolic risk factors among Spanish children:
1. Weight Status Patterns:
– Obesity prevalence increased until 2010 (13.4%; 95% CI, 11.5% to 15.5%) but showed a plateau and slight decrease by 2018 (8.1%; 95% CI, 6.0% to 10.5%) and a modest rise in 2022 (10.4%; 95% CI, 8.1% to 13.2%). These changes were statistically significant (P < .001).
2. Lipid Profile Trends:
– Total cholesterol decreased substantially from 184.6 mg/dL (SD 27.4) in 1992 to 160.3 mg/dL (SD 27.4) in 2022.
– LDL-C levels similarly declined from 113.6 mg/dL (SD 24.0) to 90.1 mg/dL (SD 24.0) over the same period.
– Non-HDL cholesterol reduced from 125.3 mg/dL (SD 26.2) to 99.8 mg/dL (SD 26.1).
– HDL-C peaked between 1998 and 2004 (approx. 66 mg/dL) but decreased significantly by 2022 to 60.5 mg/dL (P < .001).
3. Blood Pressure Measurements:
– Mean resting SBP decreased markedly from 113.5 mm Hg (SD 9.6) in 1992 to 101.0 mm Hg (SD 9.7) in 2022.
– Mean resting DBP fell from 70.4 mm Hg (SD 7.2) to 60.7 mm Hg (SD 7.3) over the 30 years.
– Both SBP and DBP changes were significant (P < .001).
4. Glycemic Marker Changes:
– Mean fasting insulin levels increased significantly from 6.3 μIU/mL (SD 5.3) in 2004 to 8.7 μIU/mL (SD 5.2) in 2022 (P < .001), indicating potentially worsening insulin resistance despite improvements in other metabolic parameters.
These findings suggest a complex cardiometabolic landscape, wherein lipid and blood pressure profiles have improved, while insulin resistance may be emerging as a growing concern.
Expert Commentary
This comprehensive, long-term study conducted in a European pediatric population contributes valuable insights into evolving cardiometabolic risk patterns. The observed plateau in obesity prevalence is promising and may reflect the impact of public health interventions and lifestyle changes targeting childhood obesity in Spain.
Improvements in lipid profiles and blood pressure levels could result from increased health awareness, better nutrition, or enhanced physical activity; however, the decline in protective HDL-C levels warrants further investigation. The paradoxical rise in fasting insulin levels despite stable or reduced obesity prevalence raises important questions about underlying metabolic health and the influences of early insulin resistance.
Some limitations include the study’s regional scope limited to Cuenca province, which may affect generalizability to other Spanish or global populations. Additionally, repeated cross-sectional designs cannot infer individual longitudinal trajectories but provide valuable population-level trend data. The decreasing blood pressure trends contrast with some global data, suggesting region-specific factors at play.
Overall, this study underscores the importance of continuing surveillance of pediatric cardiometabolic health, integrating multiple biomarkers beyond weight alone, and tailoring prevention strategies appropriately.
Conclusion
Over the last 30 years in Spain, pediatric body composition and cardiometabolic risk factors have demonstrated both encouraging improvements and emerging challenges. While obesity appears to have stabilized and lipid and blood pressure parameters improved among children aged 8 to 11, rising insulin levels suggest increased cardiometabolic vulnerability.
These findings highlight the need for ongoing early screening, multifaceted interventions focused on metabolic health, and nuanced public health policies aiming to optimize cardiovascular outcomes from childhood onward. Future research should explore mechanisms driving insulin changes and evaluate interventions that sustain favorable trends without unforeseen metabolic consequences.
References
Sequí-Domínguez I, Sánchez-López M, Garrido-Miguel M, Solera-Martínez M, Díaz-Goñi V, de Arenas-Arroyo SN, Henriksson P, Herraiz-Adillo Á, Martínez-Vizcaíno V, Rodríguez-Gutiérrez E. Body Composition and Cardiometabolic Risk in Children. JAMA Netw Open. 2025 Oct 1;8(10):e2535004. doi: 10.1001/jamanetworkopen.2025.35004. PMID: 41037267; PMCID: PMC12492057.
World Health Organization. Report of the Commission on Ending Childhood Obesity. Geneva: WHO; 2016.
Kelly AS, Barlow SE, Rao G, et al. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches. Circulation. 2013;128(15):1689-1712.
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